Acute Massive Hemorrhage From Intestinal Crohn Disease

Homan, William P.; Tang, Cheng Yong; Thorbjarnarson, Bjorn

doi:10.1001/archsurg.1976.01360260069019

Cited by 65 publications

(20 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Probablemente la mejoría en las unidades de tratamiento de enfermedades agudas y, en la calidad y condiciones quirúrgicas sean factores a tener en cuenta. En nuestros pacientes el lugar de sangrado se encuentra localizado en el íleon; y aunque la gran mayoría de las otras series reportadas también refieren la localización del sangrado a ese nivel (2,9,16); se han descritos casos en los que la localización del punto de sangrado es mucho más heterogénea, incluyendo localización colónica (1,12).…”

Section: Discussionunclassified

Hemorragia digestiva baja masiva en pacientes con enfermedad de Crohn

Acosta¹,

Rı́os²,

Muñoz³

2007

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

Barreiro de Acosta M, Seijo Ríos S, Domínguez Muñoz JE. Hemorragia digestiva baja masiva en pacientes con enfermedad de Crohn. Rev Esp Enferm Dig 2007; 99: 388-391. RESUMENObjetivo: analizar la frecuencia de las hemorragias masivas en la EC e intentar determinar sus potenciales factores de riesgo (ambientales, propios de la enfermedad y genéticos).Material y métodos: se estudió de manera retrospectiva una cohorte de 174 pacientes -103 mujeres (59%) y 71 hombres (41%), edad media de 37 años-con EC, analizándose las hemorragias digestivas masivas que se habían producido en relación con su enfermedad. Se revisaron asimismo potenciales factores de riesgo como hábito tabáquico, localización de la enfermedad y presencia de mutaciones genéticas en CARD15, RTL-4 y CD14, entre otros.Resultados: tres pacientes (1,7%) presentaron una hemorragia digestiva masiva que precisó intervención quirúrgica para su resolución. Esta indicación de cirugía supone el 3,4% de las cirugías en relación con la EC. Todos los pacientes eran jóvenes y su enfermedad seguía un patrón inflamatorio y estaba localizada en el íleon. No se ha evidenciado asociación estadísticamente significativa entre las hemorragias digestivas masivas y los potenciales factores de riesgo analizados.Conclusiones: la hemorragia digestiva baja masiva es una complicación poco común, aunque grave de la EC. Se trata habitualmente de pacientes con patrón inflamatorio de la enfermedad y afectación ileal. Para su diagnóstico resulta clave la asociación de endoscopia y arteriografía, y su resolución suele ser quirúrgica.Palabras clave: Enfermedad de Crohn. Hemorragia. Factores predictivos. ABSTRACTObjective: we aimed at evaluating the frequency of acute severe bleeding in CD and its potential association to some risk factors, including clinical features of CD, environmental factors, and genetic alterations.Material and methods: 174 consecutive patients with CD (103 female (59%) and 71 men (41%), with a mean age of 37 years) were included. We analyzed all major acute lower gastrointestinal (GI) hemorrhage related to CD. Potential risk factors like smoking, site of disease, and presence of gene mutations in CARD15, TLR-4, and CD14 were also analyzed.Results: three patients (1.7%) suffered from severe acute lower GI bleeding. All patients required surgery to resolve their hemorrhage, and this indication represented 3.4% of all surgical procedures related to CD. All three patients were young (< 25 years) and suffered ileal CD with inflammatory pattern (L1-B1 in the Vienna Classification). No relationship was found between acute bleeding and any of the potential risk factors evaluated.Conclusions: acute severe GI bleeding is a rare, but severe complication in CD patients, and presents mainly in patients with inflammatory ileal disease. An association of endoscopy and arteriography is necessary for diagnosis. Urgent surgery is usually required in these patients.Key words: Crohn´s disease. Hemorrhage. Risk factors. INTRODUCCIÓNEl sangrado gastrointestinal bajo se ha descrito en ...

show abstract

Section: Discussionunclassified

Hemorragia digestiva baja masiva en pacientes con enfermedad de Crohn

Acosta¹,

Rı́os²,

Muñoz³

2007

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

show abstract

“…A rare complication of Crohn disease is lower gastrointestinal (GI) bleeding, occurring in 1-2.5% of patients [37][38][39]. Localization of the site of bleeding has generally been accomplished by arteriography [37,40].…”

Section: Discussionmentioning

confidence: 99%

“…Localization of the site of bleeding has generally been accomplished by arteriography [37,40]. The value of conventional CT without oral contrast material, but immediately following negative arteriography in localizing the site of significant but intermittent GI hemorrhage, by demonstrating the presence of focally dense intraluminal contrast within the small bowel loops has recently been shown [41].…”

Section: Discussionmentioning

confidence: 99%

Spiral CT demonstration of hypervascularity in Crohn disease: “vascular jejunization of the ileum” or the “comb sign”

1995

View full text Add to dashboard Cite

show abstract

“…As a result of permanent VEGF stimulation, sprouting vulnerable vessels are located at the inflamed mucosal surface; thus possibly resulting in intermittent bleeding and so contributing to chronic anemia in Crohn's disease [18,19] . However, a small number of patients with Crohn's disease also suffers from massive recurrent bleeding [20,21] . As such episodes of severe bleeding are not associated with high disease activity [20][21][22] , it can be speculated that the severe bleeding in such patients results from larger superficially located vessels with arteriovenous short circuits.…”

Section: Mechanisms Of Bleedingmentioning

confidence: 99%

“…However, a small number of patients with Crohn's disease also suffers from massive recurrent bleeding [20,21] . As such episodes of severe bleeding are not associated with high disease activity [20][21][22] , it can be speculated that the severe bleeding in such patients results from larger superficially located vessels with arteriovenous short circuits. Angiodysplasias have been documented in several of these patients; however they have not been definitely proven to cause this bleeding [20][21][22] .…”

Section: Mechanisms Of Bleedingmentioning

confidence: 99%

Angiogenesis and vascular malformations: Antiangiogenic drugs for treatment of gastrointestinal bleeding

Juergen¹,

Bauditz²,

Herbert³

et al. 2007

WJG

View full text Add to dashboard Cite

Treatment of gastrointestinal bleeding in patients with angiodysplasias and Osler's disease (hereditary hemorrhagic telangiectasia) is clinically challenging. Frequently, vascular malformations occur as multiple disseminated lesions, making local treatment an unfavorable choice or impossible. After local therapy, lesions often recur at other sites of the intestine. However, as there are few therapeutic alternatives, repeated endoscopic coagulations or surgical resections are still performed to prevent recurrent bleeding. Hormonal therapy has been employed for more than 50 years but has recently been shown to be ineffective. Therefore, new therapeutic strategies are required. Understanding of the pathophysiology of angiogenesis and vascular malformations has recently substantially increased. Currently, multiple inhibitors of angiogenesis are under development for treatment of malignant diseases. Experimental and clinical data suggest that antiangiogenic substances, which were originally developed for treatment of malignant diseases, may also represent long-awaited specific drugs for the treatment of vascular malformations. However, antiangiogenics display significantly different actions and side-effects. Although antiangiogenics like thalidomide seem to inhibit gastrointestinal bleeding, other substances like bevacizumab can cause mucosal bleeding. Therefore differential and cautious evaluation of this therapeutic strategy is necessary.

show abstract

Acute Massive Hemorrhage From Intestinal Crohn Disease

Cited by 65 publications

References 14 publications

Hemorragia digestiva baja masiva en pacientes con enfermedad de Crohn

Hemorragia digestiva baja masiva en pacientes con enfermedad de Crohn

Spiral CT demonstration of hypervascularity in Crohn disease: “vascular jejunization of the ileum” or the “comb sign”

Angiogenesis and vascular malformations: Antiangiogenic drugs for treatment of gastrointestinal bleeding

Contact Info

Product

Resources

About