Yoshikawa Masaaki, Kinoshita Hiroki, Nishimura Naoki, Takai Rieko, Matsuda Takuya, Nakatani Satoshi, Shioyama Erika, Takeda Kosuke, Yoshiji Hitoshi
Department of Internal Medicine, Kokuho Central Hospital, 404-1 Miyako, Tawaramoto, Nara Prefecture, 636-0302, Japan.
Department of Gastroenterology, Nara Medical University, Kashihara, Nara Prefecture, 634-8522, Japan.
BMC Gastroenterol. 2021 Jan 13;21(1):27. doi: 10.1186/s12876-020-01595-3.
Gastritis cystica polyposa (GCP) is a recently recognized entity histologically characterized by hyperplasia and cystic dilatation of the gastric glands spreading through the submucosal layer. Its symptoms include those affecting the upper gastrointestinal tract, such as upper abdominal pain, nausea, and anorexia, although some patients might be asymptomatic. GCP rarely causes severe hemorrhage. Recently, we encountered a GCP case that exhibited severe hemorrhage.
A 53 year-old man visited the emergency department complaining of hematemesis. He underwent distal gastrectomy and Billroth II reconstruction for duodenal ulcers 32 years ago. Upper gastrointestinal endoscopy detected bleeding from the reddened mucosa at the anastomosis; thus, tentative endoscopic hemostasis was conducted. Despite medical treatment with transfusion, melena with significant hemodynamic impairment persisted. He was treated again with endoscopic hemostasis and interventional radiology (IVR) but remained unresponsive to these procedures. He eventually underwent partial resection of the anastomosis site with Roux-en-Y reconstruction and finally achieved excellent postoperative recovery. Histopathological examination of the resected specimen suggested a GCP bleeding.
GCP can indeed cause severe hemorrhage. Hemorrhage caused by GCP may not respond to endoscopic hemostasis or IVR; therefore, surgical treatment should be decided without delay.
胃息肉样囊肿性胃炎（GCP）是一种最近才被认识的疾病，其组织学特征为胃腺增生并伴有囊性扩张，病变累及黏膜下层。其症状包括影响上消化道的症状，如上腹疼痛、恶心和厌食，不过有些患者可能没有症状。GCP很少引起严重出血。最近，我们遇到了一例表现为严重出血的GCP病例。
一名53岁男性因呕血就诊于急诊科。他在32年前因十二指肠溃疡接受了远端胃切除术和毕罗Ⅱ式重建术。上消化道内镜检查发现吻合口处黏膜发红并有出血，因此进行了内镜下止血尝试。尽管进行了输血治疗，但仍有伴有明显血流动力学障碍的黑便持续存在。他再次接受了内镜止血和介入放射学（IVR）治疗，但对这些治疗均无反应。他最终接受了吻合口部位的部分切除术并进行了Roux-en-Y重建术，术后恢复良好。切除标本的组织病理学检查提示为GCP出血。
GCP确实可导致严重出血。GCP引起的出血可能对内镜止血或IVR治疗无反应；因此，应立即决定进行手术治疗。
