Lonardo Amedeo, Greco Milena, Grisendi Alberto
U.O. di Medicina Interna e Gastroenterologia, Ospedale Civile di Modena.
Ann Ital Med Int. 2004 Apr-Jun;19(2):122-7.
The aim of the present study was to draw an outline of the clinical epidemiology of bleeding gastrointestinal angiodysplasias. The study includes a report of a case and of our series of patients with bleeding gastrointestinal angiodysplasias admitted, between 1993 and 2003, to a ward of Internal Medicine where digestive endoscopy is also performed. A review of the literature is also provided. An 80-year-old cirrhotic woman with aortic stenosis, was referred to our Department because of anemia due to melena. In spite of 13 hospitalizations during which numerous diagnostic procedures including endoscopy, X-ray studies, arteriography, labeled red blood cells scanning and laparotomy with intraoperative ileoscopy, the site and nature of the bleeding lesion remained unidentified. Her red blood cell requirement progressively increased from 6 U in 1993 to 24 U in 1994 to 40 U as of September 1995. Enteroscopy disclosed duodeno-jejunal angiodysplasia. The patient subsequently received 35 additional red blood cell units during 7 new admissions. Between 1993 and 2003, 24 patients were identified. They were mainly women and their average age was 77 years. Angiodysplasias were localized in the large bowel in 92% of cases. Comorbidities included: heart disease (79%), chronic liver disease (29%) and chronic renal failure (21%). One fourth of patients were under anticoagulant drugs or had a hemostatic blood disorder. All patients received blood transfusions and endoscopic treatment was performed in approximately half of the cases. The most relevant updates are related to the pathogenic relationship between aortic stenosis, von Willebrand's disease and bleeding gastrointestinal angiodysplasias, the hemostatic alterations associated with liver cirrhosis or with chronic renal failure and the diagnosis and treatment of bleeding gastrointestinal angiodysplasias. A better understanding of the clinical epidemiology of bleeding gastrointestinal angiodysplasias may facilitate their diagnosis and contribute to an effective clinical management.
本研究的目的是勾勒出出血性胃肠道血管发育异常的临床流行病学概况。该研究包括一例病例报告以及我们收治的一系列出血性胃肠道血管发育异常患者，这些患者于1993年至2003年间入住内科病房，该病房同时也开展消化内镜检查。此外还提供了文献综述。一名80岁患有主动脉狭窄的肝硬化女性因黑便导致贫血被转诊至我科。尽管住院13次，期间进行了包括内镜检查、X线检查、动脉造影、标记红细胞扫描以及术中回肠检查的剖腹手术等众多诊断程序，但出血病变的部位和性质仍未明确。她的红细胞需求量从1993年的6单位逐渐增加到1994年的24单位，截至1995年9月达到40单位。小肠镜检查发现十二指肠 - 空肠血管发育异常。该患者随后在7次新入院期间又接受了35单位红细胞输注。1993年至2003年间，共确诊24例患者。他们主要为女性，平均年龄77岁。血管发育异常92%位于大肠。合并症包括：心脏病（79%）、慢性肝病（29%）和慢性肾衰竭（21%）。四分之一的患者正在使用抗凝药物或患有止血性血液疾病。所有患者均接受了输血治疗，约一半的病例进行了内镜治疗。最相关的新进展涉及主动脉狭窄、血管性血友病与出血性胃肠道血管发育异常之间的致病关系，与肝硬化或慢性肾衰竭相关的止血改变以及出血性胃肠道血管发育异常的诊断和治疗。更好地了解出血性胃肠道血管发育异常的临床流行病学可能有助于其诊断，并有助于进行有效的临床管理。
