By Karen E. Kim
Best specialists within the fields of gastroenterology, surgical procedure, and radiology comprehensively evaluation the pathophysiology, prognosis, administration, and therapy of acute bleeding problems of the GI tract. The authors holiday down acute bleeding into top and decrease GI tract assets and supply a differential analysis for every affliction, evidence-based algorithms for scientific perform, remedy modalities for its administration, and criteria of care. The authors define the various dilemmas confronted via physicians of their method of their sufferers, akin to localization of the bleeding resource (upper vs lower), the necessity and timing for emergency endoscopy, and the timing for radiologic intervention and/or surgical procedure.
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Extra resources for Acute Gastrointestinal Bleeding: Diagnosis and Treatment (Clinical Gastroenterology)
Associated lesions include aphthous lesions, inflammatory strictures, fistulae, polyps, and large ulcers. Although these lesions may bleed acutely, there are no reported cases of acute upper GI bleeding attributed to Crohn’s disease isolated to the esophagus, perhaps because of the exceedingly rare nature of this complication. Treatment with topical agents is often ineffective owing to the proximal distribution of the disease. Systemic immunomodulatory agents may be necessary to control Crohn’s disease of the esophagus.
Anireddy D, Timberlake G, Seibert D. Dieulafoy’s lesion of the esophagus. Gastrointest Endosc 1993; 39: 604. 94. Scheider DM, Barthel JS, King PD, Beale GD. Dieulafoy-like lesion of the distal esophagus. Am J Gastroenterol 1994; 89: 2080–2081. Chapter 2 / Nonvariceal Bleeding 33 95. Jaspersen D, Komer T, Schorr W, Brennenstuhl M, Hammar CH. Extragastric Dieulafoy’s disease as unusual source of intestinal bleeding. Esophageal visible vessel. Dig Dis Sci 1994; 39: 2558–2560. 96. Soetikno RM, Piper J, Montes H, Ukomadu C, Carr-Locke DL.
Esophageal bleeding is less common yet possible in bullous pemphigoid, a chronic disease characterized by bulla formation and circulating autoantibodies to the basement membrane. Corticosteroids are used in the management of all these disorders. Stricturing is possible, and dilation may be necessary (111,112). Esophagitis secondary to collagen vascular diseases has been reported, including Wegener’s granulomatosis and anticardiolipin antibody syndrome (113,114). Reflux esophagitis may complicate scleroderma owing to poor peristaltic activity of the esophageal smooth muscle and hypotension of the lower esophageal sphincter.