Synopsis
Recognise food-related mesenteric angina before acute thrombosis, distinguish symptomatic multivessel atherosclerosis from incidental stenosis, obtain CTA and nutritional assessment promptly, and coordinate revascularisation with cardiovascular secondary prevention.
- Typical chronic mesenteric ischaemia causes reproducible postprandial epigastric or central pain, food fear and progressive weight loss in a person with systemic atherosclerotic risk.
- Symptoms often begin 15 to 30 minutes after eating and can last hours; smaller meals reduce demand and may temporarily mask the disease.
- A bruit is neither sensitive nor specific. Normal examination, endoscopy or routine blood tests do not exclude flow-limiting mesenteric disease.
Key red flags
Pain becomes sudden, severe, continuous or disproportionate, with vomiting, blood, guarding, acidosis or shock. Treat as acute mesenteric ischaemia immediately.
Investigation priorities
Map coeliac, SMA and IMA stenosis or occlusion, calcification, collateral vessels and bowel or alternative abdominal pathology.
Management branches
A patient has reproducible meal-related pain, food fear or unexplained weight loss with vascular risk.
- Assess acute-on-chronic warning signs and use emergency CTA if pain is persistent, disproportionate or accompanied by peritonism or organ dysfunction.
- For a stable syndrome, request CTA and evaluate cancer, pancreatic, peptic and biliary alternatives in parallel according to the phenotype.
Key medicines
Antiplatelet therapyUse the current BNF and vascular-team regimen, commonly single antiplatelet before intervention and a device-specific plan after stenting.
High-intensity statinUse the current NICE NG238 secondary-prevention regimen and titrate to response, interactions and tolerance.