Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Clin Gastroenterol Hepatol. 2011 Mar;9(3):234-41. doi: 10.1016/j.cgh.2010.11.006. Epub 2010 Nov 27.
BACKGROUND & AIMS: The diagnosis of chronic gastrointestinal ischemia (CGI) remains a clinical challenge. We aimed to assess the diagnostic value of clinical features, visualization of the gastrointestinal arteries, and evaluation of mucosal perfusion in patients clinically suspected of CGI.
A total of 186 patients referred for suspicion of CGI were prospectively included and followed up. All patients had an extensive diagnostic work-up, including visualization of the gastrointestinal arteries with computed tomography, magnetic resonance, or conventional angiography, and mucosal perfusion with tonometry. The reference standard for CGI was persistent clinical response after adequate therapy. The diagnostic value of individual and combined tests was assessed with multivariable logistic regression analysis.
A total of 116 (62%) patients were diagnosed with CGI. In a multivariable model solely based on clinical features, the strongest predictors for CGI were the presence of postprandial pain, weight loss per month in kilograms, concomitant cardiovascular disease, and presence of an abdominal bruit. However, this model showed limited discriminative ability for the presence or absence of CGI (c-statistic, 0.62). Adding radiologic imaging to the prediction model improved the discriminative ability substantially (c-statistic, 0.81). Adding tonometry to the prediction model further improved the discriminative ability of the model (c-statistic, 0.90). The combination of clinical features and tonometry with a c-statistic of 0.88 approximated the discriminative ability of the latter model.
Clinical features alone have a limited value to assess CGI correctly. Visualization of the gastrointestinal arteries and evaluation of mucosal perfusion substantially improve the diagnosis of CGI. The strongest diagnostic contribution comes from mucosal perfusion assessment.
慢性胃肠道缺血（CGI）的诊断仍然是一个临床挑战。我们旨在评估临床特征、胃肠道动脉可视化和黏膜灌注评估在临床上怀疑 CGI 的患者中的诊断价值。
共前瞻性纳入 186 例因怀疑 CGI 而就诊的患者，并进行了随访。所有患者均进行了广泛的诊断检查，包括计算机断层扫描、磁共振成像或常规血管造影显示胃肠道动脉，以及张力计评估黏膜灌注。CGI 的参考标准是充分治疗后持续的临床反应。采用多变量逻辑回归分析评估个体和联合检查的诊断价值。
共有 116 例（62%）患者被诊断为 CGI。在仅基于临床特征的多变量模型中，CGI 的最强预测因素是餐后疼痛、每月体重减轻、并存心血管疾病和腹部杂音。然而，该模型对 CGI 的存在或不存在的区分能力有限（c 统计量为 0.62）。将影像学检查纳入预测模型可显著提高区分能力（c 统计量为 0.81）。将张力计纳入预测模型进一步提高了模型的区分能力（c 统计量为 0.90）。以 c 统计量为 0.88 的临床特征和张力计组合与后者模型的区分能力相近。
仅凭临床特征评估 CGI 的准确性有限。胃肠道动脉的可视化和黏膜灌注评估可显著提高 CGI 的诊断准确性。最强的诊断贡献来自黏膜灌注评估。
