Dina Ion, Nedelcu Maria, Iacobescu Claudia Georgeta, Baboi Ion Daniel, Bălăceanu Alice Lavinia
Semiology Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Gastroenterology Department, Clinical and Emergency Hospital "Sf. Ioan", 042122 Bucharest, Romania.
J Clin Med. 2025 Jul 14;14(14):4972. doi: 10.3390/jcm14144972.
Rare presentations are surprising and may disturb the day-to-day routine of a medical unit; however, they are expected (not as individual entities, but as a group of "uncommon causes"). While reviewing the literature in relation to three clinical cases of upper gastrointestinal bleeding (UGIB) encountered in our institution-gastric metastases of breast cancer (GMB), pyloric gland adenoma, and gastrointestinal stromal tumor (GIST)-we identified seven and 29 case reports for the first two entities, and over 100 publications addressing GIST. This prompted a shift in focus from novel reporting to diagnostic contextualization. We found it difficult to obtain an overview of the spectrum of UGIB etiologies, as most publications refer to a few individual entities or to a subgroup of rare causes. The narrative review we conducted arose from this particular research methodology. Based on a broad literature search, UGIB etiologies were organized in five categories (lesions of the mucosa, neoplasms, vascular causes, bleeding predisposition, and external sources of bleeding). In the management of patients with UGIB, the underlying etiology deviates from the classic peptic ulcer disease/esophageal varices dyad in approximately half of the cases. This underscores the need for heightened clinical vigilance, particularly in complex scenarios, where endoscopic findings, imaging results, and histopathological interpretations may be unexpected or prone to misinterpretation. As an illustration, we conducted two systematic reviews of case reports of bleeding GMB and PGA. Our findings support a proactive diagnostic and research mindset and advocate for improved awareness of uncommon UGIB etiologies.
罕见的临床表现令人惊讶，可能会扰乱医疗单位的日常工作；然而，它们是可以预期的（不是作为个别病例，而是作为一组“罕见病因”）。在回顾我们机构遇到的三例上消化道出血（UGIB）临床病例——乳腺癌胃转移（GMB）、幽门腺腺瘤和胃肠道间质瘤（GIST）——的相关文献时，我们发现前两个病例实体分别有7例和29例病例报告，而关于GIST的出版物超过100篇。这促使我们将重点从新颖的报告转向诊断背景分析。我们发现很难全面了解UGIB的病因谱，因为大多数出版物只涉及少数个别病例实体或罕见病因的一个亚组。我们进行的叙述性综述就源于这种特殊的研究方法。基于广泛的文献检索，UGIB病因被分为五类（黏膜病变、肿瘤、血管病因、出血易感性和外部出血来源）。在UGIB患者的管理中，大约一半病例的潜在病因不同于经典的消化性溃疡疾病/食管静脉曲张二元组。这凸显了提高临床警惕性的必要性，特别是在复杂情况下，内镜检查结果、影像学结果和组织病理学解释可能出乎意料或容易被误解。作为例证，我们对出血性GMB和PGA的病例报告进行了两项系统综述。我们的研究结果支持积极主动的诊断和研究思维方式，并提倡提高对罕见UGIB病因的认识。
