Muftah Mayssan, Mulki Ramzi, Dhere Tanvi, Keilin Steven, Chawla Saurabh
Department of Medicine (Mayssan Muftah), Atlanta, United States.
Medicine, Division of Digestive Diseases, Emory University School of Medicine (Ramzi Mulki, Tanvi Dhere, Steven Keilin, Saurabh Chawla), Atlanta, United States.
Ann Gastroenterol. 2019 Mar-Apr;32(2):113-123. doi: 10.20524/aog.2018.0341. Epub 2018 Dec 20.
Recurrent obscure gastrointestinal bleeding amongst patients with chronic kidney disease is a challenging problem gastroenterologists are facing and is associated with an extensive diagnostic workup, limited therapeutic options, and high healthcare costs. Small-bowel angiodysplasia is the most common etiology of obscure and recurrent gastrointestinal bleeding in the general population. Chronic kidney disease is associated with a higher risk of gastrointestinal bleeding and of developing angiodysplasia compared with the general population. As a result, recurrent bleeding in this subgroup of patients is more prevalent and is associated with an increased number of endoscopic and radiographic procedures with uncertain benefit. Alternative medical therapies can reduce re-bleeding; however, more studies are needed to confirm their efficacy in this subgroup of patients.
慢性肾脏病患者反复出现不明原因的胃肠道出血是胃肠病学家面临的一个具有挑战性的问题，它与广泛的诊断检查、有限的治疗选择以及高昂的医疗费用相关。小肠血管发育异常是普通人群中不明原因和反复胃肠道出血的最常见病因。与普通人群相比，慢性肾脏病与更高的胃肠道出血风险和发生血管发育异常的风险相关。因此，该亚组患者的反复出血更为普遍，并且与内镜检查和影像学检查数量增加相关，而这些检查的益处并不确定。替代药物治疗可以减少再出血；然而，需要更多研究来证实其在该亚组患者中的疗效。
