Ohmori Teppei, Konishi Hiroyuki, Nakamura Shinichi, Shiratori Keiko
Institute of Gastroenterology, Tokyo Women's Medical University Hospital, Japan.
Intern Med. 2012;51(12):1455-60. doi: 10.2169/internalmedicine.51.7190. Epub 2012 Jun 15.
Many patients on hemodialysis for chronic renal failure suffer from progressive anemia. In hemodialysis patients with gastrointestinal bleeding, endoscopic examination often fails to identify hemorrhagic lesions. We surveyed hemodialysis patients with obscure gastrointestinal bleeding (OGIB) for the presence of intestinal lesions by capsule endoscopy (CE).
Among 90 patients who underwent CE, 13 had hemodialysis-related anemia (8 men and 5 women, age 66.5 ± 7.9 years, Hb 8.8 ± 1.9 g/dL, mean ± SD) and 77 had non-hemodialysis anemia (47 men and 30 women, age 55.7 ± 19.9 years, Hb of 11.9 ± 3.1 g/dL). The types and distribution of hemorrhagic lesions were investigated by CE. All patients had signs or symptoms of gastrointestinal bleeding but no active bleeding site was detected by endoscopy. The CE-observed lesions were classified into reddening, erosions/ulcers, vascular lesions, and tumors. The characteristic features of each lesion and patient demographic data were compared.
Vascular lesions were significantly more frequent in the hemodialysis group than in the controls (p<0.001). Reddening was observed in all patients of the hemodialysis group and mainly found in the ileum. Erosions/ulcers were observed in 4 patients (30.7%) and were more frequent in the jejunum. Vascular lesions were observed in 8 patients (61.5%) and they were more frequent in the ileum. A submucosal tumor was seen in one patient. There were no significant differences in demographic factors between patients with erosions/ulcers and those with a vascular lesion.
Vascular lesions are common in anemic hemodialysis patients with OGIB and should be considered in the differential diagnosis of anemia in patients on hemodialysis with OGIB.
许多慢性肾衰竭接受血液透析的患者患有进行性贫血。在伴有胃肠道出血的血液透析患者中，内镜检查常常无法识别出血性病变。我们通过胶囊内镜（CE）对不明原因胃肠道出血（OGIB）的血液透析患者进行肠道病变检查。
在90例行CE检查的患者中，13例患有血液透析相关性贫血（8例男性和5例女性，年龄66.5±7.9岁，血红蛋白8.8±1.9g/dL，均值±标准差），77例患有非血液透析性贫血（47例男性和30例女性，年龄55.7±19.9岁，血红蛋白11.9±3.1g/dL）。通过CE研究出血性病变的类型和分布。所有患者均有胃肠道出血的体征或症状，但内镜检查未发现活动性出血部位。CE观察到的病变分为发红、糜烂/溃疡、血管病变和肿瘤。比较每个病变的特征和患者人口统计学数据。
血液透析组血管病变的发生率显著高于对照组（p<0.001）。血液透析组所有患者均观察到发红，主要见于回肠。4例患者（30.7%）观察到糜烂/溃疡，在空肠中更为常见。8例患者（61.5%）观察到血管病变，在回肠中更为常见。1例患者发现黏膜下肿瘤。糜烂/溃疡患者和血管病变患者的人口统计学因素无显著差异。
血管病变在伴有OGIB的贫血血液透析患者中很常见，在伴有OGIB的血液透析患者贫血的鉴别诊断中应予以考虑。
