y tratamiento endoscópico de la hemorragia digestiva por lesión de Dieulafoy. Rev Esp Enferm Dig 2007; 99: 505-510. RESUMENObjetivo: conocer la incidencia, forma de presentación, localización y resultados del tratamiento endoscópico en la hemorragia digestiva causada por lesión de Dieulafoy.Material y métodos: se revisaron de forma retrospectiva todos los casos de hemorragia digestiva por lesión de Dieulafoy entre los años 2000 y 2006. Se recogieron los principales datos clí-nicos y endoscópicos, tipo de tratamiento empleado, eficacia del mismo, recidiva, complicaciones y mortalidad durante el ingreso.Resultados: se encontraron 41 pacientes, 26 varones y 15 mujeres, con edad media de 71,19 años. La lesión de Dieulafoy fue la causa del 1,55% de los casos de hemorragia digestiva aguda en el periodo estudiado. La incidencia de hemorragia digestiva por lesión de Dieulafoy fue de 2,2 casos por cada 100.000 habitantes y año. La mayoría de los pacientes presentaban hemorragia activa en el momento de la endoscopia (85,36%) y comorbilidad (92,68%). La localización más frecuente fue el estómago (60,97%), seguida del duodeno (29,26%). El tratamiento endoscópico logró la hemostasia inicial en el 100% de los casos. Tres pacientes (7,31%) presentaron recidiva hemorrágica, todos ellos habían sido tratados inicialmente con esclerosis con adrenalina y respondieron adecuadamente a un segundo tratamiento endoscó-pico. Ningún paciente precisó cirugía. La mortalidad durante el ingreso fue del 4,87%.Conclusiones: la lesión de Dieulafoy es una causa poco frecuente, pero potencialmente grave, de hemorragia digestiva y puede aparecer en cualquier punto del tracto gastrointestinal. El tratamiento endoscópico es eficaz y presenta pocas complicaciones. La esclerosis única con adrenalina se asocia a un mayor riesgo de recidiva hemorrágica.Palabras clave: Dieulafoy. Hemorragia digestiva. Tratamiento endoscópico. ABSTRACTObjective: the aim of the study was to assess the incidence, clinical presentation, location, and response to endoscopic therapy of gastrointestinal bleeding from Dieulafoy's lesion.Material and methods: all consecutive episodes of gastrointestinal bleeding due to Dieulafoy's lesion seen between 2000 and 2006 were retrospectively reviewed. All main clinical and endoscopic data were collected: type and efectiveness of endoscopic therapy, rebleeding, complications, and mortality during hospitalization.Results: we found 41 patients, 26 males and 15 females, median age of 71.19 years. Dieulafoy's lesion accounted for 1.55% of all gastrointestinal bleeding episodes during the study period. The incidence of Dieulafoy's lesion was 2.2 cases/100.000 inhabitants/year. Active bleeding at endoscopy was present in 85.36%, and comorbidity in 92.68%. The stomach was the most frequent location (60.97%), followed by duodenum (29.26%). Endoscopic therapy achieved initial hemostasis in all cases. Three patients (7.31%) initially treated with epinephrine injection showed rebleeding and properly responded to a second session of endoscopic t...
Upper gastrointestinal bleeding (UGIB) secondary to gastrosplenic fistula (GSF) is an uncommon condition (1). We report a case of massive UGIB in the setting of a primary gastric lymphoma that infiltrated and eroded the splenic artery.
BackgroundPatients with psoriatic arthritis (PsA) may have predominant axial (axPsA) or peripheral (pPsA) manifestations. The development of TNF inhibitors (TNFi) has changed the course of PsA. However, most published data is focused on pPsA but almost no data is available for TNFi response in axPsA.Objectivesto analyse the efficacy and the predictive factors of clinical response in patients with axPsA and pPsA starting treatment with TNFi in clinical practice.MethodsAn observational study analysing data from a prospective cohort including 93 patients (pts) with axPsA or pPsA treated with TNFi from 2002–2018 was conducted. Demographic information, disease activity indexes (ASDAS for axPsA and DAS28 for pPsA) and laboratory tests were collected before starting TNFi (baseline visit) and 6 months later (6 m visit). At 6 m, the percentage of pts achieving inactive disease (ASDAS <1.3) for axPsA or remission (DAS28 <2.6) for pPsA as well as the percentage of pts achieving clinical improvement (defined as ASDAS-clinically important improvement=delta-ASDAS>1.1 or delta-DAS28 >1.2) were determined. Baseline predictor factors of inactive disease/remission and clinical improvement at 6 m were identified using a univariable and multivariable binary regression models adjusted for confounder factors.ResultsOut of 93 included pts, 45 pts had predominant axPsA and 48 pPsA. Administered TNFi was etanercept for most pts (42%), infliximab in 29%, adalimumab in 22% and golimumab in 7%. Baseline characteristics are shown in table 1. Male sex was more frequent in axPsA vs pPsA (62% vs 42%; p=0.04, respectively). In axPsA, 55% clinically improved and 32% pts achieved inactive disease. After multivariable analysis, male gender (OR 25.8, p=0.01) and higher baseline ASDAS (OR 6.3, p=0.01) were associated as independent predictors of clinical improvement at 6 m. Also, male gender (OR 15.7, p=0.03) and lower BMI (OR 0.7, p=0.03) were associated as independent predictor factors for achieving inactive disease. In pPsA, 48% pts clinically improved and 33% pts were on remission at 6 m. The percentage of pts on remission tended to be higher in males than females (47% vs 20%; p=0.08, respectively). However, after running the regression analyses, none of the baseline predictor factors was significantly associated neither with clinical improvement nor with remission in patients with pPsA.Abstract AB0916 – Table 1 Total n=93p-value axPsA n=45pPsA n=48 Male, n (%)28 (62%)20 (42%)0.04BMI, Mean (SD)27.4 (5.5)26.4 (5.5)0.3Age (years), mean (SD)56 (12.9)60 (14.2)0.2Smokers, n (%)18 (41.9%)15 (31.9%)0.3Disease duration (years), mean (SD)19 (10.8)18 (8.4)0.6HLA B27, n/N (%)8/22 (36%)-RF, n/N (%)-3/44 (6.8%)ACPA, n/N (%)-0/45csDMARDs, n (%)25 (68%)24 (68%)0.9bASDAS, mean (SD)3.1 (1.2)-bDAS28, mean (SD)-4.7 (1,3)bCRP mg/L, mean (SD)13.2 (14.7)10.5 (15.3)0.3bESR, mean (SD)26.3 (20.9)27.8 (19.8)0.5ConclusionsIn clinical practice, 1 out of 3 pts with PsA is on remission 6 m after initiating a TNFi, and 1 out of 2 clinically improve; both proportions are similar...
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