What are the typical symptoms of mesenteric artery stenosis, particularly in older adults with a history of atherosclerosis, hypertension, or other cardiovascular diseases?

Symptoms of Mesenteric Artery Stenosis

The classic symptom triad of chronic mesenteric artery stenosis consists of postprandial abdominal pain (abdominal angina), fear of eating (sitophobia), and progressive unintended weight loss. 1

Core Clinical Presentation

Chronic Mesenteric Ischemia (Most Common Presentation)

Postprandial abdominal pain is the hallmark symptom, occurring in nearly 100% of symptomatic patients:

• Painful abdominal cramps and colic typically occurring 15-30 minutes after eating 1, 2
• Pain is out of proportion to physical examination findings 3
• Described as cramping, colicky discomfort in the epigastric or periumbilical region 1

Fear of eating (sitophobia) develops as a learned response:

• Patients actively avoid food to prevent pain, despite preserved appetite 1, 4
• This distinguishes mesenteric ischemia from malignancy where appetite itself is lost 1

Progressive weight loss occurs in 53-68% of patients:

• Often exceeds 10 kilograms (>20 pounds) 2, 5
• Results from reduced oral intake due to pain avoidance, not malabsorption initially 1

Additional Gastrointestinal Symptoms

Ischemic gastropathy may manifest as:

• Nausea and vomiting 1, 4
• Diarrhea (present in 25% of cases) 5
• Constipation 1
• Malabsorption in advanced cases 1

Ischemic colitis can occur in 24% of patients:

• May present with lower gastrointestinal bleeding 2
• Diagnosed by colonoscopy with biopsy 1

Acute Mesenteric Ischemia (Emergency Presentation)

When mesenteric artery thrombosis occurs acutely, the presentation differs dramatically:

• Sudden severe abdominal pain out of proportion to examination findings 1, 4
• Bowel emptying (diarrhea/vomiting) 1
• Peritoneal signs if bowel infarction develops 1
• This carries a grim prognosis and requires urgent CTA 1

Physical Examination Findings

• Abdominal bruit may be audible (though often absent) 1
• Diffuse abdominal tenderness without peritoneal signs in chronic cases 3
• Signs of malnutrition: hypoalbuminemia, anemia, electrolyte abnormalities 1

Important Clinical Context

Many patients remain asymptomatic despite significant stenosis:

• Stenosis of one or even two visceral vessels is usually well tolerated due to abundant collateral circulation between the celiac trunk, superior mesenteric artery, and inferior mesenteric artery 1
• Symptoms typically require stenosis or occlusion of at least two mesenteric arteries 1
• However, single-vessel stenosis can cause symptoms in one-third of cases, particularly if collaterals are inadequate 5

Risk factors and associated conditions to consider:

• Advanced age (67% of those ≥80 years have mesenteric stenosis at autopsy) 6
• Diffuse atherosclerotic disease including coronary artery disease 1
• Hypertension, diabetes mellitus, smoking, hypercholesterolemia 1
• 40% of patients with abdominal aortic aneurysm have significant mesenteric stenosis 1
• 27-29% of patients with aortoiliac or lower extremity arterial disease 1

Critical Pitfall to Avoid

Do not delay diagnosis in elderly patients with atherosclerotic disease who present with the classic triad. The characteristic combination of postprandial abdominal pain, food aversion, and weight loss in an elderly patient with other manifestations of atherosclerosis should immediately suggest visceral arterial insufficiency 6. Untreated symptomatic mesenteric artery disease leads to starvation, bowel infarction, and death 1.