Distinctive aspects of peptic ulcer disease,Dieulafoy'slesion,and Mallory-Weiss syndrome in patients withadvanced alcoholic liver disease or cirrhosis

AIM:To systematically review the data on distinctive aspects of peptic ulcer disease(PUD),Dieulafoy’s lesion(DL),and Mallory-Weiss syndrome(MWS)in patients with advanced alcoholic liver disease(a ALD),including alcoholic hepatitis or alcoholic cirrhosis.METHODS:Computerized literature search performed via Pub Med using the following medical subject heading terms and keywords:"alcoholic liver disease","alcoholic hepatitis","alcoholic cirrhosis","cirrhosis","liver disease","upper gastrointestinal bleeding","nonvariceal upper gastrointestinal bleeding","PUD",‘‘DL’’,‘‘Mallory-Weiss tear",and"MWS’’.RESULTS:While the majority of acute gastrointestinal(GI)bleeding with a ALD is related to portal hypertension,about 30%-40%of acute GI bleeding in patients with a ALD is unrelated to portal hypertension.Such bleeding constitutes an important complication of a ALD because of its frequency,severity,and associated mortality.Patients with cirrhosis have a markedly increased risk of PUD,which further increases with the progression of cirrhosis.Patients with cirrhosis or a ALD and peptic ulcer bleeding(PUB)have worse clinical outcomes than other patients with PUB,including uncontrolled bleeding,rebleeding,and mortality.Alcohol consumption,nonsteroidal anti-inflammatory drug use,and portal hypertension may have a pathogenic role in the development of PUD in patients with a ALD.Limited data suggest that Helicobacter pylori does not play a significant role in the pathogenesis of PUD in most cirrhotic patients.The frequency of bleeding from DL appears to be increased in patients with a ALD.DL may be associated with an especially high mortality in these patients.MWS is strongly associated with heavy alcohol consumption from binge drinking or chronic alcoholism,and is associated with a ALD.Patients with a ALD have more severe MWS bleeding and are more likely to rebleed when compared to non-cirrhotics.Preendoscopic management of acute GI bleeding in patients with a ALD unrelated to portal hypertension is similar to the management of a ALD patients with GI bleeding from portal hypertension,because clinical distinction before endoscopy is difficult.Most patients require intensive care unit admission and attention to avoid over-transfusion,to correct electrolyte abnormalities and coagulopathies,and to administer antibiotic prophylaxis.Alcoholics should receive thiamine and be closely monitored for symptoms of alcohol withdrawal.Prompt endoscopy,after initial resuscitation,is essential to diagnose and appropriately treat these patients.Generally,the same endoscopic hemostatic techniques are used in patients bleeding from PUD,DL,or MWS in patients with a ALD as in the general population.CONCLUSION:Nonvariceal upper GI bleeding in patients with a ALD has clinically important differences from that in the general population without a ALD,including:more frequent and more severe bleeding from PUD,DL,or MWS.

Endoscopic full-thickness resection to treat active Dieulafoy's disease: A case report

BACKGROUND At present,minimally invasive endoscopic treatment is mostly used for patients with actively bleeding Dieulafoy’s lesions,,as it has the advantages of minimal trauma,short operation time and good hemostatic effect,although bleeding can easily recur postoperatively.Recently,extensive gastric cuneiform resection has been advocated for use in these patients because the constant-diameter artery follows a long path to the gastric mucosa.CASE SUMMARY A 47-year-old man was admitted to the hospital for repeated hematemesis and black stool,and he was diagnosed with Dieulafoy’s disease.We chose a method that not only simulates surgical gastric cuneiform resection but also reduces trauma.We performed enlarged local endoscopic full-thickness resection of the gastric wall and abdominal constant-diameter artery and sutured the gastric wall.Postoperative follow-up showed that the constant-diameter artery had been resected from the gastric wall,which was confirmed to have no blood flow signals by endoscopic ultrasonography.CONCLUSION Endoscopic full-thickness resection of the gastric wall and abdominal constantdiameter artery with suturing of the gastric wall has demonstrated potential as a new treatment for Dieulafoy's disease.

Recurrent hemoptysis in pediatric bronchial Dieulafoy’s disease with inferior phrenic artery supply:A case report

BACKGROUND Bronchial Dieulafoy’s disease(BDD)is characterized by the erosion of an anomalous artery in the submucosa of the bronchus.The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmonary arteries,which is different from chronic inflammatory injury of the airway in adult patients.The internal thoracic artery,subclavian artery,and intercostal artery are known to be involved in the blood supply to the BDD lesion in children.CASE SUMMARY We report a case of BDD in a 4-year-old boy with recurrent hemoptysis for one year.Selective angiography showed a dilated right bronchial artery,and anastomosis of its branches with the right lower pulmonary vascular network.Bronchoscopy showed nodular protrusion of the bronchial mucosa with a local scar.Selective embolization of the bronchial artery was performed to stop bleeding.One month after the first intervention,the symptoms of hemoptysis recurred.A computed tomography angiogram(CTA)showed another tortuous and dilated feeding artery in the right lower lung,which was an abnormal ascending branch of the inferior phrenic artery(IPA).The results of angiography were consistent with the CTA findings.The IPA was found to be another main supplying artery,which was not considered during the first intervention.Finally,the IPA was also treated by microsphere embolization combined with coil interventional closure.During the one-year follow-up,the patient never experienced hemoptysis.CONCLUSION The supplying arteries of the bleeding lesion in children with BDD may originate from multiple different aortopulmonary collateral arteries,and the IPA should be considered to reduce missed diagnosis.CTA is a noninvasive radiological examination for the screening of suspected vessels,which shows a high coincidence with angiography,and can serve as the first choice for the diagnosis of BDD.

Uremic Bleeding in 2 Patients with Dieulafoy’s Lesion: Case Report and Literature Review

Dieulafoy’s lesions are rare vascular malformations of the gastrointestinal tract. A Dieulafoy’s lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can cause severe and intermittent arterial bleeding from small vascular stumps that are difficult to visualize. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. Recently, uremic syndrome has been identified as a risk factor for gastric mucosal lesions. We present two clinical cases of acute digestive bleeding due to Dielafoy lesion with chronic kidney disease as the main cause, where two different therapies were performed endoscopically. We concluded with the results of our patients that the best therapy was the application of the hemostatic hemoclip on the injury vs the injection with adrenaline on the wound site. Uremia is identified as a risk factor for upper gastrointestinal bleeding in patients with pre-existing Dieulafoy’s lesion, as well as a higher incidence of new bleeding.

支气管Dieulafoy病的诊断与治疗

目的探讨支气管Dieulafoy病的临床表现、诊断及治疗,以提高对该病的认识。方法回顾性分析6例支气管Dieulafoy病的临床表现、支气管镜下病变特点、诊断方法及治疗。结果临床表现5例为咯血,1例为胸痛。支气管镜下5例见管腔内光滑突起病灶,1例见黏膜下血管扭曲分布。5例经支气管镜及支气管动脉造影诊断,1例经支气管动脉造影和术后病理诊断。4例行支气管动脉栓塞术,其中1例栓塞后行肺叶切除术,1例在支气管动脉造影下以立止血注入畸形支气管动脉,1例内科止血治疗。结论对于不明原因咯血和(或)支气管镜下见到管腔内光滑突起时,应考虑支气管Dieulafoy病可能,支气管镜下谨慎活检。及时行支气管动脉造影可诊断。支气管动脉栓塞和外科手术是治疗的主要方法,肺叶切除术可根治。

Dieulafoy病的诊断与治疗(附18例报告)

目的 :探讨Dieulafoy病的内镜诊断与治疗。方法 :回顾性分析 1 8例引起上消化道出血的Dieulafoy病的临床表现、内镜下特征、治疗方法与效果。结果 :1 8例中有 1 3例 (72 .2 % )为 1次检查确诊 ,5例为 2次或 2次以上检查确诊 ;其中 1 5例经内镜止血成功 ,首次治疗成功 1 2例 (66 .7% ) ,3例经 2次内镜止血成功 (1 6 .6 % ) ,3例需外科手术 (1 6 .6 % )。结论 :在Dieulafoy病的诊断及治疗中 。

血管栓塞术在Dieulafoy病所致上消化道出血临床诊治中的应用价值

目的探讨血管栓塞术在Dieulafoy病临床诊治中的应用价值。方法回顾性分析我院2005—2009年收治的42例Dieulafoy病所致上消化道出血患者的临床诊治资料。结果 42例患者中,33例术前行胃镜检查确诊胃Dieulafoy病,5例术前胃镜检查未见异常而经数字减影血管造影确诊,4例因病情危重术前无法行胃镜检查而直接行血管造影栓塞术。患者均行血管造影栓塞术,其中38例行1次血管栓塞术,4例行2次血管栓塞术,无一例行外科手术。止血成功率为100%,平均住院时间为7.5d,均无严重并发症发生。结论血管造影栓塞术在Dieulafoy病所致上消化道出血的诊治中有极为重要的作用,建议将血管栓塞术作为Dieulafoy病的首选治疗方法。

Dieulafoy病在中国的诊治现状——国内文献分析

背景:Dieulafoy病病灶较隐匿,临床上易漏诊或误诊。目的:分析Dieulafoy病的临床特点等因素,探讨其发病机制、诊断方法和有效治疗措施,以提高对该病的认识。方法:复习1994～2003年国内相关文献41篇,对463例Dieulafoy病例进行回顾分析。结果:463例Dieulafoy病患者的男女比例为3.8:1,发病年龄11～83岁,平均年龄47.岁。部分文献显示,在同期因上消化道大出血而行内镜检查的患者中,Dieulafoy病的检出率为0.8%～2.6%。86.4%的患者经内镜检查确诊,其余病例经手术或血管造影确诊。病灶分布最多见于贲门周围的胃壁(包括胃体上部和胃底),病理特征为黏膜下恒径小动脉破损,周围黏膜正常。内镜治疗止血成功率为82.8%,各种治疗的总止血率为97.2%,2.8%的患者因该病而死亡。结论:Dieulafoy病是消化道大出血的少见原因之一,急诊内镜检查是主要的诊断方法,提高对该病的认识和仔细的内镜检查是及时、准确诊断的关键,内镜治疗是首选的有效治疗措施。

Dieulafoy病致消化道大出血的介入治疗

目的探讨介入治疗Dieulafoy病所致的消化道大出血的效果及应用价值。方法10例Dieulafoy病所致急性消化道大出血患者常规行腹腔动脉和胃左动脉造影,发现有胃左动脉出血征象和(或)血管异常者8例,6例使用明胶海绵栓塞,2例血管瘤样扩张者使用明胶海绵+弹簧钢圈栓塞;另2例无明显出血征象者中1例给予垂体后叶素灌注,另1例未予介入治疗。结果本组病例术中均无严重并发症。栓塞的8例患者中,1例明胶海绵栓塞术后第3天再呕血,后行外科手术治疗,其余7例均未再出血;1例垂体后叶素灌注患者1周后症状消失出院。结论介入疗法安全、快捷、见效快,是急诊处理Dieulafoy病所致消化道大出血较为理想的治疗手段。

双镜联合胃楔形切除术微创根治胃Dieulafoy病20例报告

目的探讨双镜联合微创根治胃Dieulafoy病的优势。方法1999～2007年我院共收治胃Dieulafoy病20例,在胃镜引导下,腹腔镜下应用腔内切割吻合器(Endo-GIA)行胃楔形切除术。结果20例手术均获成功,无术后并发症,早期活动拔除胃管并进食。20例随访3～36个月,无再次出血。结论胃镜是胃Dieulafoy病的首选诊断方法,胃镜引导下腹腔镜胃楔形切除术应是此病的首选治疗方法,降低再次出血率和胃壁溃疡发生率。

Dieulafoy病19例临床分析

目的 探讨Dieulafoy病发病情况、诊断及治疗方法。方法 回顾性分析 1 9例Dieulafoy病的临床表现、诊断、治疗方法及疗效。结果 全部病例均表现突发上消化道大出血。初次胃镜检查确诊 1 2例 ( 6 3. 2% ),第 2次检查确诊 4例 ( 2 1. 1% ),术中探查确诊 3例 ( 1 5. 8% ); 1 4例经一次内镜下止血成功, 1例经二次内镜下止血成功, 4例行外科手术止血 (包括 1例内镜下止血后 7 2h再出血者 )。结论 急诊胃镜是诊断Dieulafoy病首选方法;治疗首选内镜下止血,内镜下止血不成功者,应立刻手术治疗。

内镜在Dieulafoy病诊断与治疗中的价值

目的 探讨内镜在Dieulafoy病诊断与治疗中的价值。 方法 回顾性分析我院 1994年 6月～ 2 0 0 2年 6月 2 1例引起上消化道出血的Dieulafoy病的内镜下特征、治疗方法与效果。 结果 2 1例中 15例 (71 4 % )为 1次检查确诊 ,6例为 2次或 2次以上检查确诊。 17例经内镜止血成功 ,首次治疗成功 14例 (6 6 7% ) ,3例经 2次内镜止血成功 (14 3% ) ;4例外科手术治疗 (19 0 % )。 结论 Dieulafoy病的诊断与治疗 ,内镜为首选方法。

食管Dieulafoy病2例报道

食管Dieulafoy病为罕见的上消化道出血病因之一,其临床表现与其他部位Dieulafoy病类似,病变隐匿,病情凶险,内镜下止血为首选的诊断和治疗方法。本文报道2例食管Dieulafoy病,为该病的临床诊治提供参考。

Dieulafoy病

Ｄｉｅｕｌａｆｏｙ病系胃粘膜下动脉先天性发育异常，其病灶是由表浅性粘膜糜烂、缺损和粘膜下恒径动脉构成，是引起上消化道大出血并非罕见的原因。其出血急速且量大，往往在短时间内招致失血性休克，其病灶微小，出血部位隐匿，在诊断治疗时常常遇到困难。我院手术治疗Ｄｉｅｕ－ｌａｆｏｙ病３例，认为术前内窥镜和手术探查是其主要的诊断方法，对本病的充分认识是避免误诊和漏诊的关键。

经内镜注射治疗Dieulafoy病大出血

目的本文探讨经内镜注射治疗Ｄｉｅｕｌａｆｏｙ病大出血。方法Ｄｉｅｕｌａｆｏｙ病是上消化道出血的罕见病因。自１９９２年２月至１９９７年３月经胃镜诊断上消化道出血１２４０例，检出Ｄｉｅｕｌａｆｏｙ病１３例，占１０％。本病以呕血和黑便为主要表现，易发生失血性休克。病变部位多见于胃体近侧端，表现为病变中心小动脉喷血或血管断端渗血，１３例患者除１例手术治疗外，１２例于血管周围注射５％鱼肝油酸钠。结果１０例即刻止血，有效率８３３％，治疗后无严重副作用发生。

Dieulafoy病合并消化道出血11例诊治体会

目的:探讨Dieulafoy病合并消化道出血的诊治方法。方法:回顾性分析11例Dieulafoy病合并消化道出血的诊治经过。结果:7例通过胃镜明确诊断,2例通过选择性腹腔动脉造影发现出血动脉,后经胃镜证实,1例通过内镜+手术探查后病理证实,1例通过肠镜明确诊断。6例经内镜止血治疗,3例经介入栓塞止血治疗,4例行手术治疗,1例死亡。结论:内镜、选择性腹腔动脉造影、手术探查及病理是该病的主要诊断方法,而介入栓塞、内镜治疗以及手术是主要治疗方法。

内镜下钛夹闭合联合局部注射肾上腺素治疗上消化道Dieulafoy病42例临床分析

目的探讨内镜下钛夹闭合联合局部注射肾上腺素治疗上消化道Dieulafoy病的临床效果。方法 42例因呕血和(或)解黑便病人行急诊内镜检查,明确诊断为上消化道Dieulafoy病,病灶位于食管下端8例、胃底14例、胃体5例、胃窦3例、十二指肠球部4例、十二指肠球部降部交接3例,十二指肠降部5例。对Dieulafoy病灶进行内镜下钛夹闭合联合局部注射1∶10000肾上腺素治疗,内镜治疗后再次出血的病人进行第二次内镜下钛夹闭合联合局部注射1∶10000肾上腺素治疗。结果内镜下止血术后即时止血42例(100%),5例病人(11.9%)72h内因再次出血进行第二次内镜下钛夹闭合联合局部注射1∶10000肾上腺素治疗,2例病人出血停止,72h总的止血有效率为(92.85%),3例(7.15%)病人因效果欠佳转外科手术治疗。结论内镜下钛夹闭合联合局部注射1∶10000肾上腺素治疗上消化道Dieulafoy病止血率为(92.85%),是一种安全、有效,创伤小的治疗上消化道Dieulafoy病的首选方法。

下消化道Dieulafoy病一例报道

Dieulafoy病是胃肠道血管畸形的一种,胃Dieulafoy病多见,回肠患病报道少见,临床发现回肠病灶较难,本院采用数字减影血管造影发现出血点,术中通过数字减影血管造影导管注射美兰染色发现病变肠段后手术切除,成功救治下消化道Dieulafoy病一例,避免了手术探查寻找病灶,缩短了抢救时间,值得临床借鉴。

急诊内镜联合选择性动脉造影诊治Dieulafoy病4例临床分析

目的探讨急诊内镜联合选择性动脉造影诊治Dieulafoy病的临床价值。方法我院消化内科2009年1月1日～2010年12月31日共收治Dieulafoy病18例,对其中急诊内镜联合选择性动脉造影救治Dieulafoy病所致上消化道大出血4例进行临床分析,通过急诊内镜联合选择性动脉造影的协同应用,观察对出血部位、病因的诊断价值和止血效果。结果 4例患者均在就诊1～24h内胃镜检查确诊Dieulafoy病,其中3例给予镜下钛夹止血或药物喷洒止血后仍有活动性出血随即行选择性动脉造影血管栓塞治疗,1例因镜下出血表现为喷射样,并血压下降,给予病灶旁钛夹标记后随即行选择性动脉造影血管栓塞治疗。本组4例在选择性动脉造影同时结合内镜所见均给予相应病变血管弹簧栓或明胶海绵栓塞止血治疗并成功止血。结论急诊内镜联合选择性动脉造影血管栓塞术协同诊治Dieulafoy病所致消化道出血,两者互为补充,是一种安全、有效、可靠的诊治方法。

Dieulafoy病19例临床诊断分析

目的 探讨Dieulafoy病发病情况、诊断及治疗方法。方法 回顾性分析 19例Dieulafoy病的临床表现、诊断、治疗方法及疗效。结果 全部病例均是突发上消化道大出血 ;初次胃镜检查确诊 12例 (6 3 2 % ) ,第二次检查确诊4例 ,术中探查确诊 3例 ;13例经一次内镜下止血成功 ,1例经二次内镜下止血成功 ,4例行外科手术。结论 急诊胃镜是诊断Dieulafoy病首选方法 ;治疗首选内镜下止血 ,内镜下止血不成功 ,立刻外科手术。