[Upper gastrointestinal bleeding secondary to Dieulafoy's lesion: differential features]. / Presenta características diferenciales la hemorragia digestiva alta por lesión de Dieulafoy?

OBJECTIVE: To analyze the possible differential features of upper gastrointestinal (GI) bleeding due to Dieulafoy's lesion (DL) compared with bleeding due to gastroduodenal ulcer. MATERIAL AND METHODS: We evaluated variables associated with patient characteristics, hemorrhagic characteristics and clinical severity in 31 cases of bleeding secondary to DL and 31 cases of gastroduodenal ulcer bleeding. Univariate and multivariate statistical analysis were performed. RESULTS: The comorbidity rate was 80% in the DL group and 42% in the ulcer group (OR = 5.54; 95%CI, 1.5-20.7; p < 0.0004). Lesion location was gastric in 87% of DL versus 39% of ulcers (OR = 10.7; 95%CI, 2.6-47.6; p < 0.0003). More than one gastroscopy was required for diagnosis in 30% of DL vs. 3.2% of ulcers (OR = 12.9; 95%CI, 1.4-291; p < 0.01). Endoscopic treatment was required in 97% of DL and 39% of ulcers (OR = 47.5; 95%CI, 5.5-106.1; p < 0.0001). Active bleeding during endoscopy was registered in 81% of DL and in 29% of ulcers (OR = 10.2; 95%CI, 2.7-40.3; p < 0.0005). The remaining variables analyzed showed no significant differences. The mortality rate was 9.7% in the DL group and 3.2% in the ulcer group (p = NS). Multivariate analysis showed that gastric location (p < 0.01), active bleeding (p < 0.01), and comorbidity (p < 0.02) were more frequent in DL. CONCLUSIONS: Active bleeding and gastric location of the lesion were more frequent in the DL group than in the ulcer group. Diagnosis of DL is difficult, requiring a greater number of gastroscopies. Initial hemorrhage severity and the success rate of endoscopic treatment were similar in the two groups. The higher mortality found in DL can be explained by the greater comorbidity in these patients, with a worse bleeding tolerance.

¿Presenta características diferenciales la hemorragia digestiva alta por lesión de Dieulafoy? / Upper gastrointestinal bleeding secondary to Dieulafoy’s lesion: differential features

Objetivo: Analizar la presencia de posibles rasgos diferenciales de la hemorragia digestiva alta (HDA) por lesión de Dieulafoy (LD), comparándola con el sangrado por úlcera gastroduodenal. Material y métodos: Evaluamos los parámetros referentes a las características de los pacientes, de la hemorragia y de la gravedad clínica en 31 casos de hemorragia por LD y 31 por úlcera gastroduodenal. Se efectuó un análisis comparativo univarinate y multivariante entre ambos grupos. Resultados: El índice de comorbilidad fue del 80% en LD y del 42% en la úlcera (odds ratio [OR] = 5,54; intervalo de confianza del 95%, 1,5-20,7; p < 0,0004). La localización de la lesión fue gástrica en el 87% de las LD y en el 39% de las úlceras (OR = 10,7; IC del 95%, 2,6-47,6; p < 0,0003). Se precisó más de una gastroscopia para llegar al diagnóstico en el 30% de LD frente al 3,2% de las úlceras (OR = 12,9; IC del 95%, 1,4-291; p < 0,01). Fue necesario aplicar tratamiento endoscópico en el 97% de las LD frente al 39% de las úlceras (OR = 47,5; IC del 95%, 5,5-106,1; p < 0,0001). Se registró un sangrado activo durante la endoscopia en el 81% de las LD frente al 29% de las úlceras (OR = 10,2; IC del 95%, 2,7-40,3; p < 0,0005). El resto de los parámetros analizados no mostró diferencias significativas. La tasa de mortalidad fue del 9,7% en las LD frente al 3,2% en las úlceras (p = no significativo). En el análisis multivariante, la localización gástrica de la lesión (p < 0,01), el sangrado activo (p < 0,01) y la comorbilidad (p < 0,02) fueron superiores en la LD. Conclusiones: En la LD, la localización gástrica y el sangrado activo son hallazgos más frecuentes que en el grupo ulceroso. El diagnóstico de LD es más difícil, ya que requiere un mayor número de gastroscopias. La gravedad inicial de la hemorragia y el éxito del tratamiento endoscópico son similares en ambos grupos. La mayor mortalidad encontrada en las LD podría explicarse por la mayor comorbilidad de estos pacientes, con una peor tolerancia al sangrado

Objective: To analyze the possible differential features of upper gastrointestinal (GI) bleeding due to Dieulafoy’s lesion (DL) compared with bleeding due to gastroduodenal ulcer. Material and methods: We evaluated variables associated with patient characteristics, hemorrhagic characteristics and clinical severity in 31 cases of bleeding secondary to DL and 31 cases of gastroduodenal ulcer bleeding. Univariate and multivariate statistical analysis were performed. Results: The comorbidity rate was 80% in the DL group and 42% in the ulcer group (OR = 5.54; 95%CI, 1.5-20.7; p < 0.0004). Lesion location was gastric in 87% of DL versus 39% of ulcers (OR = 10.7; 95%CI, 2.6-47.6; p < 0.0003). More than one gastroscopy was required for diagnosis in 30% of DL vs. 3.2% of ulcers (OR = 12.9; 95%CI, 1.4-291; p < 0.01). Endoscopic treatment was required in 97% of DL and 39% of ulcers (OR = 47.5; 95%CI, 5.5-106.1; p < 0.0001). Active bleeding during endoscopy was registered in 81% of DL and in 29% of ulcers (OR = 10.2; 95%CI, 2.7-40.3; p < 0.0005). The remaining variables analyzed showed no significant differences. The mortality rate was 9.7% in the DL group and 3.2% in the ulcer group (p = NS). Multivariate analysis showed that gastric location (p < 0.01), active bleeding (p < 0.01), and comorbidity (p < 0.02) were more frequent in DL. Conclusions: Active bleeding and gastric location of the lesion were more frequent in the DL group than in the ulcer group. Diagnosis of DL is difficult, requiring a greater number of gastroscopies. Initial hemorrhage severity and the success rate of endoscopic treatment were similar in the two groups. The higher mortality found in DL can be explained by the greater comorbidity in these patients, with a worse bleeding tolerance