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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Angiodysplasia is an important vascular lesion of the gut and a source of significant morbidity from bleeding. This lesion is probably responsible for approximately 6.0% of cases of lower gastrointestinal (GI) bleeding and 1.2-8.0% of cases of hemorrhage from the upper GI tract. Small bowel angiodysplasia accounts for 30-40% of cases of GI bleeding of obscure origin and represents the single most common cause for hemorrhage in this subset of patients. Lesions in the large bowel occur most often in the right colon. Their cause is unknown but most are probably acquired and the result of a degenerative process associated with aging. The incidence of colonic angiodysplasia among strictly asymptomatic individuals has never been determined and the natural history for these lesions is incompletely understood. Angiodysplasia in the upper GI tract occurs most often in the stomach and duodenum. When affected patients have been evaluated by colonoscopy concomitant lesions have been diagnosed in one-third of instances. Angiodysplasia has been purported to occur with higher frequency in patients with renal failure, von Willebrand's disease, aortic stenosis, cirrhosis, and pulmonary disease. Not all of these associations have been subjected to critical analysis, but available evidence does not support a strong relationship in most instances. Patients with bleeding angiodysplasia are occasionally treated with hormones or, more often, by endoscopic methods. Uncontrolled case studies have reported reduction or cessation of bleeding in subjects managed with conjugated estrogens. However, prospective randomized controlled trials assessing the efficacy of hormonal therapy are limited, and results from two trials conflict. Safety profiles for the endoscopic methods are acceptable, and reported efficacies are high, although not all methods have been extensively evaluated specifically for the treatment of angiodysplasia. Perforation of the right colon is a potential problem, especially for monopolar electrocoagulation and lasers.
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PMID:Angiodysplasia of the gastrointestinal tract. 825 4

Angiodysplasic lesions can be located anywhere in the gastrointestinal tract, but most of them are found in the cecum and right colon. Angiodysplasias are very infrequent in the stomach and small bowel. These lesions can be associated with several clinical conditions, such as certain coagulation disorders and liver diseases. We report the case of a diffuse gastrointestinal angiodysplasia in a female patient with idiopathic cirrhosis of the liver who developed a coagulopathy which mimicked von Willebrand disease. After repeated blood transfusions, which were not able to control the anemia of the patient, an antrectomy was performed because most lesions were located in the antrum. The procedure did not achieve a suitable control of the bleeding. Finally, a hormonal therapy combining estrogens and progestagens, was able to control, at least partially, the patient's chronic gastrointestinal bleeding.
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PMID:[Diffuse gastrointestinal angiodysplasia associated with cryptogenic hepatic cirrhosis and coagulopathy simulating von Willebrand disease]. 896 79

The aim of the present study was to draw an outline of the clinical epidemiology of bleeding gastrointestinal angiodysplasias. The study includes a report of a case and of our series of patients with bleeding gastrointestinal angiodysplasias admitted, between 1993 and 2003, to a ward of Internal Medicine where digestive endoscopy is also performed. A review of the literature is also provided. An 80-year-old cirrhotic woman with aortic stenosis, was referred to our Department because of anemia due to melena. In spite of 13 hospitalizations during which numerous diagnostic procedures including endoscopy, X-ray studies, arteriography, labeled red blood cells scanning and laparotomy with intraoperative ileoscopy, the site and nature of the bleeding lesion remained unidentified. Her red blood cell requirement progressively increased from 6 U in 1993 to 24 U in 1994 to 40 U as of September 1995. Enteroscopy disclosed duodeno-jejunal angiodysplasia. The patient subsequently received 35 additional red blood cell units during 7 new admissions. Between 1993 and 2003, 24 patients were identified. They were mainly women and their average age was 77 years. Angiodysplasias were localized in the large bowel in 92% of cases. Comorbidities included: heart disease (79%), chronic liver disease (29%) and chronic renal failure (21%). One fourth of patients were under anticoagulant drugs or had a hemostatic blood disorder. All patients received blood transfusions and endoscopic treatment was performed in approximately half of the cases. The most relevant updates are related to the pathogenic relationship between aortic stenosis, von Willebrand's disease and bleeding gastrointestinal angiodysplasias, the hemostatic alterations associated with liver cirrhosis or with chronic renal failure and the diagnosis and treatment of bleeding gastrointestinal angiodysplasias. A better understanding of the clinical epidemiology of bleeding gastrointestinal angiodysplasias may facilitate their diagnosis and contribute to an effective clinical management.
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PMID:[Bleeding gastrointestinal angiodysplasias: our experience and a review of the literature]. 1531 67

Classification of vascular abnormalities of the gastrointestinal tract on the basis of anatomy and pathophysiology has recently been suggested. Angiodysplasia, an example of an arteriovenous lesion, may cause either acute or chronic bleeding. Diagnosis may be difficult. High-quality standard endoscopy, capsule endoscopy, and double-balloon enteroscopy are most efficacious. Therapy using argon plasma coagulation is currently preferred. Pharmacological therapy has been employed, but a final conclusion about its efficacy cannot yet be drawn. Dieulafoy lesion, an arterial type of vascular abnormality, is rare but serious. It can be responsible for severe haemorrhage. Mechanical endoscopic methods are the most efficacious. Gastric antral vascular ectasia (GAVE), a capillary lesion, can be safely biopsied; it coincides with several diseases (including liver cirrhosis), may cause chronic iron-deficiency anaemia, and is best treated by argon plasma coagulation. Haemangiomas, benign neoplastic lesions, usually occur as part of other specific syndromes; they are difficult to manage due to the multiplicity and size of the lesions.
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PMID:Vascular lesions of the gastrointestinal tract. 1834 86