Thirty-seven patients admitted consecutively to the Gastroenterology Unit with haemorrhage from oesophageal varices were treated by injection sclerotherapy. The patients were subdivided according to age at presentation (below 65, over 65 years). The mortality and morbidity of the two groups, over the period of follow-up (mean 5.1 months) were compared. The risk of rebleeding was higher in the elderly (0.23 overall) than in the young (0.11 overall) and was reflected in the higher mortality, four of 14 elderly patients and four of 23 younger patients. A further three elderly patients succumbed to intercurrent illness during the same period. In three of the surviving elderly, complete resolution of varices was noted. Complications of sclerotherapy occurred in eight out of 51 injections in the elderly and six out of 97 in the young but were usually well tolerated. This study suggests that injection sclerotherapy is useful in the treatment of bleeding oesophageal varices in the elderly and suggests recommendations for improved survival.
Three patients presented with acute pericarditis. No cause was found and, in each case, the pericarditis was recurrent. Investigation revealed evidence of malabsorption due to adult celiac disease. Two of the patients responded to a gluten-free diet and cortiscosteroid therapy. The third patient responded to a gluten-free diet alone and remains well. Celiac disease is a multisystem disorder in which extraintestinal involvement is common. Recurrent pericarditis may be such a manifestation.
assess the nature of such lesions using endoscopic ultrasound (EUS) prior to a biopsy. Methods A total of 22 consecutive patients with portal hypertension who underwent an EUS evaluation between June 2008 and November 2011 for upper GI polypoid lesions found on endoscopy were included in the study. Procedure and pathology reports, obtained from patients' electronic records, were reviewed. Results Of the 22 patients (16 men, 6 women, median age 66) who underwent upper GI endoscopy, 11 had lesions in the proximal stomach (gastro-oesophageal junction, fundus, gastric body) while eight had lesions in the distal stomach (antrum, pylorus) and three in the duodenum. Six (27.3%) proved to be varices and 4 (18.2%) polypoid lesions over varices (2 benign, 2 malignant). Whereas, 7 (31.8%) patients had true polyps. The remaining lesions found on EUS included 1 (4.5%) case of gastric fold, 1 gastric antral vascular ectasia (GAVE), one ulcer, 1 case of external compression and one patient had a normal EUS with no lesion seen. Of the 10 cases of varices and varices underlying polypoid lesions, 8 (80%) were in the proximal stomach. Histology of non-vascular lesions under EUS were available in 11 patients, which showed 5 (45.5%) inflammatory polyps, 2 (18.2%) adenocarcinoma, 2 (18.2%) adenoma, 1 (9.1%) normal and one was reported as insufficient sample. Conclusion Indeterminate upper GI lesions encountered during routine endoscopy in patients with portal hypertension are commonly either varices or may develop around varices. We recommend EUS evaluation prior to biopsying such lesions in order to avoid potential serious complications such as iatrogenic variceal bleed.
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