Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions,...Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions, angiodysplasia, and esophagitis are trending up, which necessities physicians to be aware of those pathologies and their specifics. Here, we represent a case of a 62-year-old male on dual antiplatelet therapy who was transferred to our hospital due to severe melena with suspicion of upper gastrointestinal bleeding. Due to hemodynamic instability, the patient was intubated and started on vasopressors. However, several repeated EGDs and CTs of the abdomen with GI bleeding protocol did not reveal the location of active bleeding to stop it. At the same time, clinically, the patient was hemodynamically unstable with continued melena. On the last EGD, a small area of concern resembling gastric varix was clipped for identification purposes, and the patient underwent a selective angiogram with further diagnosis of Dieulafoy’s lesion, which was successfully embolized. Our case demonstrates that Dieulafoy’s lesions can present as severe life-threatening hemorrhage, hard to diagnose with traditional methods such as EGD or CTs, in which case it is recommended to proceed with an angiogram sooner rather than later for further diagnosis and treatment if needed.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""> <i><span style="font-family:Verdana;">Helicobacter&...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""> <i><span style="font-family:Verdana;">Helicobacter</span></i> <i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> is the most common cause of chronic human infections worldwide with the highest reported prevalence in Africa. It is associated with numerous upper gastrointestinal diseases such as gastritis, peptic ulcers, and gastric cancer. Endoscopic findings in the stomach usually associated with </span><i><span style="font-family:Verdana;">Helicobacter</span></i> <i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infections include gastritis and gastro-esophageal reflux disease (GERD), however, these findings are suggestive but not diagnostic of </span><i><span style="font-family:Verdana;">Helicobacter</span></i> <i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This was a prospective study conducted between January 2018 and February 2019 at the Aga Khan University Hospital where dyspeptic patients scheduled for gastroduodenoscopy were enrolled. These patients were evaluated for </span><i><span style="font-family:Verdana;">Helicobacter</span></i> <i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection by rapid urease test, culture and histopathology. Diagnostic findings and patient history collected from medical files w</span></span><span style="font-family:Verdana;">ere</span><span style="font-family:""><span style="font-family:Verdana;"> documented and data analyzed. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> A total of 487 dyspeptic patients undergoing esophagogastroduodenoscopy (EGD) were enrolled in the study and 199 dyspeptic patients were positive for </span><i><span style="font-family:Verdana;">Helicobacter</span></i> <i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection. The prevalence was 54.6% in males and 45.4% in females (p = 0.1546. The most common clinical indication and endoscopic findings w</span></span><span style="font-family:Verdana;">ere</span><span style="font-family:""><span style="font-family:Verdana;"> heart burn (25.2%) and gastritis (53.7%). Histopathology revealed that 86.1% of the dyspeptic patients had chronic active gastritis (p < 0.005) and 52.8% of them had </span><i><span style="font-family:Verdana;">H</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Classical endoscopic findings such as GERD are not always indicative of </span><i><span style="font-family:Verdana;">H</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection as its association with </span><i><span style="font-family:Verdana;">H</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection was not statistically significant in this study.展开更多
文摘Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions, angiodysplasia, and esophagitis are trending up, which necessities physicians to be aware of those pathologies and their specifics. Here, we represent a case of a 62-year-old male on dual antiplatelet therapy who was transferred to our hospital due to severe melena with suspicion of upper gastrointestinal bleeding. Due to hemodynamic instability, the patient was intubated and started on vasopressors. However, several repeated EGDs and CTs of the abdomen with GI bleeding protocol did not reveal the location of active bleeding to stop it. At the same time, clinically, the patient was hemodynamically unstable with continued melena. On the last EGD, a small area of concern resembling gastric varix was clipped for identification purposes, and the patient underwent a selective angiogram with further diagnosis of Dieulafoy’s lesion, which was successfully embolized. Our case demonstrates that Dieulafoy’s lesions can present as severe life-threatening hemorrhage, hard to diagnose with traditional methods such as EGD or CTs, in which case it is recommended to proceed with an angiogram sooner rather than later for further diagnosis and treatment if needed.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""> <i><span style="font-family:Verdana;">Helicobacter</span></i> <i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> is the most common cause of chronic human infections worldwide with the highest reported prevalence in Africa. It is associated with numerous upper gastrointestinal diseases such as gastritis, peptic ulcers, and gastric cancer. Endoscopic findings in the stomach usually associated with </span><i><span style="font-family:Verdana;">Helicobacter</span></i> <i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infections include gastritis and gastro-esophageal reflux disease (GERD), however, these findings are suggestive but not diagnostic of </span><i><span style="font-family:Verdana;">Helicobacter</span></i> <i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This was a prospective study conducted between January 2018 and February 2019 at the Aga Khan University Hospital where dyspeptic patients scheduled for gastroduodenoscopy were enrolled. These patients were evaluated for </span><i><span style="font-family:Verdana;">Helicobacter</span></i> <i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection by rapid urease test, culture and histopathology. Diagnostic findings and patient history collected from medical files w</span></span><span style="font-family:Verdana;">ere</span><span style="font-family:""><span style="font-family:Verdana;"> documented and data analyzed. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> A total of 487 dyspeptic patients undergoing esophagogastroduodenoscopy (EGD) were enrolled in the study and 199 dyspeptic patients were positive for </span><i><span style="font-family:Verdana;">Helicobacter</span></i> <i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection. The prevalence was 54.6% in males and 45.4% in females (p = 0.1546. The most common clinical indication and endoscopic findings w</span></span><span style="font-family:Verdana;">ere</span><span style="font-family:""><span style="font-family:Verdana;"> heart burn (25.2%) and gastritis (53.7%). Histopathology revealed that 86.1% of the dyspeptic patients had chronic active gastritis (p < 0.005) and 52.8% of them had </span><i><span style="font-family:Verdana;">H</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Classical endoscopic findings such as GERD are not always indicative of </span><i><span style="font-family:Verdana;">H</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection as its association with </span><i><span style="font-family:Verdana;">H</span></i><span style="font-family:Verdana;">. </span><i><span style="font-family:Verdana;">pylori</span></i><span style="font-family:Verdana;"> infection was not statistically significant in this study.