RESUMO
BACKGROUND: Immune checkpoint inhibitors (ICIs) have increased our ability to treat an ever-expanding number of cancers. We describe a case series of 25 patients who were diagnosed with gastritis following ICI therapy. MATERIALS AND METHODS: This was a retrospective study involving 1712 patients treated for malignancy with immunotherapy at Cleveland Clinic from January 2011 to June 2019 (IRB 18-1225). We searched electronic medical records using ICD-10 codes for gastritis diagnosis confirmed on endoscopy and histology within 3 months of ICI therapy. Patients with upper gastrointestinal tract malignancy or documented Helicobacter pylori-associated gastritis were excluded. RESULTS: Twenty-five patients were found to meet the criteria for diagnosis of gastritis. Of these 25 patients, most common malignancies were non-small cell lung cancer (52%) and melanoma (24%). Median number of infusions preceding symptoms was 4 (1-30) and time to symptom onset 2 (0.5-12) weeks after last infusion. Symptoms experienced were nausea (80%), vomiting (52%), abdominal pain (72%), and melena (44%). Common endoscopic findings were erythema (88%), edema (52%), and friability (48%). The most common diagnosis of pathology was chronic active gastritis in 24% of patients. Ninety-six percent received acid suppression treatment and 36% of patients also received steroids with an initial median dose of prednisone 75 (20-80) mg. Within 2 months, 64% had documented complete resolution of symptoms and 52% were able to resume immunotherapy. CONCLUSION: Patients presenting with nausea, vomiting, abdominal pain, or melena following immunotherapy should be assessed for gastritis and if other causes are excluded, may require treatment as consideration for complication of immunotherapy.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Gastrite , Infecções por Helicobacter , Neoplasias Pulmonares , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Estudos Retrospectivos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Melena/complicações , Melena/tratamento farmacológico , Centros de Atenção Terciária , Neoplasias Pulmonares/tratamento farmacológico , Gastrite/induzido quimicamente , Gastrite/complicações , Gastrite/tratamento farmacológico , Dor Abdominal/complicações , Dor Abdominal/tratamento farmacológico , Vômito/tratamento farmacológico , Náusea/tratamento farmacológicoRESUMO
PURPOSE OF REVIEW: Upper gastrointestinal bleeding (UGIB) has significant morbidity and UGIB cases have been described in coronavirus disease 2019 (COVID-19) patients. Management of this condition can be challenging considering both the possible severe COVID-19-related pneumonia as well as the risk of the virus spreading from patients to health operators. The aim of this paper is to review the most recent studies available in the literature in order to evaluate the actual incidence of UGIB, its clinical and endoscopic manifestations and its optimal management. RECENT FINDINGS: UGIB has an incidence between 0.5% and 1.9% among COVID-19 patients, and it typically presents with melena or hematemesis. Peptic ulcers are the most common endoscopic findings. High Charlson Comorbidity Index (CCI), dialysis, acute kidney injury and advanced oncological disease increase the risk for UGIB. Although anticoagulants are commonly used in COVID-19 patients they are not associated with an increased incidence of UGIB. Conservative management is a common approach that results in similar outcomes compared to upper GI endoscopic treatment. Apparently, UGIB in COVID-19 seems not have a detrimental effect and only one study showed an increased mortality in those who developed UGIB during hospitalization. SUMMARY: Incidence of UGIB in COVID-19 patients is similar to that of the general population. Despite the widespread use of anticoagulants in these patients, they are not associated with an increased risk of UGIB. Conservative management could be an effective option, especially for patients that are at risk of intubation.
Assuntos
COVID-19 , Anticoagulantes/uso terapêutico , COVID-19/complicações , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hematemese/induzido quimicamente , Hematemese/epidemiologia , Humanos , Melena/induzido quimicamente , Melena/complicações , Melena/epidemiologia , Estudos RetrospectivosAssuntos
Aneurisma Infectado/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/cirurgia , Coma/complicações , Angiografia por Tomografia Computadorizada , Duodeno/diagnóstico por imagem , Duodeno/patologia , Endoscopia , Endoscopia do Sistema Digestório , Fístula/cirurgia , Hemorragia Gastrointestinal/microbiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Fístula Intestinal/microbiologia , Fístula Intestinal/cirurgia , Masculino , Melena/complicações , Pessoa de Meia-Idade , Infecções por Salmonella/sangue , Choque/complicações , VômitoRESUMO
Gastric adenomas are usually located in the antrum, or occasionally in the fundus of the stomach. Most adenomas are solitary, pedunculated mass. The report describes a 17-year girl who visited the emergency room with complaints of stabbing pain of upper abdomen, nausea, vomiting and melena for last one week. Emergency endoscopic examination revealed a giant polyp with a long about 15 cm pedicle embedded in the duodenum. The polyp was completely removed by surgery, about 15 x 3 x 4 cm in size. At 5-year follow-up by endoscopy and ultrasonography, the patient remained in good general condition. It emphasizes that giant gastric adenomas must be removed by endoscopy or surgery due to its potential of malignancy. It is necessary to follow-up for detecting early gastric neoplasm.
Assuntos
Adenoma/cirurgia , Duodeno/patologia , Endoscopia do Sistema Digestório/métodos , Pólipos/cirurgia , Neoplasias Gástricas/cirurgia , Adenoma/patologia , Adolescente , Feminino , Humanos , Melena/complicações , Melena/diagnóstico , Pólipos/diagnóstico , Neoplasias Gástricas/patologia , Resultado do Tratamento , Vômito/complicações , Vômito/diagnósticoRESUMO
While esophagogastric varices are common manifestations of portal hypertension, variceal bleeding from the jejunum is a rare complication of liver cirrhosis. In addition, ectopic variceal bleeding occurs in the duodenum and at sites of previous bowel surgery in most cases, including of stomas. We report a case of obscure overt gastrointestinal bleeding from jejunal varices in a 55-year-old woman who had not previously undergone abdominal surgery, who had liver cirrhosis induced by the hepatitis C virus. Emergency endoscopy revealed the presence of esophageal varices without stigmata of recent bleeding, and no bleeding focus was found at colonoscopy. She continued to produce recurrent melena with hematochezia and received up to 21 units of packed red blood cells. CT angiography revealed the presence of jejunal varices, but no active bleeding was found. Capsule endoscopy revealed fresh blood in the jejunum. The patient submitted to embolization of the jejunal varices via the portal vein, after which she had a stable hemoglobin level and no recurrence of the melena. This is a case of variceal bleeding from the jejunum in a liver cirrhosis patient without a prior history of abdominal surgery.
Assuntos
Hemorragia Gastrointestinal , Doenças do Jejuno/diagnóstico , Cirrose Hepática/diagnóstico , Angiografia , Endoscopia por Cápsula , Embolização Terapêutica , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico , Feminino , Humanos , Hipertensão Portal , Doenças do Jejuno/terapia , Melena/complicações , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Upper gastrointestinal (GI) bleeding is recognized as a common and potentially life-threatening abdominal emergency that needs a prompt assessment and aggressive emergency treatment. A retrospective study was undertaken at Bugando Medical Centre in northwestern Tanzania between March 2010 and September 2011 to describe our own experiences with fibreoptic upper GI endoscopy in the management of patients with upper gastrointestinal bleeding in our setting and compare our results with those from other centers in the world. FINDINGS: A total of 240 patients representing 18.7% of all patients (i.e. 1292) who had fibreoptic upper GI endoscopy during the study period were studied. Males outnumbered female by a ratio of 2.1:1. Their median age was 37 years and most of patients (60.0%) were aged 40 years and below. The vast majority of the patients (80.4%) presented with haematemesis alone followed by malaena alone in 9.2% of cases. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking prior to the onset of bleeding was recorded in 7.9%, 51.7% and 38.3% of cases respectively. Previous history of peptic ulcer disease was reported in 22(9.2%) patients. Nine (3.8%) patients were HIV positive. The source of bleeding was accurately identified in 97.7% of patients. Diagnostic accuracy was greater within the first 24 h of the bleeding onset, and in the presence of haematemesis. Oesophageal varices were the most frequent cause of upper GI bleeding (51.3%) followed by peptic ulcers in 25.0% of cases. The majority of patients (60.8%) were treated conservatively. Endoscopic and surgical treatments were performed in 30.8% and 5.8% of cases respectively. 140 (58.3%) patients received blood transfusion. The median length of hospitalization was 8 days and it was significantly longer in patients who underwent surgical treatment and those with higher Rockall scores (P < 0.001). Rebleeding was reported in 3.3% of the patients. The overall mortality rate of 11.7% was significantly higher in patients with variceal bleeding, shock, hepatic decompensation, HIV infection, comorbidities, malignancy, age > 60 years and in patients with higher Rockall scores and those who underwent surgery (P < 0.001). CONCLUSION: Oesophageal varices are the commonest cause of upper gastrointestinal bleeding in our environment and it is associated with high morbidity and mortality. The diagnostic accuracy of fibreoptic endoscopy was related to the time interval between the onset of bleeding and endoscopy. Therefore, it is recommended that early endoscopy should be performed within 24 h of the onset of bleeding.
Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Endoscopia do Sistema Digestório/métodos , Tecnologia de Fibra Óptica , Hemorragia Gastrointestinal/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Criança , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/etiologia , Infecções por HIV/complicações , Hematemese/complicações , Humanos , Lactente , Masculino , Melena/complicações , Pessoa de Meia-Idade , Úlcera Péptica/complicações , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Fatores Sexuais , Fumar/efeitos adversos , Tanzânia , Adulto JovemRESUMO
Small-bowel varices are rare and almost always occur in cases with portal hypertension. We encountered a patient with bleeding jejunal varices due to liver cirrhosis. Percutaneous retrograde sclerotherapy was performed via the superficial epigastric vein. Melena disappeared immediately after treatment. Disappearance of jejunal varices was confirmed by contrast-enhanced computed tomography. After 24 months of follow-up, no recurrent melena was observed.
Assuntos
Varizes Esofágicas e Gástricas/terapia , Jejuno/irrigação sanguínea , Escleroterapia/métodos , Meios de Contraste , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/diagnóstico , Feminino , Humanos , Imageamento Tridimensional , Melena/complicações , Pessoa de Meia-Idade , Choque Hemorrágico/etiologia , Tomografia Computadorizada por Raios XAssuntos
Hemangioma/congênito , Linfangioma/diagnóstico , Melena/congênito , Neoplasias Cutâneas/congênito , Trombocitopenia/congênito , Evolução Fatal , Feminino , Hemangioma/complicações , Humanos , Lactente , Recém-Nascido , Melena/complicações , Neoplasias Cutâneas/complicações , Trombocitopenia/complicaçõesRESUMO
Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare angiomatosis characterized by distinctive cutaneous and gastrointestinal venous malformations that result in gastrointestinal haemorrhage and iron-deficiency anaemia secondary to the bleeding episodes. We hope to emphasize the possibility of recurrent melaena in BRBNS and heighten physicians' awareness about the disease to contribute to its early detection.
Assuntos
Anemia Ferropriva/etiologia , Anemia Refratária/etiologia , Hemorragia Gastrointestinal/complicações , Nevo Azul/complicações , Neoplasias Cutâneas/complicações , Adolescente , Anemia Ferropriva/terapia , Anemia Refratária/terapia , Biópsia , Vesícula/complicações , Transfusão de Sangue , Endoscopia Gastrointestinal , Humanos , Ferro/administração & dosagem , Masculino , Melena/complicações , Nevo Azul/diagnóstico , Borracha , Neoplasias Cutâneas/diagnóstico , Síndrome , Resultado do TratamentoRESUMO
BACKGROUND: Patients with systemic sclerosis may develop mild abnormalities of liver function tests. More serious hepatic involvement has been well documented but is rare. Idiopathic portal hypertension had been reported only in a few female patients with systemic sclerosis. CASE PRESENTATION: An 82-year-old man with known systemic sclerosis presented with melaena. Urgent gastroscopy revealed oesophageal varices, which re-started bleeding during the procedure and were treated ensocopically, with Sengstaken tube and glypressin. Liver function tests and coagulation were normal. Non-invasive liver screen (including hepatitis viral serology and autoantibodies) was negative. Ultrasound scan of the abdomen revealed a small liver with coarse texture and no focal lesion. Hepato-portal flow was demonstrated in the portal vein. The spleen was enlarged. A moderate amount of free peritoneal fluid was present. A CT scan confirmed the absence of portal vein thrombosis. One month following discharge the patient had a liver biopsy. Histological examination showed essentially normal liver tissue; there was no evidence of any excess inflammation and no features to suggest cirrhosis or drug-induced liver disease. Taking into account the above evaluation we concluded that the patient had idiopathic portal hypertension. CONCLUSION: Both male and female patients with systemic sclerosis may -- rarely -- develop idiopathic portal hypertension.
Assuntos
Hipertensão Portal/complicações , Escleroderma Sistêmico/complicações , Idoso de 80 Anos ou mais , Varizes Esofágicas e Gástricas/complicações , Humanos , Hipertensão Portal/fisiopatologia , Circulação Hepática , Masculino , Melena/complicações , Sistema Porta/fisiopatologiaRESUMO
Gastric leiomyoma is an uncommonly found benign submucosal neoplasm which may cause hemorrhage in rare cases. A 67-years-old patient was admitted to our attention due to two episodes of hematemesis and melena occurred in the previous two days. Esophagogastroduodenoscopy showed a giant semi-pedunculated gastric polyp (diameter of 4 centimeters) located at the distal body. A large ulcer with a clot was seen on the polyp. We treated endoscopically the giant polyp using the new two-steps-technique recently described by us for the treatment of the large pedunculated gastric and colorectal polyps, and the polypectomy was successfully performed without immediate or delayed complications. Histological evaluation of the transected polyp revealed morphology according to a gastric submucosal leiomyoma. Endoscopic control, performed one and four weeks and 12 months later, showed complete reepithelization of the gastric mucosa, without any sign of endoscopic, endosonographic and histological recurrence of the disease. This case report shows that our endoscopic approach may be successfully used also for giant semi-pedunculated gastric polyps.
Assuntos
Endoscopia do Sistema Digestório/métodos , Leiomioma/diagnóstico , Pólipos/diagnóstico , Gastropatias/diagnóstico , Neoplasias Gástricas/diagnóstico , Idoso , Diagnóstico Diferencial , Hematemese/complicações , Hematemese/diagnóstico , Humanos , Itália , Leiomioma/cirurgia , Leiomioma/ultraestrutura , Melena/complicações , Melena/diagnóstico , Pólipos/cirurgia , Pólipos/ultraestrutura , Período Pós-Operatório , Gastropatias/patologia , Gastropatias/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
OBJECTIVE: To evaluate the role of capsule endoscopy in the detection of causes of obscure gastrointestinal bleeding. METHODS: Fifteen patients, nine males and six females, mean age 46 years (range 20-75 years), were investigated. All patients had undergone upper and lower gastrointestinal endoscopy with no evidence of causes of bleeding. Indication for capsule endoscopy was overt bleeding in 10 patients (eight with melaena and two with rectal bleeding) and anaemia in five patients. RESULTS: Diagnosis was made in four out of 10 patients with overt bleeding (40%) and in four out of five (80%) in the group with anaemia. The overall detection rate was 53%. Of the eight patients with melaena, two had angiodysplasia, one showed a diffuse inflammation of the jejunum and ileum probably related to associated portal hypertension, and five had a normal examination. Of the two patients with rectal bleeding, one had a polyp in the terminal ileum and the other a normal examination. Of the five patients with anaemia, one had jejunal carcinoma, three had Crohn's disease and one had a normal endoscopy. CONCLUSION: Wireless capsule endoscopy is safe, effective, non-invasive, and provides definitive diagnosis in about one-half of patients presenting with obscure gastrointestinal bleeding and previous negative endoscopic examinations.
Assuntos
Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/etiologia , Adenocarcinoma/complicações , Adulto , Idoso , Anemia/etiologia , Angiodisplasia/complicações , Doença de Crohn/complicações , Feminino , Humanos , Neoplasias do Jejuno/complicações , Masculino , Melena/complicações , Pessoa de Meia-Idade , RetoRESUMO
BACKGROUND: Anthranoid laxatives are the most commonly used purgatives in the therapy of acute and chronic constipation. Recent experimental data and a prospective cohort study provide evidence of a possible risk of anthranoid use for the development of colorectal neoplasms. MATERIALS AND METHODS: We performed a prospective case control study at the University of Erlangen to investigate the risk of anthranoid laxative use for the development of colorectal adenomas or carcinomas. A total of 202 patients with newly diagnosed colorectal carcinomas, 114 patients with adenomatous polyps, and 238 patients (controls) with no colorectal neoplasms who had been referred for total colonoscopy were studied. The use of anthranoid preparations was assessed by standardised interview, and endoscopically visible or microscopic melanosis coli was studied by histopathological examination. RESULTS: There was no statistically significant risk of anthranoid use for the development of colorectal adenomas (unadjusted odds ratio 1.0; 95% CI 0.5-1.9) or carcinomas (unadjusted odds ratio 1.0; 95% CI 0.6-1.8). Even after adjustment for the risk factors age, sex, and blood in the stools by logistic regression analysis the odds ratio for adenomas was 0.84 (95% CI 0. 4-1.7) and for carcinomas 0.93 (95% CI 0.5-1.7). Also, there were no differences between the patient and control groups for duration of intake. Macroscopic and high grade microscopic melanosis coli were not significant risk factors for the development of adenomas or carcinomas. CONCLUSION: Neither anthranoid laxative use, even in the long term, nor macroscopic or marked microscopic melanosis coli were associated with any significant risk for the development of colorectal adenoma or carcinoma.
Assuntos
Adenoma/induzido quimicamente , Carcinoma/induzido quimicamente , Catárticos/efeitos adversos , Neoplasias Colorretais/induzido quimicamente , Melanose/induzido quimicamente , Adenoma/complicações , Adulto , Idoso , Carcinoma/complicações , Estudos de Casos e Controles , Neoplasias Colorretais/complicações , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Melanose/complicações , Melena/complicações , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Fumar/efeitos adversosAssuntos
Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Complicações Cardiovasculares na Gravidez , Púrpura Trombocitopênica Trombótica/complicações , Adulto , Feminino , Hemorragia Gastrointestinal/patologia , Humanos , Jejuno/patologia , Melena/complicações , Melena/cirurgia , GravidezRESUMO
Colonic varices are a recognized cause of rectal bleeding in portal hypertension. We report here a patient who presented with melaena several months after resection of an ileal carcinoid tumour. Subsequent colonoscopy for continued episodes of rectal bleeding demonstrated extensive colonic varices. In the absence of portal hypertension, the varices appeared to be related to mesenteric venous obstruction. The management of bleeding colonic varices, in these circumstances, is discussed.
Assuntos
Tumor Carcinoide/complicações , Colo/irrigação sanguínea , Neoplasias do Íleo/complicações , Melena/complicações , Oclusão Vascular Mesentérica/complicações , Varizes/complicações , Idoso , Angiografia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/terapia , Colonoscopia , Seguimentos , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/terapia , Masculino , Melena/diagnóstico , Melena/terapia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/terapia , Varizes/diagnóstico , Varizes/terapiaRESUMO
We describe a patient presenting with palpable lymph nodes due to non-Hodgkin's lymphoma. Chemotherapy induced complete remission. One year later he complained of cramping abdominal pain, diarrhoea and bloody stools all due to Crohn's disease of the colon. There are only a few more patients described with a combination of inflammatory bowel disease and malignant lymphoma. So far there is no explanation for the co-incidence of the two diseases.