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Peña Amaya RG, Figueredo Peña MDC. Variceal hemorrhage in a patient with cirrhosis and congenital hemophilia A: A therapeutic challenge. SAGE Open Med Case Rep 2024; 12:2050313X241255825. [PMID: 38800133 PMCID: PMC11119485 DOI: 10.1177/2050313x241255825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
We describe the case of a 61-year-old male patient with a history of hemophilia A and previous hepatitis C virus infection with sustained virological response and no previous documentation of cirrhosis, who was admitted for variceal bleeding. He was taken for endoscopic evaluation with evidence of active variceal hemorrhage requiring rubber band ligation. Patients with congenital coagulation disorders, such as hemophilia A, are excluded from international guidelines for gastrointestinal bleeding, making their management and counseling challenging. In this article, we describe the specific interventions to be performed in patients with hemophilia A and upper gastrointestinal tract bleeding, specifically variceal bleeding, focusing on pre-endoscopic and endoscopic management.
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Affiliation(s)
- Rafael Gregorio Peña Amaya
- Specialist in Internal Medicine, Fellow of Gastroenterology, University Hospital San Ignacio, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - María del Carmen Figueredo Peña
- Specialist in Internal Medicine and Gastroenterology, Gastroenterology and Digestive Endoscopy Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
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Luo Y, Li Q, Liao Z, Luo Z. Unusual case of retroperitoneal hematoma and duodenal ulcerative bleeding after nephrectomy: Case report. Medicine (Baltimore) 2024; 103:e33765. [PMID: 38306569 PMCID: PMC10843467 DOI: 10.1097/md.0000000000033765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/24/2023] [Indexed: 02/04/2024] Open
Abstract
RATIONALE Retroperitoneal hematomas are relatively common in patients undergoing nephrectomy. Herein, we report an unusual case involving a giant retroperitoneal hematoma and subsequent duodenal ulcerative bleeding following a radical nephrectomy. PATIENT CONCERNS A 77-year-old woman was admitted to our hospital for lower back pain, and she had severe right hydronephrosis and a urinary tract infection. DIAGNOSES The patient was diagnosed and confirmed as high-grade urothelial carcinoma. INTERVENTIONS After ineffective conservative treatments, a right radical nephrectomy and ureteral stump resection were performed. The patient received proton pump inhibitors to prevent stress ulcer formation and bleeding. On the first day post-surgery, she had normal gastrointestinal (GI) endoscopy findings. On the second day post-surgery, abdominal computed tomography revealed a retroperitoneal hematoma. Notably, 14 days post-surgery, massive GI bleeding occurred, and GI endoscopy identified an almost perforated ulcer in the bulbar and descending duodenum. OUTCOMES The patient died on day 15 after surgery. LESSONS Duodenal ulceration and bleeding might occur following a retroperitoneal hematoma in patients treated with nephrectomy. Timely intervention may prevent duodenal ulcers and complications, and thus could be a promising life-saving intercession.
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Affiliation(s)
- Yong Luo
- Hengyang Medical School, University of South China; Trauma Centre & Emergency Department, The Second Affiliated Hospital of the University of South China, Hengyang, P.R. China
| | - Qing Li
- Hengyang Medical School, University of South China; Trauma Centre & Emergency Department, The Second Affiliated Hospital of the University of South China, Hengyang, P.R. China
| | - Zhanchen Liao
- Trauma Centre & Emergency Department, and Institute of Urology and Organ Transplantation, The Second Affiliated Hospital of the University of South China, Hengyang, P.R. China
| | - Zhigang Luo
- Trauma Centre & Emergency Department, and Institute of Urology and Organ Transplantation, The Second Affiliated Hospital of the University of South China, Hengyang, P.R. China
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Samii A, Norouzi M, Ahmadi A, Dorgalaleh A. Gastrointestinal Bleeding in Congenital Bleeding Disorders. Semin Thromb Hemost 2022; 48:529-541. [PMID: 35021252 DOI: 10.1055/s-0041-1741571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Gastrointestinal bleeding (GIB) is serious, intractable, and potentially life-threatening condition. There is considerable heterogeneity in GIB phenotypes among congenital bleeding disorders (CBDs), making GIB difficult to manage. Although GIB is rarely encountered in CBDs, its severity in some patients makes the need for a comprehensive and precise assessment of underlying factors and management approaches imperative. Initial evaluation of GIB begins with assessment of hematological status; GIB should be ruled out in patients with chronic anemia, and in presentations that include hematemesis, hematochezia, or melena. High-risk patients with recurrent GIB require urgent interventions such as replacement therapy for treatment of coagulation factor deficiency (CFD). However, the best management strategy for CFD-related bleeding remains controversial. While several investigations have identified CBDs as potential risk factors for GIB, research has focused on assessing the risks for individual factor deficiencies and other CBDs. This review highlights recent findings on the prevalence, management strategies, and alternative therapies of GIB related to CFDs, and platelet disorders.
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Affiliation(s)
- Amir Samii
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshaad Norouzi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Abbas Ahmadi
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Akbar Dorgalaleh
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
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Gavrel M, Rafowicz A, d'Oiron R, Franchi-Abella S, Lambert T, Adamsbaum C. Imaging features of atypical bleeds in young patients with hemophilia. Diagn Interv Imaging 2018; 100:135-145. [PMID: 30559038 DOI: 10.1016/j.diii.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
Abstract
Hemarthroses and muscle bleeds are well-known and well-documented complications in pediatric and young adult hemophilia patients. In contrast, deep bleeds in atypical locations can be a diagnostic challenge, since clinicians and radiologists are often unfamiliar with their clinical and radiological features. Some atypical bleeds, however, can be life-threatening or severely disabling, highlighting the need for prompt, accurate diagnosis. Rare bleeds include central nervous system bleeds (including intracranial and spinal hematomas), urogenital bleeds, intra-abdominal bleeds (mesenteric and gastrointestinal wall hematomas) and pseudo tumors in unusual locations like the sinonasal cavities. Because clinical assessment can be difficult, clinicians and radiologists should be aware of the possibility of these rare complications in their hemophilia patients, so that they can avoid unnecessary invasive diagnostic and surgical procedures and institute prompt, appropriate treatment. The purpose of this review is to illustrate the imaging features of bleeds that occur in rare locations in young (i.e., children and young adults) patients with hemophilia to make the reader more familiar with these conditions.
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Affiliation(s)
- M Gavrel
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France.
| | - A Rafowicz
- Reference Centre for Hemophilia and Hemorrhagic Constitutional Diseases, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - R d'Oiron
- Reference Centre for Hemophilia and Hemorrhagic Constitutional Diseases, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - S Franchi-Abella
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - T Lambert
- Reference Centre for Hemophilia and Hemorrhagic Constitutional Diseases, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - C Adamsbaum
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France; Faculty of Medicine, Paris-Sud University, 94270 Le Kremlin-Bicêtre, France
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Arachchillage DRJ, Makris M. Choosing and using non-steroidal anti-inflammatory drugs in haemophilia. Haemophilia 2015; 22:179-187. [DOI: 10.1111/hae.12805] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 12/11/2022]
Affiliation(s)
| | - M. Makris
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield UK
- Department of Cardiovascular Science; University of Sheffield; Sheffield UK
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Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, Kitchen S, Llinas A, Ludlam CA, Mahlangu JN, Mulder K, Poon MC, Street A. Guidelines for the management of hemophilia. Haemophilia 2012; 19:e1-47. [PMID: 22776238 DOI: 10.1111/j.1365-2516.2012.02909.x] [Citation(s) in RCA: 1264] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2012] [Indexed: 01/23/2023]
Affiliation(s)
- A. Srivastava
- Department of Hematology; Christian Medical College; Vellore; India
| | - A. K. Brewer
- Department of Oral Surgery; The Royal Infirmary; Glasgow; Scotland
| | - E. P. Mauser-Bunschoten
- Van Creveldkliniek and Department of Hematology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - N. S. Key
- Department of Medicine; University of North Carolina; Chapel Hill; NC; USA
| | - S. Kitchen
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield; UK
| | - A. Llinas
- Department of Orthopaedics and Traumatology; Fundación Santa Fe University Hospital Fundación Cosme y Damián and Universidad de los Andes and Universidad del Rosario; Bogotá; Colombia
| | - C. A. Ludlam
- Comprehensive Care Haemophilia and Thrombosis Centre; Royal Infirmary; Edinburgh; UK
| | - J. N. Mahlangu
- Haemophilia Comprehensive Care Centre; Johannesburg Hospital and Department of Molecular Medicine and Haematology; Faculty of Health Sciences; National Health Laboratory Services and University of the Witwatersrand; Johannesburg; South Africa
| | - K. Mulder
- Bleeding Disorders Clinic; Health Sciences Center; Winnipeg; Canada
| | - M. C. Poon
- Departments of Medicine; Pediatrics and Oncology, and Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program; University of Calgary, Foothills Hospital and Calgary Health Region; Calgary; Canada
| | - A. Street
- Haematology; Alfred Hospital; Melbourne; Victoria; Australia
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Inoue H, Miyatani H, Nakashima Y, Sagihara N, Yoshida Y. Successful endoscopic mucosal resection of a hyperplastic polyp in a hemophilia A patient. Dig Endosc 2011; 23:325. [PMID: 21951095 DOI: 10.1111/j.1443-1661.2010.01095.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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8
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CHOE BH, KIM JY, LEE JH, KIM JM, CHU MA, CHO SM, LEE KS. Upper gastrointestinal bleeding in children with haemophilia: a clinical significance ofHelicobacter pyloriinfection. Haemophilia 2009; 16:277-80. [DOI: 10.1111/j.1365-2516.2009.02140.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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9
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KOUIDES PA, FOGARTY PF. How do we treat: upper gastrointestinal bleeding in adults with haemophilia. Haemophilia 2009; 16:360-2. [DOI: 10.1111/j.1365-2516.2009.02130.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Evaluation and Management of Hereditary Hemophilia in the Emergency Department. J Emerg Nurs 2009; 35:437-41. [DOI: 10.1016/j.jen.2008.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 08/28/2008] [Accepted: 09/14/2008] [Indexed: 11/15/2022]
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Eyster ME, Asaad SM, Gold BD, Cohn SE, Goedert JJ. Upper gastrointestinal bleeding in haemophiliacs: incidence and relation to use of non-steroidal anti-inflammatory drugs. Haemophilia 2007; 13:279-86. [PMID: 17498077 DOI: 10.1111/j.1365-2516.2007.01453.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This multicentre study sought to estimate the incidence of upper gastrointestinal (UGI) bleeding in haemophiliacs and its relationship to use of non-steroidal anti-inflammatory drugs (NSAIDs). Cox models were used to estimate relative hazards (RH) with 95% confidence intervals (CI) for postulated risk factors. Conditional logistic regression and stored sera were used to assess UGI bleeding risk with Heliobacter pylori seropositivity in cases compared with closely matched controls. During a mean of 17.4 months (range 2-34), 2285 participants, ages 13-89 (mean 36.5) were followed for 3309 person-years (py). Forty-two experienced a UGI bleeding event (incidence 1.3 per 100 py), most from ulcer (11), gastritis (four), varices (five) and Mallory Weiss tears (eight). RH was significantly increased with traditional NSAID use for <1 month (OR: 3.66; 95% CI: 1.1-11.9), but not with coxibs use. RH was significantly and independently increased with age >46 years (3.5; 95% CI: 1.1-10.6) and hepatic decompensation (4.4; 95% CI: 1.7-11.6). Likelihood of bleeding was substantially but not significantly increased (OR: 4.6; 95% CI: 0.3-83.9) with H. pylori seropositivity. These findings suggest that coxibs are a safer alternative than traditional NSAIDs in the treatment of haemophilic arthropathy.
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Affiliation(s)
- M E Eyster
- Division of Hematology and Oncology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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Katsumi A, Matsushita T, Hirashima K, Iwasaki T, Adachi T, Yamamoto K, Kojima T, Takamatsu J, Saito H, Naoe T. Recurrent intramural hematoma of the small intestine in a severe hemophilia A patient with a high titer of factor VIII inhibitor: a case report and review of the literature. Int J Hematol 2006; 84:166-9. [PMID: 16926140 DOI: 10.1532/ijh97.06053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 17-year-old man with severe hemophilia A (factor VIII <1%) developed intermittent left upper quadrant pain. He had a high titer of factor VIII inhibitor (1024 Bethesda units/mL) and was diagnosed with intramural hematoma of the jejunum. He was managed conservatively with activated prothrombin complex concentrate (APCC), resulting in the resolution of symptoms. He developed recurrent intramural hematoma of the small intestine over the next 54 months, and was successfully treated with APCC. This case highlights a rare clinical manifestation in hemophilia patients, and also indicates the effectiveness of APCC instead of exploratory surgery for intramural hematoma. Cases of intramural hematoma of the gastrointestinal tract among hemophilia patients are also reviewed.
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Affiliation(s)
- Akira Katsumi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Affiliation(s)
- Michael F McGee
- Department of Surgery, Case Western Reserve University School of Medicine, Case Medical Center, Cleveland, OH 44106, USA
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Szczepanik AB, Zaleska M, Wiszniewski A, Wislawski S, Misiak A, Maryniak R, Windyga J. Helicobacter pylori infection in patients with haemophilia in Poland: prevalence and risk of upper gastrointestinal bleeding. Haemophilia 2005; 11:376-9. [PMID: 16011591 DOI: 10.1111/j.1365-2516.2005.01086.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Infection with Helicobacter pylori is the main aetiological factor for erosive gastritis and duodenal or gastric peptic ulcers often complicated with life-threatening bleeding in patients with coagulation disorders. The aim of this prospective study was to evaluate the prevalence of Helicobacter pylori infection in haemophilia patients, and to assess the risk of gastrointestinal bleeding associated with this infection. From 2000 to 2002, 146 patients with haemophilia (129, haemophilia A; 13, haemophilia B), mean age, 39.9 years (+/-7.3), were investigated for H. pylori infection using IgG and IgA latex serological test. The control group included 100 men with no coagulation disorders, mean age, 40.9 years (+/-9.2). For 72 (49.3%) patients with haemophilia and 39 controls (39.0%) serological tests were positive indicating the presence of H. pylori infection (P =0.1112). A history of gastrointestinal bleeding was reported in 46 patients (31.5%) with haemophilia and in two control group patients (2.0%) (P < 0.0001). Gastrointestinal bleeding was significantly more frequent in patients with haemophilia infected with H. pylori (33/46; 71.7%) than in patients with no H. pylori infection (13/46; 28.3%; P = 0.0002). In conclusion, the prevalence of H. pylori infection in haemophilic patients in Poland is comparable with that in patients with no coagulation disorders. Helicobacter pylori infection is a risk factor for duodenal and gastric ulcer bleeding in haemophilia patients. In view of the high frequency of upper gastrointestinal bleeding associated with H. pylori infection, we believe that screening and eradication therapy are appropriate in haemophilia patients.
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Affiliation(s)
- A B Szczepanik
- Department of Surgery, Institute of Haematology and Blood Transfusion, Warsaw, Poland.
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Horan P, Drake M, Patterson RN, Cuthbert RJG, Carey D, Johnston SD. Acute onset dysphagia associated with an intramural oesophageal haematoma in acquired haemophilia. Eur J Gastroenterol Hepatol 2003; 15:205-7. [PMID: 12560769 DOI: 10.1097/00042737-200302000-00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
A 78-year-old man presented with a 5-day history of epistaxis and spontaneous bruising, and a 2-day history of acute dysphagia. Barium swallow, computerized tomography scan of the chest and upper gastrointestinal endoscopy were suggestive of an upper oesophageal tumour, although biopsies failed to confirm this. Investigations including a raised activated partial thromboplastin time led to the detection of an inhibitor causing functional factor VIII deficiency. Following treatment with intravenous human immunoglobulin, oral prednisolone and oral cyclophosphamide, the patient's dysphagia resolved. There was a resolution of the findings seen at the initial endoscopy and on computerized tomography scan of the chest, consistent with an oesophageal haematoma. Follow-up endoscopy failed to detect recurrence or an aetiological factor.
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Affiliation(s)
- Paul Horan
- Department of Gastroenterology (Level 6), Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK
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Eleftheriadis N, Makri S, Aggouridaki C, Pithara E, Makris P. Helicobacter pylori infection in upper gastrointestinal bleeding in patients with hereditary hemorrhagic disorders. Eur J Intern Med 2002; 13:480-484. [PMID: 12446191 DOI: 10.1016/s0953-6205(02)00157-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND: In patients with hereditary bleeding disorders, upper gastrointestinal bleeding presents a life-threatening complication, while the role of Helicobacter pylori (H. pylori) infection in this group of patients has not been fully clarified in the literature. The aim of the present study was to evaluate the role of H. pylori infection and of dental status in upper gastrointestinal bleeding in patients with hereditary hemorrhagic disorders (HHD). METHODS: Thirty-seven patients with HHD (18 patients with and 19 without a history of upper gastrointestinal bleeding) and 26 control patients without HHD, who were admitted to our hospital for elective gastroscopy due to dyspeptic symptoms, were included in the study. Endoscopy was performed on all patients with gastrointestinal bleeding and on controls. ELISA was used to detect IgG, anti-CagA, and IgA antibodies to H. pylori in the serum and saliva of patients and controls. Moreover, dental status was examined using the decayed/missing/filled teeth index (DMFT) in all subjects. The chi(2)-test was used for statistical analysis. RESULTS: Some 64.8% of the patients and 65.4% of the controls had H. pylori IgG antibodies in serum (P>0.1, NS) while 54.05% of the patients and 34.6% of controls were anti-CagA-positive in serum (P=NS). However, 83 and 26.3% of the HHD patients with and without gastrointestinal bleeding, respectively, were serum anti-CagA-positive (P<0.01) while 72 and 58%, respectively, were serum IgG-positive (P=NS). H. pylori antibodies in saliva and the DMFT calculated index did not differ between the two subgroups. Subsequently, all serum anti-CagA-positive HHD patients received 1-week of triple H. pylori eradication therapy with omeprazole, clarithromycin, and amoxicillin orally. During a 2-year follow-up, none of these patients reported upper gastrointestinal bleeding. CONCLUSIONS: Although no statistically significant difference in H. pylori infection was found between HHD and controls, the CagA strain appeared more frequently in those HHD patients with a history of upper gastrointestinal bleeding. Given our results and the limited data available in the literature, we would recommend anti-CagA screening and therapy to all patients with HHD. However, further studies with a longer follow-up and a greater number of patients are necessary.
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Affiliation(s)
- Nikos Eleftheriadis
- Hemostatic Unit of The First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Stl. Kiriakidi 1, PC 54636, Thessaloniki, Greece
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Pitcher GJ, Bowley DMG, Chasumba G, Zuckerman M. Life-threatening haemorrhage from a gastric Dieulafoy lesion in a child with haemophilia. Haemophilia 2002; 8:719-20. [PMID: 12199687 DOI: 10.1046/j.1365-2516.2002.00675.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- G J Pitcher
- Division of Paediatric Surgery Johannesburg Hospital and the University of the Witwatersrand, South Africa.
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Toyoda H, Fukuda Y, Nakano I, Katano Y, Ebata M, Nagano K, Morita K, Yokozaki S, Takeuchi M, Hayakawa T, Takamatsu J. Massive bleeding from a gastric erosion after transcatheter arterial chemoembolization for hepatocellular carcinoma in a patient with mild haemophilia A. Haemophilia 2000; 6:688-92. [PMID: 11122397 DOI: 10.1046/j.1365-2516.2000.00414.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We observed massive bleeding from a gastric erosion following transcatheter arterial chemoembolization (TAE) in a patient with mild haemophilia A. A 78-year-old haemophiliac (factor VIII level over 60%) received TAE with farmorubicin and spongel. Haematemesis and melena with loss of consciousness occurred 3 days [corrected] after TAE, and endoscopy revealed superficial erosions with oozing. Toxic effects of the anticancer drug in conjunction with the bleeding disorder may have caused the massive bleeding. We should always consider the possibility of unexpected complications in patients with bleeding disorders; gastrointestinal bleeding can develop during treatment for liver tumours.
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Affiliation(s)
- H Toyoda
- Second Department of Internal Medicine, Nagoya University School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550 Japan
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Sreenivas DV, Bharavi C, Anjum F, Kumar YR N, Kumar A. Spontaneous hemobilia in a hemophiliac treated by factor VIII replacement and nasobiliary drainage. Dig Dis Sci 1998; 43:2606-9. [PMID: 9881489 DOI: 10.1023/a:1026682723264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
We report a case of spontaneous hemobilia in a hemophilia patient presenting with classical Sandblom's triad of symptoms. Endoscopic retrograde cholangiography was helpful in establishing the diagnosis. Hemobilia subsided with factor VIII replacement and endoscopic nasobiliary drainage. Endoscopic nasobiliary drainage resulted in lysis of the clots in the biliary tree and relief of obstructive jaundice.
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Affiliation(s)
- D V Sreenivas
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, India
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Abstract
BACKGROUND Lower gastrointestinal bleeding can be a confusing clinical conundrum, the satisfactory evaluation and management of which requires a disciplined and orderly approach. Diagnosis and management has evolved with the development of new technology such as selective mesenteric angiography and colonoscopy. PURPOSE This study was undertaken to review the available data in the literature and to determine the current optimum method of evaluation and management of lower gastrointestinal hemorrhage most likely to result in a successful outcome. METHODS Data available on the topic of lower gastrointestinal bleeding in the English literature were obtained via MEDLINE search and were reviewed and analyzed. RESULTS The colonic origin of lower gastrointestinal hemorrhage in order of decreasing incidence is diverticulosis, inflammatory bowel disease, including ischemic and infectious colitis, colonic neoplasia, benign anorectal disease, and arteriovenous malformations. Approximately 10 to 15 percent of all cases of rectal bleeding are attributable to a cause that is proximal to the ligament of Treitz. Small intestinal sources such as arteriovenous malformations, diverticula, and neoplasia account for between 3 and 5 percent of all cases. Colonoscopy successfully identified an origin in severe hematochezia in 74 to 82 percent of cases. Mesenteric angiography has a sensitivity of 42 to 86 percent. The best method of management depends on whether hemorrhage persists, the severity of continued hemorrhage, the cumulative transfusion requirement, and the specific origin of bleeding. CONCLUSION Lower gastrointestinal hemorrhage is a complex clinical problem that requires disciplined and sophisticated evaluation for successful management. Diverticulosis is the most common cause. Colonoscopy is the diagnostic procedure of choice both for its accuracy in localization and its therapeutic capability. Selective mesenteric angiography should be reserved for those patients in whom colonoscopy is not practical. Precise identification of the bleeding source is crucial for a successful outcome. Specific directed therapy, such as segmental colonic resection for bleeding diverticulosis, is associated with the highest success rate and the lowest morbidity. A complete review of lower gastrointestinal bleeding is contained herein.
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Affiliation(s)
- A M Vernava
- Section of Colon and Rectal Surgery, Saint Louis University School of Medicine, Missouri, USA
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Thompson NP, Wakefield AJ, Pounder RE. Inherited disorders of coagulation appear to protect against inflammatory bowel disease. Gastroenterology 1995; 108:1011-5. [PMID: 7698567 DOI: 10.1016/0016-5085(95)90197-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIMS Crohn's disease and ulcerative colitis seem to be rarely associated with inherited diseases of coagulation. Histological and hematologic studies suggest that thrombotic mesenteric microvascular occlusion is involved in the pathogenesis of inflammatory bowel disease. The aim of this study was to perform a national survey to determine the prevalence of inflammatory bowel disease among patients with inherited disorders of coagulation. METHODS Using a postal and telephone questionnaire survey sent to directors of all 129 hemophilia centers in the United Kingdom, the number of patients with inflammatory bowel disease and either hemophilia or von Willebrand's disease was determined. The expected number of cases of inflammatory bowel disease in this population was estimated using published data. RESULTS Of 6433 patients with hemophilia and 3129 patients with von Willebrand's disease, 4 cases of Crohn's disease were reported compared with expected 11.97-16.58 cases (standardized morbidity ratio, 0.33-0.24; 95% confidence interval, 0.90-0.01; P < 0.05). Ulcerative colitis also occurred significantly less frequently than expected: 9 observed cases in comparison with expected 19.43-31.35 cases (standardized morbidity ratio, 0.46-0.29; 95% confidence interval, 0.91-0.01; P < 0.025). CONCLUSIONS This epidemiological study provides further evidence that thrombosis and vascular occlusion may be important in the pathogenesis of inflammatory bowel disease.
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Affiliation(s)
- N P Thompson
- University Department of Medicine, Royal Free Hospital School of Medicine, London, England
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McCoy HE, Kitchens CS. Small bowel hematoma in a hemophiliac as a cause of pseudoappendicitis: diagnosis by CT imaging. Am J Hematol 1991; 38:138-9. [PMID: 1951304 DOI: 10.1002/ajh.2830380212] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute abdominal pain in a hemophiliac should be approached as hemorrhage until proven otherwise. With factor replacement available, a conservative approach can be taken as opposed to immediate exploratory surgery. Diagnostic imaging can define areas of hemorrhage. We report a case of "pseudoappendicitis" in a hemophiliac with terminal ileum circumferential bowel wall hematoma diagnosed by CT with the initial diagnostic scan. Factor replacement resulted in resolution of the signs and symptoms of the pseudoappendicitis and follow-up CT scan revealed resolution of the hematoma. A review of the literature reveals few CT documented circumferential bowel wall hematomas with limited clinical histories and no cases with follow-up scans after conservative management.
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Affiliation(s)
- H E McCoy
- Department of Medicine, University of Florida College of Medicine, JHMHC, Gainesville 32610-0277
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Affiliation(s)
- J C Underwood
- Department of Pathology, University of Sheffield Medical School
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Pauly MP, Watson-Williams E, Trudeau WL. Intussusception presenting with lower gastrointestinal hemorrhage in a hemophiliac. Gastrointest Endosc 1987; 33:115-8. [PMID: 3494646 DOI: 10.1016/s0016-5107(87)71526-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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