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不明原因消化道出血的诊断和处理 被引量：13

Diagnosis and Management of Obscure Gastrointestinal Bleeding
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摘要 不明原因消化道出血（OGIB）的诊断和处理曾是内科医师和消化科医师面临的挑战.胶囊内镜和双气囊小肠镜检查的发展使OGIB的处理发生了根本的变革.本文讨论OGIB的病因、诊断检查手段和诊断处理流程.此外,对OGIB最常见的病因-血管发育不良采用联合激素、奥曲肽或沙利度胺等药物治疗也一并予以讨论. Obscure gastrointestinal bleeding （OGIB） has been the diagnostic and therapeutic challenge to internists and gastroenterologists. Development of capsule endoscopy and double-balloon enteroscopy has revolutionized the management of patients with OGIB. This article provides an overview of the etiology, diagnostic modalities and algorithm for management of OGIB. Furthermore, pharmacologic treatment of angiodysplasia, the most common cause of OGIB, with a combination of hormone, octreotide and thalidomide is also discussed.
作者 刘文忠
机构地区 上海交通大学医学院附属仁济医院消化内科 上海市消化疾病研究所
出处 《胃肠病学》 2010年第3期129-132,共4页 Chinese Journal of Gastroenterology
关键词 胃肠出血 诊断 胶囊内镜 双气囊小肠镜 血管发育不良 奥曲肽 沙立度胺 Gastrointestinal Hemorrhage Diagnosis Capsule endoscopy Double-Balloon Enteroscopy Angiodysplasia Octreotide Thalidomide
分类号 R57 [医药卫生—消化系统]
  • 相关文献

参考文献15

  • 1Shinozaki S, Yamamoto H, Yano T, et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol, 2010, 8 (2): 151-158.
  • 2Alexander JA, Leighton JA. Capsule endoscopy and balloon-assisted endoscopy: competing or complementary technologies in the evaluation of small bowel disease? Curt Opin Gastroenterol, 2009, 25 (5): 433-437.
  • 3Douard R, Wind P, Berger A, et al. Role of intraoperative enteroscopy in the management of obscure gastointestinal bleeding at the time of video-capsule endoscopy. Am J Surg, 2009, 198 (1): 6-11.
  • 4Fry LC, Bellutti M, Neumann H, et al. Incidence of bleeding lesions within reach of conventional upper and lower endoscopes in patients undergoing double-balloon enteroscopy for obscure gastrointestinal bleeding. Aliment Pharmacol Ther, 2009, 29 (3): 342-349.
  • 5Postgate A, Despott E, Burling D, et al. Significant small- bowel lesions detected by alternative diagnostic modalities after negative capsule endoscopy. Gastrointest Endosc, 2008, 68 (6): 1209-1214.
  • 6Viazis N, Papaxoinis K, Vlaehogiannakos J, et al. Is there a role for second-look capsule endoscopy in patients with obscure GI bleeding after a nondiagnostie first test? Gastrointest Endosc, 2009, 69 (4): 850-856.
  • 7Somsouk M, Gralnek IM, lnadomi JM. Management of obscure occult gastrointestinal bleeding: a cost- minimization analysis. Clin Gastroenterol Hepatol, 2008, 6 (6): 661-670.
  • 8Pasha SF, Leighton JA, Das A, et al. Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease: a meta-analysis. Clin Gastroenterol Hepatol, 2008, 6 (6): 671-676.
  • 9Raju GS, Gerson L, Das A, et al; American Gastroenterological Association. American Gastroenterologieal Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology, 2007, 133 (5): 1694-1696.
  • 10Gerson L, Kamal A. Cost-effectiveness analysis of management strategies for obscure GI bleeding. Gastrointest Endosc, 2008, 68 (5): 920-936.

二级参考文献10

  • 1Selby W. Can clinical features predict the likelihood of finding abnormalities when using capsule endoscopy in patients with GI bleeding of obscure origin? Gastrointest Endosc, 2004, 59: 782-787.
  • 2Gerson LB, Van Dam J. Wireless capsule endoscopy and double-balloon enteroscopy for the diagnosis of obscure gastrointestinal bleeding. Tech Vase Interv Radiol, 2004,7: 130-135.
  • 3Junquera F, Feu F, Papo M, Videla S, Armengol JR,Bordas JM, Saperas E, Pique JM, Malagelada JR. A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. Gastroenterology, 2001, 121: 1073- 1079.
  • 4Nordquist LT, Wallach PM. Octreotide for gastrointestinal bleeding of obscure origin in an anticoagulated patient.Dig Dis Sci, 2002, 47: 1514-1515.
  • 5D'Amato RJ, Loughnan MS, Flynn E, Folkman J.Thalidomide is an inhibitor of angiogenesis. Proc Natl Acad Sci U S A, 1994, 91: 4082-4085.
  • 6Junquera F, Saperas E, de Torres I, Vidal MT, Malagelada JR. Increased expression of angiogenic factors in human colonic angiodysplasia. Am J Gastroenterol, 1999, 94:1070-1076.
  • 7Ozawa CR, Banfi A, Glazer NL, Thurston G, Springer ML,Kraft PE, McDonald DM, Blau HM. Microenvironmental VEGF concentration, not total dose, determines a threshold between normal and aberrant angiogenesis. J Clin Invest, 2004, 113: 516-527.
  • 8Bauditz J, Schachschal G, Wedel S, Lochs H. Thalidomide for treatment of severe intestinal bleeding. Gut, 2004,53:609-612.
  • 9戈之铮,胡运彪,高云杰,萧树东.胶囊内镜的临床应用[J].中华消化杂志,2003,23(1):7-10. 被引量：98
  • 10戈之铮,胡运彪,萧树东.胶囊内镜与推进式小肠镜诊断不明原因消化道出血的评价[J].中华消化内镜杂志,2003,20(4):223-226. 被引量：87

共引文献10

同被引文献135

引证文献13

二级引证文献61

胃肠病学
2010年 第3期

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