Buerger's Disease

Buerger's disease, not to be confused with Berger's disease, is a serious, if almost always preventable disease that it is strongly linked to tobacco use. Once it develops, even quiting will only slow down or halt the progression of the disease which may include amputation of limbs. It was first identified in the late 1800's by Dr von Winiwarter but it would be over 25 years before it was studied enough to give a diagnostic criteria.

Thromboanglitis obliterans, as it is clinically known, is rare in the US now with less than 20 cases per 100,000; it is much more common in southern Asia through the Middle East (what was known as the silk road). It is most common in Bangladesh and that is attributed to a raw type of cigarette smoked there called “Bidi”. They where common in the college crowd in the US during the 1990's but have since fallen out of favor. The early presentation of TO is pain in the extremities when they are not being used. This is caused by the blocking and narrowing of the arteries. If left untreated it will eventually turn into gangrene as the tissue dies and start to decompose. This will require amputation.

Diagnosis

The disease is very hard to diagnose as it is mimicked by so many other things. In fact, you are never really diagnosed with it at all as much as every thing else is ruled out. The diagnostic checklist is mostly filled with make-sure-it-is- not. Once you have been screened for almost everything, Buerger's disease is what you are left with.

That said, there is a list of diagnostic criteria. It is mostly male thought it does occur in females (more so in more recent years). The standard age is between 20 and 40-45. There is almost always a history tobacco use. It can be either present or recent and it can be in any form, smoked or chewed. Heavy use will of course increase the chance of developing the disease. Autoimmune diseases need to be excluded as well as diabetes mellites and clotting issues. Emdoli needs to be ruled out as well. Then, of course, there is the pain (or worse, the gangrene).

Prognosis

Buerger's disease is not curable. There is some disagreement if it is life shortening but what is agreed upon is that continued smoking will result in amputation sooner or later. Abstaining from tobacco might or might not stop further progression but will slow it down. Anti-inflammatories don't seem to work but the pain can be managed.