Kovács Márta, Pák Péter, Németh Artúr, Pák Gábor, Fehér János, Rácz István
Vaszary Kolos Kórház II. Belgyógyászati Osztály Esztergom.
Orv Hetil. 2007 Aug 12;148(32):1491-7. doi: 10.1556/OH.2007.28170.
Limited number of data are available on small bowel changes due to portal hypertension. The present retrospective, comparative study was aimed to analyse the diagnostic yield and to describe the findings with capsule endoscopy of cirrhotic patients with obscure gastrointestinal bleeding.
Capsule endoscopy findings of 11 cirrhotic patients with portal hypertension and 22 non-cirrhotic patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy were compared. Capsule video recordings were evaluated by two investigators at both workplaces. Patients after capsule endoscopy were followed-up until a mean of 19 (1-42) months.
In total 7 men and 5 women were examined at two medical centres in 48 months with a mean age of 66.2 (+/-7.6) years. The average period between the first clinical symptoms and capsule endoscopy was 15.7 (+/-14.9) months. During this period patients were hospitalized in an average of 2.8 (+/-1.3) times and 7.9 examinations were performed per patients prior to capsule endoscopy. A small bowel bleeding source was diagnosed in all 11 patients. Two definitive bleeding sources were observed in 7 patients (63%). Lesions connected to portal hypertension were found in all patients (8 angiodysplasias, 2 portal hypertensive enteropathies and 1 bowel varix). During the follow-up period rebleeding occurred in 27.3% of cirrhotic patients compared with 18.2% rebleeding rate in the control group.
Capsule endoscopy is a useful method in patients with portal hypertension and obscure gastrointestinal bleeding after negative upper endoscopy and colonoscopy. Multiple angiodysplasias are often diagnosed in the background of small bowel bleedings, and several bleeding sources frequently occur in these patients.
关于门静脉高压导致的小肠变化的数据有限。本回顾性比较研究旨在分析诊断率，并描述不明原因胃肠道出血的肝硬化患者的胶囊内镜检查结果。
比较了11例门静脉高压肝硬化患者和22例不明原因胃肠道出血的非肝硬化患者的胶囊内镜检查结果，这些患者均接受过非诊断性上消化道内镜检查和结肠镜检查。两名研究者在两个工作地点对胶囊视频记录进行评估。胶囊内镜检查后的患者进行随访，平均随访时间为19（1 - 42）个月。
在48个月内，两个医疗中心共检查了7名男性和5名女性，平均年龄为66.2（±7.6）岁。首次临床症状出现至胶囊内镜检查的平均时间为15.7（±14.9）个月。在此期间，患者平均住院2.8（±1.3）次，在进行胶囊内镜检查前，每位患者平均接受了7.9次检查。所有11例患者均诊断出小肠出血源。7例患者（63%）观察到两个明确的出血源。所有患者均发现与门静脉高压相关的病变（8例血管发育异常、2例门静脉高压性肠病和1例肠静脉曲张）。随访期间，肝硬化患者再出血发生率为27.3%，而对照组再出血率为18.2%。
对于门静脉高压且上消化道内镜检查和结肠镜检查阴性的不明原因胃肠道出血患者，胶囊内镜检查是一种有用的方法。在小肠出血背景下常诊断出多发血管发育异常，且这些患者常出现多个出血源。
