Harki Jihan, Plompen Elisabeth P C, van Noord Désirée, Hoekstra Jildou, Kuipers Ernst J, Janssen Harry L A, Tjwa Eric T T L
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Gastrointest Endosc. 2016 Mar;83(3):627-36. doi: 10.1016/j.gie.2015.07.013. Epub 2015 Aug 29.
GI ischemia is a concerning adverse event of portal vein thrombosis (PVT). Minimally invasive techniques, such as visible light spectroscopy (VLS), have greatly improved the ability to diagnose GI ischemia. The aim of this study was to assess the clinical presentation and characteristics of GI ischemia in patients with PVT.
Patients with noncirrhotic, nonmalignant PVT were included in this prospective cohort study. Clinical symptoms of GI ischemia were assessed by a structured questionnaire, VLS, and radiologic evaluation of the mesenteric vasculature. VLS measurements were compared with those in patients with cirrhosis and with a reference population.
We included 15 patients with chronic PVT and 1 patient with acute PVT (median age 46.1 years [interquartile range [IQR], 30.9-53.7]; 44% male). Decreased mucosal oxygenation in at least 1 location of the GI tract was found in 12 patients (75%). Compared with the reference population (median 60.0 [IQR, 56.2-61.7]), VLS measurements were mostly decreased in the descending duodenum in patients with PVT (median 55.5 [IQR, 52.3-58.8]; P = .02) and patients with cirrhosis (median 52.0 [IQR, 46.5-54.0], P = .003). Symptoms typical for GI ischemia, such as postprandial pain and exercise-induced pain, were reported in 10 patients (63%) with PVT. In patients with extension of thrombosis into the superior mesenteric vein and splenic vein and/or presence of hypercoagulability, decreased VLS measurements were observed compared with historical control subjects.
In patients with chronic PVT, GI ischemia is frequent. VLS enables objective and quantitative determination of GI mucosal ischemia. Onset of abdominal symptoms such as postprandial pain should prompt the physician to re-evaluate extent, cause, and treatment of PVT.
胃肠道缺血是门静脉血栓形成（PVT）的一种令人担忧的不良事件。诸如可见光光谱法（VLS）等微创技术极大地提高了诊断胃肠道缺血的能力。本研究的目的是评估PVT患者胃肠道缺血的临床表现和特征。
本前瞻性队列研究纳入了非肝硬化、非恶性PVT患者。通过结构化问卷、VLS以及肠系膜血管系统的放射学评估来评估胃肠道缺血的临床症状。将VLS测量结果与肝硬化患者及参照人群的结果进行比较。
我们纳入了15例慢性PVT患者和1例急性PVT患者（中位年龄46.1岁[四分位间距[IQR]，30.9 - 53.7]；44%为男性）。12例患者（75%）在胃肠道至少1个部位发现黏膜氧合降低。与参照人群（中位值60.0[IQR，56.2 - 61.7]）相比，PVT患者（中位值55.5[IQR，52.3 - 58.8]；P = 0.02）和肝硬化患者（中位值52.0[IQR，46.5 - 54.0]，P = 0.003）的VLS测量值在十二指肠降部大多降低。10例（63%）PVT患者报告了胃肠道缺血的典型症状，如餐后疼痛和运动诱发的疼痛。与历史对照受试者相比，在血栓延伸至肠系膜上静脉和脾静脉和/或存在高凝状态的患者中观察到VLS测量值降低。
在慢性PVT患者中，胃肠道缺血很常见。VLS能够客观定量地测定胃肠道黏膜缺血。餐后疼痛等腹部症状的出现应促使医生重新评估PVT的范围、病因和治疗。
