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Davide Stradella on Ischaemic Diseases of the Gastrointestinal Tract

Davide Stradella/LinkedIn

Jan 21, 2026, 16:38

Davide Stradella on Ischaemic Diseases of the Gastrointestinal Tract

Davide Stradella, Medical Director – Gastroenterology and Digestive Endoscopy at Mauriziano Hospital of Turin, shared on LinkedIn:

”Acute abdominal pain can be challenging.

Ischaemic disease could be a cause with wide range of severity where sometimes timing is fundamental.

Here’s a short clinical review (with graphic supported by AI)

Ischaemic Diseases of the Gastrointestinal Tract

A practical clinical overview

Why it matters

GI ischaemia ranges from self-limited disease to life-threatening emergencies. Early recognition changes outcomes—especially in elderly, vasculopathic, or critically ill patients.

Main Entities (from top to bottom)

1. Acute Mesenteric Ischaemia (AMI)

The emergency

Mechanisms
• Arterial embolism (AF, cardiac sources)
• Arterial thrombosis (atherosclerosis)
• Non-occlusive mesenteric ischaemia (NOMI – shock, vasopressors)
• Mesenteric venous thrombosis

Clinical red flags
• Severe abdominal pain out of proportion to exam
• Metabolic acidosis, ↑ lactate
• Rapid progression to peritonitis

Diagnosis
• CT angiography (gold standard)
• Labs are supportive, not diagnostic

Management
• Immediate resuscitation
• Broad-spectrum antibiotics
• Revascularization (endovascular or surgical)
• Early surgery if bowel necrosis suspected

Delay equals bowel loss + high mortality

2. Chronic Mesenteric Ischaemia

“Abdominal angina”

Typical patient
• Elderly, smoker, diffuse atherosclerosis

Key features
• Post-prandial pain
• Fear of eating → weight loss
• Diarrhea or bloating

Diagnosis
• CTA or MRA
• Duplex US as screening

Treatment
• Revascularization (endovascular first-line)
• Risk factor control

3. Ischaemic Colitis

The most common GI ischaemia

Triggers
• Hypotension, dehydration
• Heart failure, dialysis
• Drugs (NSAIDs, vasoconstrictors)
• Post-operative states

Clinical presentation
• Crampy abdominal pain
• Acute hematochezia
• Left-sided predominance (watershed areas)

Endoscopic findings
• Segmental erythema
• Edema, petechiae
• Cyanosis or ulcerations in severe cases

Management
• Supportive (IV fluids, bowel rest)
• Antibiotics if moderate–severe
• Surgery only if necrosis/perforation

Most cases are reversible if recognized early

4. Small Bowel Ischaemia

Often underdiagnosed

Causes
• Mesenteric thrombosis
• NOMI
• Strangulation, volvulus

Clues
• Severe pain, minimal early findings
• Rapid deterioration

Diagnosis
• CTA
• Limited role for endoscopy

5. Gastric and Duodenal Ischaemia

Rare but severe

Associated with
• Shock
• Severe atherosclerosis
• Vasculitis

Endoscopy
• Pale or necrotic mucosa
• Ulcers with sharp demarcation

Clinical Take-Home Messages
• Pain out of proportion equals think mesenteric ischaemia
• Normal labs do NOT exclude ischaemia
• CTA is the diagnostic cornerstone
• Time is bowel (and life)
• Ischaemic colitis is often benign—but not always

Biblio
-ACG Guideline: Colon Ischemia, 2015
-ESVS Guidelines: Mesenteric Ischaemia, 2017
-ACR Appropriateness: Acute Abd Pain, 2022
-UpToDate: Mesenteric Ischemia
-Brandt LJ. NEJM Ischemic Colitis”

Davide Stradella on Ischaemic Diseases of the Gastrointestinal Tract