FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S BELLY ACHE COULD BE "ABDOMINAL ANGINA"

Question: My doctor said that I have abdominal angina? Do you know anything about this problem? Is it a real syndrome, and if so, is it treatable?

Your doctor didn't make up the term "abdominal angina." It certainly is a real condition. Your confusion -- or perhaps disbelief would be a more accurate description -- probably stems from the term "angina." Most of us think of heart pain (aka "angina pectoris") upon hearing the term "angina." I suspect that we physicians are responsible for this because we often apply the verbal shorthand of calling acute episodes of chest pain caused by heart problems "angina" instead of using the complete name, angina pectoris. My American Heritage Dictionary defines angina as: 1. A condition, such as croup or diphtheria, in which spasmodic and painful suffocation or spasms occur. 2. Angina pectoris.

Abdominal angina is a condition that follows the first definition in that the sufferer typically has attacks of abdominal pain. This is not the stomach ache that all of us have suffered from occasionally. It is a dull, gnawing or cramping pain typically felt in the upper or middle portions of the abdomen. The pain usually begins 10 to 30 min after eating, and gradually increases until it reaches a plateau and then slowly decreases over one to three hours. As the condition worsens, the pain increases in frequency and severity so that the patient progressively reduces meal size and/or avoids eating. As a consequence, the person loses weight.

Abdominal angina and angina pectoris involve different organs but have the same underlying cause. In abdominal angina it is the stomach and intestines (rather than the heart) which are temporarily deprived of adequate amounts of blood to perform their jobs optimally. This poor circulation is almost always caused by hardening of the arteries, a condition doctors call arteriosclerosis, although rarely there are other causative factors.

The first step in treatment of abdominal angina involves testing to be sure that the pain is actually caused by that disorder. In this regard it is no different than being sure chest pain is due to angina pectoris. Once the diagnosis is established, the cause is almost always a narrowing or "blockage" in a section of one or more of the arteries supplying blood to the stomach, small intestine or colon.

Treatment of abdominal angina is, as you might suspect, much like that for angina pectoris. Once the narrowed area of the affected artery or arteries has been identified, a surgical plan is made to correct the condition. This may be accomplished by inserting a balloon-tipped instrument into the narrowed section. The balloon is then filled, thereby stretching the artery so that it is no longer blocked -- once the balloon is removed, of course. In some individuals a more dramatic surgery may be required to remove or bypass the blocked portion of the artery or arteries. And just like in heart disease, surgery for abdominal angina is only part of the treatment. Attention to problems such as high cholesterol, high blood pressure and diabetes are necessary to reduce the chances of recurrence.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.