A Case of Heyde Syndrome with Resolution of Gastrointestinal Bleeding Two Weeks After Aortic Valve Replacement.

BACKGROUND Heyde syndrome is the association between gastrointestinal (GI) bleeding from arteriovenous malformation (AVM) and aortic stenosis. The aim of this study was to review Heyde syndrome and to discuss the management of this condition. CASE REPORT A 56-year-old female with a history of severe aortic stenosis and recurrent GI bleeding secondary to small bowel AVM, presented for hospital admission with melena and maroon blood in her stool. The patient underwent esophagogastroduodenoscopy with push enteroscopy, full colonoscopy, and mesenteric angiogram with failure to identify any active bleeding sources. Her hemoglobin continued to drop, requiring daily transfusion of packed red blood cells (PRBCs). Von Willebrand factor (VWF) antigen was low at 37%, and VWF large multimers were low and consistent with acquired VWF disease. The patient was then transferred to a tertiary care center and underwent transcatheter aortic valve replacement. Two weeks after discharge, she presented again with an episode of melena, with hemoglobin of 7.6 gm/dL and hematocrit of 25.1%. She was transfused 4 units of PRBCs and monitored for 48 hours, and then discharged without further episodes of GI bleeding. At the 2-month follow-up, she had stable hemoglobin at 15.1 gm/dL without further episodes of GI bleeding. At the 6-month follow-up she showed stable hemoglobin at 14.3 gm/dL without further episodes of GI bleeding. CONCLUSIONS Physicians need to consider Heyde syndrome in patients with aortic stenosis and GI bleeding secondary to angiodysplasia. Physicians should also be attentive in patients with Heyde syndrome presenting with GI bleeding after undergoing aortic valve replacement, as GI bleeding might take time to resolve completely in these patients.

Not your father's colonoscopy: a high-tech future for screening and surveillance of colorectal cancer.

The 20-year technology slump in endoscopic innovation is finally giving way to a flurry of technologies, of which many are directed specifically at improving or even replacing traditional colonoscopy. These technologies include "smart" overtubes, electronically mapped and driven instruments, and completely self-propelled devices. In addition to nonendoscopic technologies such as CT, these innovations may dramatically alter the practice of colorectal cancer screening, the "bread and butter" of gastroenterologists in this country. There are multiple and complex forces driving these changes, including a mismatch between the supply and demand in colonoscopy, patient convenience and comfort, costs, and more recently, a growing concern about the miss rate of conventional colonoscopy.