ABSTRACT
We report the clinical details, imaging findings, and management for a 39-year-old female presenting with recurrent episodes of pain in abdomen due to systemic lupus erythematous vasculitis associated with spontaneous isolated inferior mesenteric dissection. Spontaneous mesenteric artery dissection is an uncommon cause of mesenteric ischemia. Symptomatic spontaneous isolated inferior mesenteric artery (IMA) dissection is a rare condition, and its association with systemic lupus erythematosus is not previously described in the English literature. The optimal treatment options are debatable and include medical management, surgical reconstruction, and endovascular therapy. We wish to highlight spontaneous isolated IMA dissection as a rare etiology for chronic mesenteric ischemia and its management by endovascular methods.
Subject(s)
Angioplasty, Balloon , Aortic Dissection/therapy , Mesenteric Artery, Inferior , Mesenteric Ischemia/therapy , Abdominal Pain/etiology , Adult , Aortic Dissection/diagnostic imaging , Aortic Dissection/etiology , Aortic Dissection/physiopathology , Angioplasty, Balloon/instrumentation , Chronic Disease , Computed Tomography Angiography , Drug-Eluting Stents , Female , Humans , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Mesenteric Artery, Inferior/diagnostic imaging , Mesenteric Artery, Inferior/physiopathology , Mesenteric Ischemia/diagnostic imaging , Mesenteric Ischemia/etiology , Mesenteric Ischemia/physiopathology , Treatment OutcomeABSTRACT
Recent data from Asian countries including India has shown a significant decline in the frequency of peptic ulcer disease (PUD) compared to the past. H. pylori is considered the most important risk factor for PUD, and we aimed to explore the current frequency of H. pylori infection in different age groups of patients with dyspepsia. Patients >15 years of age with dyspeptic symptoms were prospectively recruited in this study from 2010 to 2014 after obtaining informed consent. Patients were divided into three age groups: 15-30 years, 31-50 years, and >50 years, and the minimum sample size required in the three groups with a power of 90% was 259, 256, and 188, respectively. All patients underwent upper gastrointestinal endoscopy; rapid urease test was done on gastric mucosal biopsy to detect H. pylori. The clinical, demographic features and socioeconomic status were recorded. The institute review board approved the study. We included 1000 patients with dyspepsia during the study period. Their mean age was 40.0+13.3 years, and 69.3% were males. Infection with H. pylori was detected in 419 (41.9%) patients. Among men, H. pylori was present in 45.7% while the frequency of infection in women was lower at 33.2% (p < 0.001). In the 15-30 years age group (n = 303), the frequency of infection was 42.6% while it was 48.3% in the 31-50 years group (n = 350) and 34.9% in the above 50 years group (n = 347). Male sex was a significant risk factor for H. pylori infection (p < 0.001). H. pylori infection, an important risk factor for PUD, was detected in less than half of the dyspeptic patients in the current study.
