Holleran Grainne, Hall Barry, Zgaga Lina, Breslin Niall, McNamara Deirdre
a Department of Clinical Medicine , Trinity College Dublin , Ireland ;
b Department of Public Health and Primary Care , Trinity College Dublin , Ireland ;
Scand J Gastroenterol. 2016;51(4):393-9. doi: 10.3109/00365521.2015.1102317. Epub 2015 Nov 5.
Small bowel angiodysplasias (SBA) account for 50% of obscure gastrointestinal bleeding. Lesions bleed recurrently and current treatments are relatively ineffective at reducing re-bleeding. Little is known about the natural history of SBA which is needed to guide treatment decisions and counsel patients on prognosis.
The aim of this study is to describe the natural history of a cohort of patients with SBA.
Patients with SBA were identified retrospectively and clinical and outcome information were collected. Logistic regression analysis was performed to identify factors associated with re-bleeding.
SBAs were found in 86 patients of which 54% (n = 47) were female, and the average age was 71.6 years. The majority (69%) had multiple lesions, mean of 2.76/patient, and 65% were located in the jejunum. Follow-up was available in 65% (n = 56). There was a significant increase in haemoglobin level from 10.05g/dL to 11.94g/dL, p < 0.001 after mean follow up of 31.9 (6-62) months. Re-bleeding events occurred in 80% (n = 45), with an average of 2.91/person. The mean interval between diagnosis and the first re-bleeding event was 10.7 months. Of the group overall, 70% (n = 40) required transfusions during follow up, and 67% required hospitalisation due to re-bleeding. About 50% received a directed treatment, including argon plasma coagulation, somatostatin analogues, or surgical resection. A total of 3.5% (n = 2) died as a direct consequence of bleeding from SBAs. Multiple lesions (p = 0.048) and valvular heart disease (p = 0.034) were predictive of re-bleeding.
Our results show the significant impact of SBA on patients' morbidity, with high rates of re-bleeding, persistent anaemia and a mortality rate of 3.5%, despite the use of currently available medical and endoscopic therapies.
小肠血管发育异常（SBA）占不明原因胃肠道出血的50%。病变反复出血，目前的治疗方法在减少再出血方面相对无效。关于SBA的自然病程知之甚少，而这对于指导治疗决策和向患者提供预后咨询是必要的。
本研究的目的是描述一组SBA患者的自然病程。
回顾性确定SBA患者，并收集临床和结局信息。进行逻辑回归分析以确定与再出血相关的因素。
在86例患者中发现了SBA，其中54%（n = 47）为女性，平均年龄为71.6岁。大多数（69%）有多个病变，平均每位患者2.76个，65%位于空肠。65%（n = 56）的患者有随访数据。平均随访31.9（6 - 62）个月后，血红蛋白水平从10.05g/dL显著升高至11.94g/dL，p < 0.001。80%（n = 45）发生再出血事件，平均每人2.91次。诊断与首次再出血事件之间的平均间隔为10.7个月。在整个研究组中，70%（n = 40）在随访期间需要输血，67%因再出血需要住院治疗。约50%接受了针对性治疗，包括氩等离子体凝固、生长抑素类似物或手术切除。共有3.5%（n = 2）因SBA出血直接死亡。多个病变（p = 0.048）和心脏瓣膜病（p = 0.034）是再出血的预测因素。
我们的结果表明，尽管使用了目前可用的药物和内镜治疗，SBA对患者的发病率仍有显著影响，再出血率高、贫血持续存在且死亡率为3.5%。
