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Gastrointestinal ischemia

Taina Nykänen, Erno Peltola, Leena Kylänpää, Marianne Udd
PURPOSE: To evaluate the safety, efficacy, and feasibility of transcatheter arterial embolization (TAE) in the treatment of lower gastrointestinal bleeding (LGIB). METHODS: Study group comprised all patients receiving angiography for LGIB in the Helsinki University Hospital during the period of 2004-2016. Hospital medical records provided the study data. Rebleeding, complication, and mortality rates (≤ 30 days) were the primary outcomes. Secondary outcomes included need for blood transfusions, durations of intensive care unit and hospital admissions, incidence of delayed rebleeding, and long-term complications, as well as overall survival...
March 16, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Louisa J D van Dijk, Leon M G Moons, Desirée van Noord, Adriaan Moelker, Hence J M Verhagen, Marco J Bruno, Ellen V Rouwet
OBJECTIVE: An isolated stenosis of the celiac artery (CA) or the superior mesenteric artery (SMA) is frequently detected in patients with abdominal complaints. The dilemma is whether these patients suffer from chronic mesenteric ischemia (CMI) and whether they will benefit from revascularization. We evaluated the long-term clinical success rates for single CA or SMA revascularization in patients with gastrointestinal symptoms and confirmed mucosal ischemia. METHODS: This was a retrospective cohort analysis of 59 consecutive patients with gastrointestinal symptoms and a single atherosclerotic mesenteric artery stenosis who were referred to our tertiary care institution between 2006 and 2010 for standardized diagnostic workup of CMI, including measurement of mucosal ischemia with visible light spectroscopy or gastric-jejunal tonometry...
March 6, 2018: Journal of Vascular Surgery
Ashish Joshi, Sushil Falodia, Naveen Kumar, R L Solanki
Strictures of the small intestine have been attributed many causes of Crohn's disease, nonsteroidal anti-inflammatory drugs, neoplastic, post-surgical, and corrosive ingestion. Opium as a cause of small intestine strictures has not been described. Six cases of opium addicts diagnosed with small intestine strictures were selected after excluding the possible etiology of strictures. Investigations like upper gastrointestinal endoscopy, colonoscopy (in patients with small intestinal obstruction), barium meal follow-through, and histopathology of strictures were done in all patients...
March 7, 2018: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Tadashi Tsubouchi, Takeshi Kunimatsu, Shinji Tsujimoto, Akihiko Kiyoshi, Yasunori Katsura, Seiko Oku, Kazuhiro Chihara, Yukiko Mine, Toru Yamada, Isao Shimizu, Kiyoko Bando
The pharmacological activity of DSP-6952, a novel compound was investigated, compared to that of clinically efficacious gastrointestinal (GI) prokinetic 5-hydroxytryptamine4 (5-HT4 ) receptor agonists. DSP-6952 had a strong affinity of Ki=51.9nM for 5-HT4(b) receptor, and produced contraction in the isolated guinea pig colon with EC50 of 271.6nM and low intrinsic activity of 57%, similar to tegaserod and mosapride. In the development of the 5-HT4 receptor agonists, cardiovascular risk was deliberately evaluated, because some related prokinetics were reported to cause with cardiovascular adverse events, such as ventricular arrhythmias or ischemia...
March 1, 2018: European Journal of Pharmacology
Hiroshi Kawakami, Tesshin Ban, Yoshimasa Kubota
Hepatic portal venous gas (HPVG) is caused by gastrointestinal (GI) mucosal damage alone or in combination with bowel distension, sepsis, and invasion by gas-producing bacteria. The most common cause is mesenteric ischemia associated with bowel necrosis. Iatrogenic HPVG is a rare condition that occurs following various endoscopic procedures 1 . Herein, we present an unusual case of HPVG following balloon endoscopy (BE). This article is protected by copyright. All rights reserved.
February 17, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Eduardo Peña-Mercado, Mario Garcia-Lorenzana, Elena Arechaga-Ocampo, Claudia H González-De la Rosa, Nohra E Beltran
Gastrointestinal ischemia/reperfusion (I/R) generates pathological alterations that could lead to death. Early ischemic damage markers could be used to guide therapy and improve outcomes. AIM: To relate hypoxia-inducible factor 1α (HIF-1α) activation and inducible nitric oxide synthase (iNOS) expression to gastric impedance changes due to I/R damage. METHODS: Experimental animals were randomly distributed into 3 groups: control, ischemia (30 min) and I/R (60 min)...
February 16, 2018: Histology and Histopathology
P Copin, M Zins, A Nuzzo, Y Purcell, S Beranger-Gibert, L Maggiori, O Corcos, V Vilgrain, M Ronot
Acute mesenteric ischemia is defined as an inadequate blood supply to the gastrointestinal tract resulting in ischemic and inflammatory injury that may progress to necrosis of the bowel wall. Prognosis is poor with a mortality rate greater than 95% without treatment, dropping to around 70% when surgical treatment is performed. Contrast-enhanced computed tomography (CT) has become the cornerstone of the diagnosis by showing features of vascular disorders (occlusion and/or insufficient blood supply) and features of intestinal ischemic injury...
February 9, 2018: Diagnostic and Interventional Imaging
Rafael Struck, Maria Wittmann, Stefan Müller, Patrick Meybohm, Andreas Müller, Soyhan Bagci
OBJECTIVE: Cardiopulmonary bypass (CPB) surgery commonly threatens the heart and remote organs with ischemia-reperfusion injury. Transient episodes of ischemia to nonvital tissue, known as remote ischemic preconditioning (RIPC), is thought to help local and remote vital organs to withstand subsequent ischemic insults. DESIGN: Prospective, randomized, double-blinded control trial. SETTING: Tertiary referral academic teaching hospital. PARTICIPANTS: Thirty patients undergoing elective CPB surgery INTERVENTION: RIPC was achieved via three 5-minute cycles of upper limb ischemia using a blood pressure cuff or control (sham cuff)...
July 27, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Stephanie Carvalho Borges, Paulo Emílio Botura Ferreira, Luisa Mota da Silva, Maria Fernanda de Paula Werner, Juan Manuel Irache, Osvaldo Albuquerque Cavalcanti, Nilza Cristina Buttow
The gastrointestinal tract is extremely sensitive to ischemia and reperfusion (I/R). Studies have reported that resveratrol (RSV) is able to combat damage caused by intestinal I/R. Because of its effectiveness in increasing the permanence and bioavailability of resveratrol in the intestinal epithelium, we investigated whether the effect of resveratrol-loaded in poly(anhydride) nanoparticles reduce oxidative stress and promote myenteric neuroprotection in the ileum of rats subjected to I/R. Physicochemical evaluations were performed on nanoparticles...
February 7, 2018: Toxicology
Michael Fricker, Bridie J Goggins, Sean Mateer, Bernadette Jones, Richard Y Kim, Shaan L Gellatly, Andrew G Jarnicki, Nicholas Powell, Brian G Oliver, Graham Radford-Smith, Nicholas J Talley, Marjorie M Walker, Simon Keely, Philip M Hansbro
Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract (GIT). Cigarette smoke (CS) exposure and chronic obstructive pulmonary disease (COPD) are risk factors for CD, although the mechanisms involved are poorly understood. We employed a mouse model of CS-induced experimental COPD and clinical studies to examine these mechanisms. Concurrent with the development of pulmonary pathology and impaired gas exchange, CS-exposed mice developed CD-associated pathology in the colon and ileum, including gut mucosal tissue hypoxia, HIF-2 stabilization, inflammation, increased microvasculature, epithelial cell turnover, and decreased intestinal barrier function...
February 8, 2018: JCI Insight
Zhong Xing Shi, Jing Yang, Hong Wei Liang, Zhen Hua Cai, Bin Bai
To evaluate the different arteriographic manifestations of acute arterial massive hemorrhage of the gastrointestinal (GI) tract and the efficacy of emergency transcatheter arterial embolization (ETAE).A total of 88 patients with acute massive GI bleeding who experienced failure of initial endoscopy and/or conservative treatment were referred to our interventional department for acute GI arteriography from January 2007 to June 2015. After locating the source of bleeding, appropriate embolic agents, such as spring coil, hydroxyl methyl acrylic acid gelatin microspheres, polyvinyl alcohol (PVA) particles, etc...
December 2017: Medicine (Baltimore)
Bodil Ohlsson, Rita Gustafsson, Fredrik Swahn, Ervin Toth, Béla Veress, Henrik Thorlacius
Gastrointestinal complaints without obvious organic causes confirmed by clinical laboratory analyses, endoscopy or radiology are often referred to functional entities. Irritable bowel syndrome (IBS) is the most common functional disorder in the gut. Careful examination of these patients may reveal other diagnoses of defined etiologies, e.g., enteric neuropathy, microscopic colitis, and primary Sjögre's syndrome. The present case describes a young patient with incapacitating gastrointestinal symptoms presumed to be IBS, who underwent endoscopic full-thickness biopsy in sigmoid colon...
2018: Therapeutic Advances in Gastroenterology
Nina A Hilkens, Ale Algra, L Jaap Kappelle, Philip M Bath, László Csiba, Peter M Rothwell, Jacoba P Greving
OBJECTIVE: To study the early time course of major bleeding and its subtypes in patients with cerebral ischemia on dual and single antiplatelet therapy. METHODS: We performed a post hoc analysis on individual patient data from 6 randomized clinical trials (Clopidogrel Versus Aspirin in Patients at Risk of Ischaemic Events [CAPRIE], Second European Stroke Prevention Study [ESPS-2], Management of Atherothrombosis With Clopidogrel in High-Risk Patients [MATCH], Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance [CHARISMA], European/Australasian Stroke Prevention in Reversible Ischaemia Trial [ESPRIT], and Prevention Regimen for Effectively Avoiding Second Strokes [PRoFESS]) including 45,195 patients with a TIA or noncardioembolic ischemic stroke...
February 20, 2018: Neurology
Joerg C Schefold, Anders Perner, Theis Lange, Jørn Wetterslev, Matt P Wise, Mark Borthwick, Stepani Bendel, Frederik Keus, Anne Berit Guttormsen, Søren Marker, Mette Krag, Morten Hylander Møller
BACKGROUND: Proton pump inhibitors are often used in critically ill patients to prevent gastrointestinal bleeding despite limited evidence for benefit. Patients with acute kidney injury requiring renal replacement therapy (RRT) are at high risk of gastrointestinal bleeding as (pre-)uremia induces coagulopathy through effects on platelets and coagulation cascades. No high-quality randomized clinical trials have previously assessed the benefits and harms of prophylactic proton pump inhibitor use in this high-risk population of adult critically ill patients...
January 10, 2018: Trials
Ling Cheng, Ruifeng Zhao, Di Guo, Kailin Cai, Kaifang Zou, Jun Yang, Liangru Zhu
RATIONALE: Inferior mesenteric arteriovenous fistula (IMAVF) is a rare condition principally characterized by portal hypertension and ischemic bowel disease. Up to now, only 30 cases have been reported. Presented here is an IMAVF patient with nonpulsatile abdominal mass as the main manifestation. PATIENT CONCERNS: A 62-year-old Chinese male who complained of abdominal discomfort for a month was admitted to our hospital. Physical examination revealed a hard and hardly mobile mass...
December 2017: Medicine (Baltimore)
Angel Mier Hicks, Antonio DeRosa, Michael Raj, Richard Do, Kenneth H Yu, Maeve A Lowery, Anna Varghese, Eileen M O'Reilly
Within gastrointestinal malignancies, primary hepatocellular carcinoma and pancreatic ductal adenocarcinoma (PDAC) are frequently associated with visceral thromboses (VT). Thrombus formation in the portal (PVT), mesenteric (MVT), or splenic vein (SVT) system leads to portal hypertension and intestinal ischemia. VT in PDAC may convey a risk of increased distal thrombosis and poses therapeutic uncertainty regarding the role of anticoagulation. An increasing number of reports describe VT associated with PDAC. It is possible that early diagnosis of these events may help reduce morbidity and speculatively improve oncologic outcomes...
December 12, 2017: Clinical Colorectal Cancer
Ioannis Mantzoros, Natalia Antigoni Savvala, Orestis Ioannidis, Styliani Parpoudi, Lydia Loutzidou, Despoina Kyriakidou, Angeliki Cheva, Vasileios Intzos, Konstantinos Tsalis
Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors, commonly called carcinoids, account for about 2/3 of all neuroendocrine tumors, they are relatively rare. Small intestine neuroendocrine tumors originate from intestinal enterochromaffin cells and represent about 1/4 of small intestine neoplasms. They can be asymptomatic or cause nonspecific symptoms, which usually leads to a delayed diagnosis...
December 7, 2017: World Journal of Gastroenterology: WJG
Fabio V Lima, Dhaval Kolte, Kevin F Kennedy, David W Louis, J Dawn Abbott, Peter A Soukas, Omar N Hyder, Shafiq T Mamdani, Herbert D Aronow
OBJECTIVES: This study sought to compare in-hospital major adverse cardiac and cerebrovascular events (MACCE) following endovascular therapy with open surgery for chronic mesenteric ischemia (CMI). BACKGROUND: There are limited contemporary data on in-hospital cardiovascular outcomes among patients with CMI undergoing revascularization via endovascular therapy versus open surgery in the United States. METHODS: Patients with CMI undergoing endovascular or surgical (mesenteric bypass or endarterectomy) revascularization between 2007 and 2014 were identified from the National Inpatient Sample...
December 11, 2017: JACC. Cardiovascular Interventions
Min Xu, Xiaoli Zhu, Yizhi Liu, Zhi Li, Tianzhi An, Tianpeng Jiang, Jie Song, Lizhou Wang, Shi Zhou, Caifang Ni
BACKGROUND: To investigate the safety and effectiveness of Fuaile medical adhesive (FAL) with superselective catheterization in endovascular embolotherapy for the treatment of gastrointestinal hemorrhage (GIH) that was unresponsive to internal medicine treatment and gastroscopy management. METHODS: A total of 25 patients with GIH, confirmed using angiography but with failed results after internal medicine treatment or gastroscopy were retrospectively analyzed. A mixture of lipiodol and FAL (1:1) was used to embolize the bleeding vessels...
November 30, 2017: Journal of the Chinese Medical Association: JCMA
Cristiano Cremone, Anouk Esch, Charlotte Gagniere, Alessandro Fugazza, Faria Mesli, Michael Levy, Aurelien Amiot, Alexis Laurent, Yann LeBaleur, Francois Hemery, Nicolas De'Angelis, Francesco Brunetti, Iradj Sobhani
Background and study aims:  Urgent endoscopy is often used to diagnose and sometimes treat acute upper gastrointestinal syndromes (hemorrhage, toxic ingestion, and occlusion). However, its suitability concerning the management of lower gastrointestinal conditions in emergency circumstances is controversial. Patients and methods:  We studied the role of emergency colonoscopy in diagnosis and treatment of all consecutive patients presenting with acute lower gastrointestinal symptoms referred to our hospital on an emergency basis...
November 2017: Endoscopy International Open
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