Background: The clinical relevance of splanchnic artery stenosis is often unclear. Gastric exercise tonometry enables the identification of patients with actual gastrointestinal ischaemia. A large group of patients with splanchnic artery stenosis was studied using standard investigations, including tonometry. Methods: Patients referred with possible intestinal ischaemia were analysed prospectively, using duplex imaging, conventional abdominal angiography and tonometry. All results were discussed within a multidisciplinary team. Results: Splanchnic stenoses were found in 157 (49.7 per cent) of 316 patients; 95 patients (60.5 per cent) had one-vessel, 54 (34.4 per cent) two-vessel and eight (5.1 per cent) had three-vessel disease. Chronic splanchnic syndrome was diagnosed in 107 patients (68.2 per cent), 54 (57 per cent) with single-vessel, 45 (83 per cent) with two-vessel and all eight with three-vessel stenoses. Treatment was undertaken in 95 patients, 62 by surgery and 33 by endovascular techniques. After a median follow-up of 43 months, 84 per cent of patients were symptom free. Conclusion: Gastric exercise tonometry proved crucial in the evaluation of possible intestinal ischaemia. Comparing patients with single- and multiple-vessel stenoses, there were significant differences in clinical presentation and mortality rates.