GI ischemia in patients with portal vein thrombosis: a prospective cohort study
| Autor: | Jildou Hoekstra, Ernst J. Kuipers, Harry La Janssen, Elisabeth P.C. Plompen, Jihan Harki, Désirée van Noord, Eric T.T.L. Tjwa |
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| Přispěvatelé: | Gastroenterology & Hepatology, Internal Medicine |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Cirrhosis Duodenum Ischemia Gastroenterology Cohort Studies Young Adult 03 medical and health sciences Mesenteric Veins 0302 clinical medicine Interquartile range Internal medicine Gastroscopy medicine Humans Radiology Nuclear Medicine and imaging Oximetry Prospective Studies Superior mesenteric vein Prospective cohort study Aged Venous Thrombosis Portal Vein business.industry Spectrum Analysis Stomach Middle Aged medicine.disease Thrombosis Abdominal Pain Surgery Portal vein thrombosis Gastrointestinal Tract Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11] Splenic vein Mesenteric Ischemia 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology business Colitis Ischemic human activities |
| Zdroj: | Gastrointestinal Endoscopy, 83, 627-36 Gastrointestinal Endoscopy, 83, 3, pp. 627-36 Gastrointestinal Endoscopy, 83(3), 627-636. Mosby Inc. |
| ISSN: | 1097-6779 0016-5107 |
| Popis: | Item does not contain fulltext BACKGROUND AND AIMS: GI ischemia is a concerning adverse event of portal vein thrombosis (PVT). Minimally invasive techniques, such as visible light spectroscopy (VLS), have greatly improved the ability to diagnose GI ischemia. The aim of this study was to assess the clinical presentation and characteristics of GI ischemia in patients with PVT. METHODS: Patients with noncirrhotic, nonmalignant PVT were included in this prospective cohort study. Clinical symptoms of GI ischemia were assessed by a structured questionnaire, VLS, and radiologic evaluation of the mesenteric vasculature. VLS measurements were compared with those in patients with cirrhosis and with a reference population. RESULTS: We included 15 patients with chronic PVT and 1 patient with acute PVT (median age 46.1 years [interquartile range [IQR], 30.9-53.7]; 44% male). Decreased mucosal oxygenation in at least 1 location of the GI tract was found in 12 patients (75%). Compared with the reference population (median 60.0 [IQR, 56.2-61.7]), VLS measurements were mostly decreased in the descending duodenum in patients with PVT (median 55.5 [IQR, 52.3-58.8]; P = .02) and patients with cirrhosis (median 52.0 [IQR, 46.5-54.0], P = .003). Symptoms typical for GI ischemia, such as postprandial pain and exercise-induced pain, were reported in 10 patients (63%) with PVT. In patients with extension of thrombosis into the superior mesenteric vein and splenic vein and/or presence of hypercoagulability, decreased VLS measurements were observed compared with historical control subjects. CONCLUSIONS: In patients with chronic PVT, GI ischemia is frequent. VLS enables objective and quantitative determination of GI mucosal ischemia. Onset of abdominal symptoms such as postprandial pain should prompt the physician to re-evaluate extent, cause, and treatment of PVT. |
| Databáze: | OpenAIRE |
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