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4.
Intern Med ; 60(7): 1019-1025, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33116013

RESUMO

We herein report a case of gastric hyperplastic polyps after argon plasma coagulation (APC) for gastric antral vascular ectasia (GAVE) in the antrum of a 65-year-old man with liver cirrhosis and hypergastrinemia induced by long-term proton pump inhibitor (PPI) use. Two years after APC therapy, endoscopy demonstrated multiple gastric polyps in the antrum and angle. A gastric polyp biopsy indicated foveolar epithelium hyperplasia, which was diagnosed as gastric hyperplastic polyps. One year after switching to an H2 blocker antagonist, endoscopy revealed that the polyps and GAVE had disappeared, with normal gastrin levels suggesting that PPI-induced hypergastrinemia had caused gastric hyperplastic polyps after APC therapy, and the polyps had disappeared after discontinuing PPIs.


Assuntos
Ectasia Vascular Gástrica Antral , Pólipos , Neoplasias Gástricas , Idoso , Coagulação com Plasma de Argônio , Ectasia Vascular Gástrica Antral/etiologia , Gastrinas , Humanos , Cirrose Hepática , Masculino
5.
Semin Arthritis Rheum ; 50(5): 938-942, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32906028

RESUMO

OBJECTIVE: Gastric antral vascular ectasia (GAVE) is a vascular manifestation of systemic sclerosis (SSc) that can lead to iron deficiency anemia or acute gastrointestinal (GI) bleeding. We aimed to identify clinical features associated with GAVE. METHODS: We performed a cohort study of SSc patients who were seen at Stanford between 2004 and 2018 and had undergone esophagogastroduodenoscopy (EGD). We compared the clinical features of those with and without GAVE, and multivariable logistic regression was performed to identify clinical correlates with GAVE. RESULTS: A total of 225 patients with SSc who underwent EGD were included in this study and 19 (8.4%) had GAVE. Those with GAVE were more likely to have scleroderma renal crisis (SRC) (21% vs 3%; p < 0.01), positive anti-RNA polymerase III antibody (71% vs 19%; p < 0.01), nucleolar pattern of anti-nuclear antibody (ANA) (33% vs 11%; p=0.04), and negative ANA (<1:80 by immunofluorescence) (33% vs 11%; p=0.02). On multivariate analysis with multiple imputation, anti-RNA polymerase III positivity (OR 4.57; 95% CI (1.57 - 13.23), p < 0.01) and ANA negativity (OR 3.75; 95% CI (1.21 - 11.62), p=0.02) remained significantly associated with GAVE. CONCLUSION: Positive anti-RNA polymerase III antibody and ANA negativity were significantly associated with GAVE. Further studies are necessary to determine whether patients with these autoantibody profiles should undergo screening endoscopies for GAVE.


Assuntos
Ectasia Vascular Gástrica Antral , Escleroderma Sistêmico , Anticorpos Antinucleares , Estudos de Coortes , Ectasia Vascular Gástrica Antral/diagnóstico , Ectasia Vascular Gástrica Antral/etiologia , Humanos , RNA Polimerase III , Escleroderma Sistêmico/complicações
8.
Curr Gastroenterol Rep ; 20(8): 36, 2018 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-29961911

RESUMO

PURPOSE OF REVIEW: Gastric antral vascular ectasia (GAVE) is a well-described source of chronic blood loss. We aim to review the previously hypothesized etiologies of GAVE and focus on recent proposed mechanisms, including metabolic syndrome. We will support these theories with newly discovered clinical associations and possible therapeutic implications. RECENT FINDINGS: Historically, GAVE has been associated with connective tissue disease and liver disease. Based on these associations and its histologic appearance, GAVE has presumed to be caused by mechanical- and hormonally mediated injury. Recent findings have been notable for a clinical association with aspects of the metabolic syndrome. Therefore, the pathogenic etiology may be akin to aspects of the metabolic syndrome via microvascular injury and neoangiogenesis. The potential etiologies of GAVE include hypergastrinemia, mechanical injury, and microvascular injury with neovascular proliferation particularly in the metabolic syndrome. Further research is needed to evaluate these proposed mechanisms and potential targets for treatment.


Assuntos
Ectasia Vascular Gástrica Antral/etiologia , Síndrome Metabólica/complicações , Doenças do Tecido Conjuntivo/complicações , Ectasia Vascular Gástrica Antral/fisiopatologia , Hormônios/fisiologia , Humanos , Hipertensão Portal/complicações , Inibidores de Proteínas Quinases/efeitos adversos , Estresse Mecânico
9.
Eur J Gastroenterol Hepatol ; 29(8): 973-976, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28520574

RESUMO

BACKGROUND AND AIM: Gastric antral vascular ectasia (GAVE) is an important cause of upper gastrointestinal bleeding and anemia in patients with cirrhosis. The aim of our study was to evaluate the effect of orthotopic liver transplantation (OLT) on GAVE and associated anemia. PATIENTS AND METHODS: We performed a chart review and identified all cirrhotic patients with GAVE who underwent OLT at the University Of Alabama at Birmingham between 2005 and 2013. Population's demographics, etiology of cirrhosis, comorbidities, presentation and treatment modalities of GAVE, endoscopic and histopathologic reports, hemoglobin values before and after transplant, and immunosuppressive regimens were collected. RESULTS: Twelve patients were identified, mean age 52.4±4.4 years; seven were men (58.3%); 11 (91.7%) were White; and 6 of 12 patients had biopsy-proven GAVE. The most common etiology of cirrhosis in the cohort was chronic hepatitis C and obesity was the most common chronic condition in 50 and 83.3%, respectively. Anemia resolution was observed in 9/12 (75%) patients who underwent OLT with an increase in hemoglobin from 8.1±2.4 (5.7-13.1) before transplant to 12.0±1.4 (10-15) after transplant (P<0.0001). Esophagogastroduodenoscopy after transplant was performed in all 12 (100%) patients. The mean time between transplant and post-OLT esophagogastroduodenoscopy was 13.8±18.28 (2-57) months; complete resolution of GAVE was observed in 10 (83.3%) patients, with resolving GAVE in one (8.3%) patient. CONCLUSION: GAVE is an important cause of anemia and upper gastrointestinal bleeding in patients with liver cirrhosis. Our findings show that liver transplantation can resolve GAVE and related anemia.


Assuntos
Anemia/etiologia , Ectasia Vascular Gástrica Antral/etiologia , Hemorragia Gastrointestinal/etiologia , Cirrose Hepática/cirurgia , Transplante de Fígado , Adulto , Alabama , Anemia/sangue , Anemia/diagnóstico , Biomarcadores/sangue , Endoscopia do Sistema Digestório , Feminino , Ectasia Vascular Gástrica Antral/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemoglobinas/metabolismo , Humanos , Imunossupressores/uso terapêutico , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
Int J Rheum Dis ; 20(12): 2133-2139, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28217887

RESUMO

Gastric antral vascular ectasia (GAVE) continues to be a challenge in both diagnosis and treatment. GAVE has a diverse group of associations and presumed causes, including cirrhosis, chronic renal failure and autoimmune connective tissue diseases. However, in most occasions, the management plan of GAVE itself is the same whatever the underlying disease by using Argon plasma coagulation (APC). Herein, we will discuss three cases of systemic sclerosis-associated GAVE presenting with either acute or chronic gastrointestinal bleeding showing variable responses to APC. Anemia and telangiectasia may be the first striking presentation of systemic sclerosis (SSc). Renal artery stenosis, aortic stenosis, widespread cutaneous and mucosal telangiectasia and hypertension seem to be associated with poor prognosis and should prompt rapid intervention and careful follow-up. Moreover, the hunt for molecular underpinnings of the broad array of vascular lesions in SSc has to include von Willebrand factor and endoglin. Eventually, we will review the recent alternatives that can be effective in SSc-GAVE, such as band ligation, hematopoietic stem cells transplantation and immunotherapy.


Assuntos
Ectasia Vascular Gástrica Antral/etiologia , Escleroderma Sistêmico/complicações , Idoso , Anemia/etiologia , Coagulação com Plasma de Argônio , Endoscopia Gastrointestinal , Evolução Fatal , Feminino , Ectasia Vascular Gástrica Antral/diagnóstico , Ectasia Vascular Gástrica Antral/terapia , Hemorragia Gastrointestinal/etiologia , Hematemese/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/terapia , Resultado do Tratamento
12.
J Gastrointestin Liver Dis ; 25(3): 289-93, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27689191

RESUMO

BACKGROUND: Diagnosis of portal hypertensive gastropathy (PHG) is based on endoscopic criteria. I-scan technology, a new technique of virtual chromoendoscopy, increases the diagnostic accuracy for lesions in the gastrointestinal tract. AIM: To establish the role of i-scan endoscopy in the diagnosis of PHG. METHOD: In this prospective study, endoscopic examination was conducted first by using white light and after that i-scan 1 and i-scan 2 technology in a group of 50 consecutive cirrhotic patients. The endoscopic diagnostic criteria for PHG followed the Baveno criteria. The interobserver agreement between white light endoscopy and i-scan endoscopy was determined using Cohen's kappa statistics. RESULTS: Forty-five of the 50 patients met the diagnostic criteria for PHG when examined by i-scan endoscopy and 39 patients were diagnosed with PHG by white light endoscopy. The strength of agreement between the two methods for the diagnosis of PHG was moderate (k=0.565; 95%CI 0.271-0.859; p<0.001). I-scan 1 classified the mosaic pattern better than classic endoscopy; i-scan 2 described better the red spots. CONCLUSION: I-scan examination increased the diagnostic sensitivity of PHG. The diagnostic criteria (mosaic pattern and red spots) were easier to observe endoscopically using i-scan than in white light.


Assuntos
Endoscopia Gastrointestinal/métodos , Ectasia Vascular Gástrica Antral/diagnóstico , Mucosa Gástrica/patologia , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Idoso , Feminino , Ectasia Vascular Gástrica Antral/etiologia , Ectasia Vascular Gástrica Antral/patologia , Humanos , Hipertensão Portal/diagnóstico , Cirrose Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes
13.
World J Gastroenterol ; 22(28): 6559-64, 2016 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-27605890

RESUMO

Mastocytosis is a clonal neoplastic disorder of the mast cells (MC) that can be limited to the skin (cutaneous mastocytosis) or involve one or more extracutaneous organs (systemic mastocytosis). The clinical manifestations of mastocytosis are heterogeneous ranging from indolent disease with a long-term survival to a highly aggressive neoplasm with survival of about 6 mo. Although liver involvement in aggressive systemic mastocytosis (ASM) is relatively common, the development of portal hypertension with or without cirrhosis is rare. We report a case of ASM without skin involvement in a 72-year-old caucasian male who presented with non-cirrhotic portal hypertension based on clinical, analytical, imagiological and endoscopic findings. Given the hematological picture, the correct diagnosis was established based on ancillary tests for MC using bone marrow aspirates and biopsy. Extensive involvement of the liver and gastrointestinal tract was histologically documented. The disease progressed rapidly and severe pancytopenia and recurrent upper gastrointestinal bleeding became the dominant problem. This case illustrates the challenge in establishing a diagnosis of ASM especially when the clinical picture is atypical and without skin involvement. Gastroenterologists should consider infiltrative disease, particularly systemic mastocytosis, as a differential diagnosis in a clinical case of portal hypertension of unknown etiology.


Assuntos
Hipertensão Portal/etiologia , Mastocitose Sistêmica/complicações , Idoso , Biópsia , Ectasia Vascular Gástrica Antral/diagnóstico , Ectasia Vascular Gástrica Antral/etiologia , Mucosa Gástrica/patologia , Hepatomegalia/diagnóstico por imagem , Hepatomegalia/etiologia , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/patologia , Fígado/patologia , Masculino , Mastocitose Sistêmica/diagnóstico por imagem , Mastocitose Sistêmica/patologia , Esplenomegalia/diagnóstico por imagem , Esplenomegalia/etiologia , Tomografia Computadorizada por Raios X
14.
Crit Care Clin ; 32(3): 371-84, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27339677

RESUMO

Gastrointestinal (GI) complications of cirrhosis are frequent in patients who require intensive care support and are often the primary indication for intensive care unit (ICU) admission. Perhaps the most worrisome GI complication for the intensivist is variceal hemorrhage. Bleeding from esophageal or gastric varices represents a life-threatening event for cirrhotic patients and provides management challenges for the ICU team. Nonvariceal GI bleeding, impaired GI motility, and malnutrition also provide significant challenges for the intensivist. This article reviews GI issues that present in critically ill cirrhotic patients and their management in the acute setting.


Assuntos
Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/terapia , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Ectasia Vascular Gástrica Antral/etiologia , Ectasia Vascular Gástrica Antral/terapia , Hemorragia Gastrointestinal/etiologia , Motilidade Gastrointestinal , Humanos , Cirrose Hepática/fisiopatologia , Desnutrição Proteico-Calórica/etiologia
15.
Arthritis Rheumatol ; 67(12): 3234-44, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26246178

RESUMO

OBJECTIVE: To determine the relationships between systemic sclerosis (SSc)-related autoantibodies, as well as their clinical associations, in a well-characterized Australian patient cohort. METHODS: Serum from 505 Australian SSc patients were analyzed with a commercial line immunoassay (EuroLine; Euroimmun) for autoantibodies to centromere proteins CENP-A and CENP-B, RNA polymerase III (RNAP III; epitopes 11 and 155), the 90-kd nucleolar protein NOR-90, fibrillarin, Th/To, PM/Scl-75, PM/Scl-100, Ku, topoisomerase I (topo I), tripartite motif-containing protein 21/Ro 52, and platelet-derived growth factor receptor. Patient subgroups were identified by hierarchical clustering of the first 2 dimensions of a principal components analysis of quantitative autoantibody scores. Results were compared with detailed clinical data. RESULTS: A total of 449 of the 505 patients were positive for at least 1 autoantibody by immunoblotting. Heatmap visualization of autoantibody scores, along with principal components analysis clustering, demonstrated strong, mutually exclusive relationships between CENP, RNAP III, and topo I. Five patient clusters were identified: CENP, RNAP III strong, RNAP III weak, topo I, and other. Clinical features associated with CENP, RNAP III, and topo I were consistent with previously published reports concerning limited cutaneous and diffuse cutaneous SSc. A novel finding was the statistical separation of RNAP III into 2 clusters. Patients in the RNAP III strong cluster had an increased risk of gastric antral vascular ectasia, but a lower risk of esophageal dysmotility. Patients in the other cluster were more likely to be male and to have a history of smoking and a history of malignancy, but were less likely to have telangiectasia, Raynaud's phenomenon, and joint contractures. CONCLUSION: Five major autoantibody clusters with specific clinical and serologic associations were identified in Australian SSc patients. Subclassification and disease stratification using autoantibodies may have clinical utility, particularly in early disease.


Assuntos
Autoanticorpos/imunologia , Escleroderma Sistêmico/imunologia , Idoso , Antígenos Nucleares/imunologia , Austrália , Autoantígenos/imunologia , Proteína Centromérica A , Proteína B de Centrômero/imunologia , Proteínas Cromossômicas não Histona/imunologia , Estudos de Coortes , Contratura/etiologia , Contratura/imunologia , DNA Topoisomerases Tipo I/imunologia , Proteínas de Ligação a DNA/imunologia , Transtornos da Motilidade Esofágica/etiologia , Transtornos da Motilidade Esofágica/imunologia , Exorribonucleases/imunologia , Complexo Multienzimático de Ribonucleases do Exossomo/imunologia , Feminino , Ectasia Vascular Gástrica Antral/etiologia , Ectasia Vascular Gástrica Antral/imunologia , Humanos , Immunoblotting , Autoantígeno Ku , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Proteínas Pol1 do Complexo de Iniciação de Transcrição/imunologia , Análise de Componente Principal , RNA Polimerase III/imunologia , Proteínas de Ligação a RNA/imunologia , Doença de Raynaud/etiologia , Doença de Raynaud/imunologia , Receptores do Fator de Crescimento Derivado de Plaquetas/imunologia , Ribonucleoproteínas/imunologia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/epidemiologia , Fatores Sexuais , Fumar/epidemiologia , Telangiectasia/etiologia , Telangiectasia/imunologia
17.
Gastroenterol Hepatol ; 38(2): 97-107, 2015 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-25499848

RESUMO

Portal hypertensive gastropathy (GHP) is a complication of portal hypertension usually associated with liver cirrhosis. The pathogenesis is unclear but the presence of portal hypertension is an essential factor for its development. GHP may be asymptomatic or present as gastrointestinal bleeding or iron deficiency anemia. Endoscopic lesions vary from a mosaic pattern to diffuse red spots; the most common location is the fundus. Treatment is indicated when there is acute or chronic bleeding, as secondary prophylaxis. There is insufficient evidence to recommend primary prophylaxis in patients who have never bled. Drugs that decrease portal pressure, such as non-cardioselective beta-blockers, and/or endoscopic ablative treatments, such as argon-beam coagulation, may be used. The role of transarterial intrahepatic portosystemic shunt) or bypass surgery has been insufficiently analyzed. Antral vascular ectasia (EVA) is a rare entity in liver cirrhosis, whose pathophysiology is still unknown. Clinical presentation is similar to that of GHP and endoscopy usually shows red spots in the antrum. Biopsy is often required to differentiate EVA from GHP. There is no effective medical therapy, so endoscopic ablative therapy and, in severe cases, antrectomy are recommended.


Assuntos
Ectasia Vascular Gástrica Antral/etiologia , Hemorragia Gastrointestinal/etiologia , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Anemia Ferropriva/etiologia , Gastrectomia/métodos , Ectasia Vascular Gástrica Antral/fisiopatologia , Ectasia Vascular Gástrica Antral/cirurgia , Hemorragia Gastrointestinal/fisiopatologia , Hemorragia Gastrointestinal/cirurgia , Gastroscopia , Humanos , Derivação Portossistêmica Cirúrgica
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