Ischemic Bowel Disease

Gastrointestinal tract ischemia and infarction comprises different clinical syndromes characterized by inadequate blood perfusion to the bowel. The age of onset depends on gender and the etiology of the ischemia, even if the majority of patients are over age 60. These disorders have been increasing over the past decade and constitute approximately 1–2 % of admissions for abdominal pain in the USA and 3.7 % of surgical intervention for acute abdomen in Italy. The increase in incidence can be attributed to various factors, including increased clinical awareness, aging population, and improvement in diagnostic imaging techniques. The mortality rate is very high, between 50 and 90 %, hence, timely diagnosis is essential to improve the outcome. The pathogenesis and symptoms of intestinal ischemia are extremely variable, and the diagnosis largely depends on clinical suspicion. A recent classification of ischemic bowel diseases, developed by the American Gastroenterological Association (AGA) in 2000, defines three clinical categories: acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI) also known as intestinal angina, and ischemic colitis (IC).