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1.
Ann Intern Med ; 177(3): JC32, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38437700

RESUMO

SOURCE CITATION: Chen H, Wu S, Tang M, et al. Thalidomide for recurrent bleeding due to small-intestinal angiodysplasia. N Engl J Med. 2023;389:1649-1659. 37913505.


Assuntos
Angiodisplasia , Talidomida , Humanos , Talidomida/efeitos adversos , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/etiologia , Recidiva , Angiodisplasia/complicações , Angiodisplasia/tratamento farmacológico
2.
Blood Coagul Fibrinolysis ; 35(3): 141-146, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38358904

RESUMO

This case report discusses the medical history of a 64-year-old woman diagnosed with scleroderma and diffuse gastrointestinal angiodysplasia. The patient received bevacizumab (BVZ) therapy to address gastrointestinal bleeding that was unresponsive to endoscopic treatment. Subsequently, she developed severe thrombocytopenia. Although there were suspicions of an immune-mediated mechanism resulting from BVZ treatment, the laboratory results did not provide conclusive evidence. The patient underwent transfusions, received gamma globulin, and was treated with Romiplostim. Over time, her platelet levels gradually improved, and the bleeding was successfully controlled. It's worth noting that BVZ-induced thrombocytopenia is a relatively rare yet severe adverse effect. Recognizing and understanding the mechanisms behind thrombocytopenia is essential for developing safer treatment approaches. Further research is required to identify potential risk factors associated with this condition.


Assuntos
Anemia , Angiodisplasia , Trombocitopenia , Humanos , Feminino , Pessoa de Meia-Idade , Bevacizumab/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Transfusão de Sangue , Trombocitopenia/complicações , Trombocitopenia/tratamento farmacológico , Angiodisplasia/complicações , Angiodisplasia/tratamento farmacológico
9.
Gastroenterology ; 166(4): 690-703, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38158089

RESUMO

BACKGROUND & AIMS: Gastrointestinal angiodysplasias are vascular anomalies that may result in transfusion-dependent anemia despite endoscopic therapy. An individual patient data meta-analysis of cohort studies suggests that octreotide decreases rebleeding rates, but component studies possessed a high risk of bias. We investigated the efficacy of octreotide in reducing the transfusion requirements of patients with angiodysplasia-related anemia in a clinical trial setting. METHODS: The study was designed as a multicenter, open-label, randomized controlled trial. Patients with angiodysplasia bleeding were required to have had at least 4 red blood cell (RBC) units or parental iron infusions, or both, in the year preceding randomization. Patients were allocated (1:1) to 40-mg octreotide long-acting release intramuscular every 28 days or standard of care, including endoscopic therapy. The treatment duration was 1 year. The primary outcome was the mean difference in the number of transfusion units (RBC + parental iron) between the octreotide and standard of care groups. Patients who received at least 1 octreotide injection or followed standard of care for at least 1 month were included in the intention-to-treat analyses. Analyses of covariance were used to adjust for baseline transfusion requirements and incomplete follow-up. RESULTS: We enrolled 62 patients (mean age, 72 years; 32 men) from 17 Dutch hospitals in the octreotide (n = 31) and standard of care (n = 31) groups. Patients required a mean number of 20.3 (standard deviation, 15.6) transfusion units and 2.4 (standard deviation, 2.0) endoscopic procedures in the year before enrollment. The total number of transfusions was lower with octreotide (11.0; 95% confidence interval [CI], 5.5-16.5) compared with standard of care (21.2; 95% CI, 15.7-26.7). Octreotide reduced the mean number of transfusion units by 10.2 (95% CI, 2.4-18.1; P = .012). Octreotide reduced the annual volume of endoscopic procedures by 0.9 (95% CI, 0.3-1.5). CONCLUSIONS: Octreotide effectively reduces transfusion requirements and the need for endoscopic therapy in patients with angiodysplasia-related anemia. CLINICALTRIALS: gov, NCT02384122.


Assuntos
Anemia , Angiodisplasia , Doenças do Colo , Idoso , Humanos , Masculino , Anemia/tratamento farmacológico , Anemia/etiologia , Angiodisplasia/complicações , Angiodisplasia/diagnóstico , Angiodisplasia/terapia , Doenças do Colo/tratamento farmacológico , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/etiologia , Ferro , Estudos Multicêntricos como Assunto , Octreotida/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Padrão de Cuidado , Feminino
10.
J Thorac Cardiovasc Surg ; 167(1): 157-163, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-35577596

RESUMO

OBJECTIVE: Patients with obstructive hypertrophic cardiomyopathy may have occult gastrointestinal bleeding. In this study, we analyzed outcomes of septal myectomy in patients who had a history of gastrointestinal bleeding preoperatively to understand patient characteristics and impact of septal reduction on recurrent gastrointestinal bleeding. METHODS: We analyzed 73 adult patients who had a history of gastrointestinal bleeding before transaortic septal myectomy for obstructive hypertrophic cardiomyopathy and compared outcomes to 219 patients without gastrointestinal bleeding preoperatively. RESULTS: Patients with preoperative history of gastrointestinal bleeding were older (median (IQR) age, 65 (59-69) years, P < .001) and were more likely to have systemic hypertension (70% vs 53%, P = .020) and coronary artery disease (25% vs 13%, P = .026). Preoperatively, patients with gastrointestinal bleeding had a larger left atrial volume index (median, 53 mL/m2; interquartile range, 42-67; P = .006) and greater right ventricular systolic pressure (median, 36 mm Hg; interquartile range, 32-49; mm Hg, P = .005) but no significant difference in severity of outflow tract obstruction (P = .368). There were no perioperative deaths. The estimated 5- and 10-year survivals were 96.6% and 81.8%, respectively. At a median of 3.4 (interquartile range, 1.9-9.1) years after septal myectomy, 11 patients (15%) had recurrence of gastrointestinal bleeding, which was attributed to angiodysplasia or unknown causes in 6 patients (8%). CONCLUSIONS: Patients with a preoperative history of gastrointestinal bleeding have favorable short- and long-term outcomes after septal myectomy for obstructive hypertrophic cardiomyopathy. Remission of gastrointestinal bleeding was observed in 85% of patients postprocedure, and only 8% of the patients had recurrent gastrointestinal bleeding due to angiodysplasia or unknown causes.


Assuntos
Angiodisplasia , Cardiomiopatia Hipertrófica , Adulto , Humanos , Idoso , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/cirurgia , Resultado do Tratamento , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/cirurgia
11.
BMJ Case Rep ; 16(12)2023 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-38086578

RESUMO

The case report discusses the challenges in diagnosing gastrointestinal bleeding of unknown origin, with angiodysplasia (AD) of the appendix being a rare cause. The report presents a case of a man in his late 60s who presented with vomiting, diarrhoea and rectal bleeding. As a result of the bleeding, the patient developed a type II myocardial infarction (MI), which had to be simultaneously managed further complicating the diagnostic process. Despite a normal CT angiogram, ongoing bleeding led to suspicion of AD, which was diagnosed using colonoscopy with limited bowel preparation. The patient underwent an open appendicectomy and was found to have AD of the tip of the appendix as the cause of the bleeding. The case highlights the limitations of CT angiography in haemodynamically unstable patients and subsequent importance of colonoscopy with bowel preparation in diagnosing rare causes of bleeding, even with limited bowel preparation, and the potential life-threatening consequences of untreated AD.


Assuntos
Angiodisplasia , Apêndice , Doenças do Colo , Humanos , Masculino , Angiodisplasia/diagnóstico , Angiodisplasia/diagnóstico por imagem , Apêndice/diagnóstico por imagem , Doenças do Colo/complicações , Colonoscopia , Hemorragia Gastrointestinal/diagnóstico , Idoso
12.
J. coloproctol. (Rio J., Impr.) ; 43(4): 292-299, Oct.-Dec. 2023. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1528942

RESUMO

The aim of our study is to evaluate the value of Argon Plasma Coagulation in the treatment of gastrointestinal vascular abnormalities. Patients and methods: This is a descriptive and analytical retrospective study, from January 2009 to September 2020. 198 patients who have benefited from treatment with Argon Plasma Coagulation for vascular anomalies of the digestive tract divided into 2 groups: -Group A: Patients with radial rectitis lesions (n = 107). -Group B: Patients with lesions of digestive angiodysplasia (n = 91). Results: The mean age of our patients was 64.95 ± 9.88 years [43 - 83] in group A, while in group B the mean age was 65.19 ± 14.29 years [40 - 91] with a clear male predominance in 72.5%. The majority of patients in group A were followed for prostate cancer in 33,8%, and 26.3% of patients in group B had chronic renal failure, followed by stomach cancer in 15.8%, and esophageal cancer in 10.5%. Clinical symptomatology was dominated by rectories in 40.2% in group A versus 46.8% in group B. Rectal involvement was dominated in group A in 98.1%, whereas in group B the lesions were mainly located in the stomach in 60.5%. The endoscopic evolution was favorable in all our patients with a clear improvement of rectal lesions and digestive angiodysplasia lesions. The total complication rate in our series was nil. Conclusion: Plasma Argon coagulation is a very effective method in the endoscopic treatment of digestive haemorrhages with good tolerability and a low complication rate. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Angiodisplasia/terapia , Trato Gastrointestinal/lesões , Coagulação com Plasma de Argônio , Estudos Retrospectivos , Endoscopia
13.
Angiol. (Barcelona) ; 75(6): 399-402, Nov-Dic. 2023. ilus
Artigo em Espanhol | IBECS | ID: ibc-229804

RESUMO

Introducción: el síndrome de Klippel-Trénaunay (SKT) es una entidad clínica rara y esporádica. La tríada clásica define malformación capilar, hipertrofia ósea y de tejidos blandos y varicosidades atípicas. Caso clínico: se describe el caso de una paciente de 14 años de edad que consulta por mancha en vino de Oporto, dolor en miembro inferior izquierdo, edema y discrepancia en la longitud de las extremidades inferiores. Se catalogó como síndrome de Klippel-Trénaunay por la tríada clásica presentada. Discusión: la paciente se benefició de termoablación venosa asociada a flebectomías y de oclusión venosa con escleroespuma.(AU)


Introduction: Klippel-Trénaunay syndrome (SKT) is a rare and sporadic disease, characterized by the clinical triad of capillary malformations, bone and soft tissue hypertrophy and varicose veins. Case report: we report the case of a 14-year-old female patient who presented a port-wine stain, pain in the left lower limb, edema, and discrepancy in the length of this limb. It was classified as Klippel-Trénaunay syndrome due to the classical triad presented. Discussion: the patient underwent venous thermoablation associated with phlebectomies and sclerofoam venous occlusion.(AU)


Assuntos
Humanos , Feminino , Adolescente , Síndrome de Klippel-Trenaunay-Weber/tratamento farmacológico , Extremidade Inferior/lesões , Angiodisplasia , Malformações Vasculares , Hipertrofia , Pacientes Internados , Exame Físico , Avaliação de Sintomas , Doenças Vasculares , Pediatria
14.
N Engl J Med ; 389(18): 1649-1659, 2023 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-37913505

RESUMO

BACKGROUND: Recurrent bleeding from the small intestine accounts for 5 to 10% of cases of gastrointestinal bleeding and remains a therapeutic challenge. Thalidomide has been evaluated for the treatment of recurrent bleeding due to small-intestinal angiodysplasia (SIA), but confirmatory trials are lacking. METHODS: We conducted a multicenter, double-blind, randomized, placebo-controlled trial to investigate the efficacy and safety of thalidomide for the treatment of recurrent bleeding due to SIA. Eligible patients with recurrent bleeding (at least four episodes of bleeding during the previous year) due to SIA were randomly assigned to receive thalidomide at an oral daily dose of 100 mg or 50 mg or placebo for 4 months. Patients were followed for at least 1 year after the end of the 4-month treatment period. The primary end point was effective response, which was defined as a reduction of at least 50% in the number of bleeding episodes that occurred during the year after the end of thalidomide treatment as compared with the number that occurred during the year before treatment. Key secondary end points were cessation of bleeding without rebleeding, blood transfusion, hospitalization because of bleeding, duration of bleeding, and hemoglobin levels. RESULTS: Overall, 150 patients underwent randomization: 51 to the 100-mg thalidomide group, 49 to the 50-mg thalidomide group, and 50 to the placebo group. The percentages of patients with an effective response in the 100-mg thalidomide group, 50-mg thalidomide group, and placebo group were 68.6%, 51.0%, and 16.0%, respectively (P<0.001 for simultaneous comparison across the three groups). The results of the analyses of the secondary end points supported those of the primary end point. Adverse events were more common in the thalidomide groups than in the placebo group overall; specific events included constipation, somnolence, limb numbness, peripheral edema, dizziness, and elevated liver-enzyme levels. CONCLUSIONS: In this placebo-controlled trial, treatment with thalidomide resulted in a reduction in bleeding in patients with recurrent bleeding due to SIA. (Funded by the National Natural Science Foundation of China and the Shanghai Municipal Education Commission, Gaofeng Clinical Medicine; ClinicalTrials.gov number, NCT02707484.).


Assuntos
Angiodisplasia , Hemorragia Gastrointestinal , Fármacos Hematológicos , Enteropatias , Intestino Delgado , Talidomida , Humanos , Angiodisplasia/complicações , Angiodisplasia/tratamento farmacológico , China , Método Duplo-Cego , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/etiologia , Talidomida/administração & dosagem , Talidomida/efeitos adversos , Talidomida/uso terapêutico , Resultado do Tratamento , Enteropatias/complicações , Enteropatias/tratamento farmacológico , Recidiva , Intestino Delgado/irrigação sanguínea , Administração Oral , Fármacos Hematológicos/administração & dosagem , Fármacos Hematológicos/efeitos adversos , Fármacos Hematológicos/uso terapêutico
16.
Blood Coagul Fibrinolysis ; 34(8): 545-548, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-37942747

RESUMO

Glanzmann's Thrombasthenia (GT) is a rare hemorrhagic condition caused by a platelet surface receptor disorder of the glycoprotein (GP) IIb/IIIa. Symptoms of GT are various forms of hemorrhages, such as purpura, epistaxis and menorrhagia. Gastrointestinal bleeding (GIB) is a rare expression of the condition and may occur due to traumas in the GI tract or as a consequence of gastrointestinal angiodysplasia (GIADs). In this case report, we present a middle-aged woman with recurrent GIB consequent to GIADs with persistent melena and iron deficiency anemia. After several unsuccessful therapeutic interventions, the patient was studied by the hereditary hemorrhagic telangiectasia's (HHT - Osler-Weber-Rendu disease) unit, where she received bevacizumab, showing a complete improvement in symptoms as well as a reduction in her GIADs. This case shows that bevacizumab could be a possible line of treatment for patients with coagulation disorders with GIADs.


Assuntos
Angiodisplasia , Transtornos Plaquetários , Menorragia , Trombastenia , Humanos , Pessoa de Meia-Idade , Feminino , Trombastenia/complicações , Trombastenia/tratamento farmacológico , Bevacizumab/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas , Menorragia/etiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/complicações , Doenças Raras/complicações , Angiodisplasia/complicações , Angiodisplasia/tratamento farmacológico
18.
Eur Heart J ; 44(33): 3168-3177, 2023 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-37555393

RESUMO

AIMS: Heyde syndrome is the co-occurrence of aortic stenosis, acquired von Willebrand syndrome, and gastrointestinal bleeding. Aortic valve replacement has been demonstrated to resolve all three associated disorders. A systematic review and meta-analysis were performed to obtain best estimates of the effect of aortic valve replacement on acquired von Willebrand syndrome and gastrointestinal bleeding. METHODS AND RESULTS: A literature search was performed to identify articles on Heyde syndrome and aortic valve replacement up to 25 October 2022. Primary outcomes were the proportion of patients with recovery of acquired von Willebrand syndrome within 24 h (T1), 24-72 h (T2), 3-21 days (T3), and 4 weeks to 2 years (T4) after aortic valve replacement and the proportion of patients with cessation of gastrointestinal bleeding. Pooled proportions and risk ratios were calculated using random-effects models. Thirty-three studies (32 observational studies and one randomized controlled trial) on acquired von Willebrand syndrome (n = 1054), and 11 observational studies on gastrointestinal bleeding (n = 300) were identified. One study reported on both associated disorders (n = 6). The pooled proportion of Heyde patients with acquired von Willebrand syndrome recovery was 86% (95% CI, 79%-91%) at T1, 90% (74%-96%) at T2, 92% (84%-96%) at T3, and 87% (67%-96%) at T4. The pooled proportion of Heyde patients with gastrointestinal bleeding cessation was 73% (62%-81%). Residual aortic valve disease was associated with lower recovery rates of acquired von Willebrand syndrome (RR 0.20; 0.05-0.72; P = 0.014) and gastrointestinal bleeding (RR 0.57; 0.40-0.81; P = 0.002). CONCLUSION: Aortic valve replacement is associated with rapid recovery of the bleeding diathesis in Heyde syndrome and gastrointestinal bleeding cessation. Residual valve disease compromises clinical benefits.


Assuntos
Angiodisplasia , Estenose da Valva Aórtica , Doenças de von Willebrand , Humanos , Valva Aórtica/cirurgia , Angiodisplasia/complicações , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Doenças de von Willebrand/complicações , Hemorragia Gastrointestinal/cirurgia , Hemorragia Gastrointestinal/complicações , Síndrome , Fator de von Willebrand
19.
Digestion ; 104(6): 468-479, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37619533

RESUMO

INTRODUCTION: Aortic stenosis (AS) is sometimes associated with gastrointestinal bleeding, and this phenomenon is known as Heyde's syndrome. Such bleeding is most often considered to originate from gastrointestinal angiodysplasias, but the frequency and endoscopic features of such bleeding remain unclear. This study aimed to determine the frequency and endoscopic features of gastrointestinal angiodysplasia in patients with severe AS. PATIENTS AND METHODS: In this multicenter, retrospective study, we evaluated consecutive patients who underwent transcatheter aortic valve implantation (TAVI) with severe AS from May 2016 to December 2019. We extracted the data on the clinicopathological features according to the status of anemia, the proportion of patients who underwent gastrointestinal endoscopic examinations and demonstrated gastrointestinal angiodysplasia, and identified the endoscopic features associated with such patients. RESULTS: In 325 patients, the rates of moderate/severe anemia (hemoglobin < 11 g/dL) were 52%. Regarding medicine, there were no significant differences between the patients with and without moderate/severe anemia. Patients were examined by esophagogastroduodenoscopy (21%), colonoscopy (12%), and balloon-assisted enteroscopy or small bowel capsule endoscopy (1.5%). Patients with moderate/severe anemia had significantly more angiodysplasia (38.3% vs. 7.7%; p < 0.0001) and active bleeding (23.4% vs. 0%; p < 0.01). Angiodysplasia was detected in 21 patients (stomach, n = 9; small intestine, n = 5, and colon, n = 10). CONCLUSIONS: The results suggest, for the first time, that patients with severe AS who underwent TAVI and moderate/severe anemia frequently had gastrointestinal angiodysplasia and active bleeding throughout the entire gastrointestinal tract.


Assuntos
Anemia , Angiodisplasia , Estenose da Valva Aórtica , Endoscopia por Cápsula , Doenças do Colo , Humanos , Estudos Retrospectivos , Hemorragia Gastrointestinal/complicações , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Angiodisplasia/diagnóstico , Angiodisplasia/diagnóstico por imagem , Anemia/complicações
20.
Surg Endosc ; 37(10): 7658-7666, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37495849

RESUMO

BACKGROUND: Capsule endoscopy (CE) is the first-choice exploration in case of overt small bowel bleeding (SBB). An early CE is known to increase diagnostic yield, but long reading times may delay therapeutics. The study evaluates the diagnostic performance of the artificial intelligence tool TOP100 in patients with overt SBB undergoing early CE with Pillcam SB3. METHODS: Patients who underwent early CE (up to 14 days from the bleeding episode) for suspected overt SBB were included. One experienced endoscopist prospectively performed standard reading (SR) and a second blind experienced endoscopist performed a TOP100-based reading (TR). The primary endpoint was TR diagnostic accuracy for lesions with high bleeding potential (P2). RESULTS: A total of 111 patients were analyzed. The most common clinical presentation was melena (64%). CE showed angiodysplasias in 40.5% of patients (45/111). In per-patient analysis, TR showed a sensitivity of 90.48% (95% CI 82.09-95.80), specificity of 100% (95% CI 87.23-100) with a PPV of 100% (95% CI 94.01-100), NPV of 77.14% (95% CI 63.58-86.71) and diagnostic accuracy of 92.79 (86.29-96.84). At multivariate analysis, adequate intestinal cleansing was the only independent predictor of concordance between TR and SR (OR 2.909, p = 0.019). The median reading time for SR and TR was 23 min (18.0-26.8) and 1.9 min (range 1.7-2.1), respectively (p < 0.001). CONCLUSIONS: TOP100 provides a fast-reading mode for early CE in case of overt small bowel bleeding. It identifies most patients with active bleeding and angiodysplasias, aiding in the prioritization of therapeutic procedures. However, its accuracy in detecting ulcers, varices and P1 lesions seems insufficient.


Assuntos
Angiodisplasia , Endoscopia por Cápsula , Humanos , Inteligência Artificial , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Angiodisplasia/diagnóstico , Angiodisplasia/diagnóstico por imagem
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