BACKGROUND Severe lower gastrointestinal bleeding(SLGIB)is a rare complication of Crohn's disease(CD).The treatment of these patients is a clinical challenge.Monoclonal anti-TNFαantibody(IFX)can induce relatively...BACKGROUND Severe lower gastrointestinal bleeding(SLGIB)is a rare complication of Crohn's disease(CD).The treatment of these patients is a clinical challenge.Monoclonal anti-TNFαantibody(IFX)can induce relatively fast mucosal healing.It has been reported for the treatment of SLGIB,but there are few reports on accelerated IFX induction in CD patients with SLGIB.CASE SUMMARY A 16-year-old boy with a history of recurrent oral ulcers for nearly 1 year presented to the Gastroenterology Department of our hospital complaining of recurrent periumbilical pain for more than 1 mo and having bloody stool 4 times within 2 wk.Colonoscopy showed multiple areas of inflammation of the colon and a sigmoid colon ulcer with active bleeding.Hemostasis was immediately performed under endoscopy.The physical examination of the patient showed scattered small ulcers in the lower lip of the mouth and small cracks in the perianal area.Combined with his medical history,physical examination,laboratory examinations with high C-reactive protein(CRP),platelet count(PLT),erythrocyte sedimentation rate(ESR)and fecal calprotectin levels,imaging examinations and pathology,a diagnosis of CD was taken into consideration.According to the pediatric CD activity index 47.5,methylprednisolone(40 mg QD)was given intravenously.The abdominal pain disappeared,and CRP,PLT,and ESR levels decreased significantly after the treatment.Unfortunately,he had a large amount of bloody stool again after 1 wk of methylprednisolone treatment,and his hemoglobin level decreased quickly.Although infliximab(IFX)(5 mg/kg)was given as a combination therapy regimen,he still had bloody stool with his hemoglobin level decreasing from 112 g/L to 80 g/L in a short time,so-called SLGIB.With informed consent,accelerated IFX(5 mg/kg)induction was given 7 days after initial presentation.The bleeding then stopped.Eight weeks after the treatment,repeat colonoscopy showed mucosal healing;thus far,no recurrent bleeding has occurred,and the patient is symptom-free.CONCLUSION This case highlights the importance of accelerated IFX induction in SLGIB secondary to CD,especially after steroid hormone treatment.展开更多
Objective To explore the incidence and risk factors of severe bleeding after percutaneous renal biopsy(PRB)in patients with advanced chronic kidney disease(CKD).Methods The study was a retrospective cohort analysis.Th...Objective To explore the incidence and risk factors of severe bleeding after percutaneous renal biopsy(PRB)in patients with advanced chronic kidney disease(CKD).Methods The study was a retrospective cohort analysis.The data were collected from patients with advanced CKD who were hospitalized in the Department of Nephrology,Nanfang Hospital,Southern Medical University and underwent PRB between January 2010 and December 2020.Severe bleeding after PRB was defined by any of thefollowingcriteria:a postoperativeehemoglobin decrease of≥20 g/L within 48 hours,a maximum diameter of perirenal hematoma≥5 cm postoperatively,or the need for posterior pituitary hormone,blood transfusion,or renal vascular intervention post-surgery.The occurrence of severe bleeding following PRB served as the primary endpoint for this study.Logistic regression model was used to analyze the risk factors associated with severebleeding in patients with advanced1CKD undergoing PRB.Results A total of 895 patients aged(46.1±14.1)years were encompassed in the study.Among them,60.1%(538/895)were male,15.9%(142/895)were afflicted with diabetes,and 57.9%(518/895)suffered from hypertension.The estimated glomerular filtration rate(eGFR)was(40.1±13.2)ml min=1.(1.73 m²)-1,and the 24-hour urine protein excretion was 2.5(1.1,4.9)g.After PRB,22.9%(205/895)of the patients encountered severe bleeding,including 30 patients(14.6%)who received postoperative somatostatin,10 patients(4.9%)who underwent postoperative blood transfusion,1 patient(0.5%)who underwent postoperative renal vascular intervention for hemostasis,and no fatalities occurred.Compared to the non-severe bleeding group,patients in the severe bleeding group after PRB exhibited a higher proportion of hypertension[64.4%(132/205)vs.55.9%(386/690),X=4.627,P=0.031].Additionally,preoperative serum creatinine levels and mean arterial pressure were significantly elevated[(193.9±106.6)μmol/L vs.(180.8±102.6)μmol/L,t=-2.559,P=0.011;(95.8±10.9)mmHg vs.(93.9±11.0)mmHg,t=-2.134,P=0.033].Furthermore,platelet counts were lower in the severe bleeding group[(227.5±70.3)×10/Lvs.(247.5±74.8)×10/L,t=-3.788,P<0.001].No statistically significant differences were observed between the two groups regarding age,gender distribution,prevalence of diabetes mellitus,as well as preoperative serum albumin level,hemoglobin concentration,other coagulation function indicators and pathological histological type(all P>0.05).Multivariate logistic regression analysis indicated that body mass index(OR=0.936,95%CI 0.891-0.984,P=0.010),eGFR(0R=0.985,95%CI 0.971-0.999,P=0.034),serum albumin level(0R=1.041,95%CI 1.011-1.072,P=0.007),24 hours urinary protein excretion(0R=1.092,95%CI 1.030-1.158,P=0.003),and platelet count(OR=0.996,95%CI 0.994-0.999,P=0.002)were independently associated with the severe bleeding following PRB in patients with advanced CKD.In the PRB cohort analyzed,the six most prevalent renal histological types were as follows:IgA nephropathy(46.3%,414/895),membranous nephropathy(11.1%,99/895),focal segmental glomerulosclerosis(8.5%,76/895),diabetic nephropathy(7.6%,68/895),sclerotic kidney disease(6.9%,62/895),and vascular sclerosis of the kidneys(4.9%,44/895).Conclusion Patients with advanced CKD exhibit a heightened risk of severe bleeding following PRB,estimated at approximately 22.9%.Independent risk factors for the occurrence of severe bleeding complications in these patients include low body mass index,reduced eGFR,decreased platelet count,elevated serum albumin,and increased urinary protein level.展开更多
Objective To analyze the diagnostic value of bedside capsule endoscopy in patients with acute or severeggastrointestinal bleeding.Methods Clinical data from patients who underwent bedside capsule endoscopy due to acut...Objective To analyze the diagnostic value of bedside capsule endoscopy in patients with acute or severeggastrointestinal bleeding.Methods Clinical data from patients who underwent bedside capsule endoscopy due to acute or severe suspected gastrointestinal bleeding in Nanfang Hospital,Southern Medical University from June 2018 to September 2021 were analyzed retrospectively.The efficacy of capsule endoscopy in detecting upper gastrointestinal tract and small intestinal bleeding was evaluated.Results A total of 74 patients underwent bedside capsule endoscopy for suspected acute or severe gastrointestinal bleeding.Five patients were excluded due to failure of examination due to retention of capsule endoscope in the gastric lumen,and 69 were included in the study,of whom 54 patients with a definitive diagnosis of gastrointestinal hemorrhage.The positive detection rate of the capsule endoscopy was 83.33%(45/54),including 17 cases of ulcer,5 cases of erosion,5 cases of vascular malformation,4 protrusion mass,4 diverticulum,5 obscure gastrointestinal bleeding,1 stenosis,1 active mucosal blood exudation,1 gastric retention,1 mucosal swelling,and 1 mucosal wrinkle change.The sensitivity and specificity of capsule endoscopy in the diagnosis of upper gastrointestinal bleeding were 92.31%(12/13)and 75.00%(3/4)respectively.The sensitivity and specificity of capsule endoscopy for diagnosing small intestinal bleeding were 80.49%(33/41)and 90.91%(10/11)respectively.Conclusion Bedside capsule endoscopy demonstrates high sensitivity and specificity in the diagnosis of gastrointestinal bleeding,showing potential advantages in bedside applications for acute and severe gastrointestinal bleeding.展开更多
基金Supported by National Natural Science Foundation of China,No.81873565 and No.82100605SJTU Trans-med Awards Research,No.20190104Star Program of Shanghai Jiaotong University,No.YG2021QN54.
文摘BACKGROUND Severe lower gastrointestinal bleeding(SLGIB)is a rare complication of Crohn's disease(CD).The treatment of these patients is a clinical challenge.Monoclonal anti-TNFαantibody(IFX)can induce relatively fast mucosal healing.It has been reported for the treatment of SLGIB,but there are few reports on accelerated IFX induction in CD patients with SLGIB.CASE SUMMARY A 16-year-old boy with a history of recurrent oral ulcers for nearly 1 year presented to the Gastroenterology Department of our hospital complaining of recurrent periumbilical pain for more than 1 mo and having bloody stool 4 times within 2 wk.Colonoscopy showed multiple areas of inflammation of the colon and a sigmoid colon ulcer with active bleeding.Hemostasis was immediately performed under endoscopy.The physical examination of the patient showed scattered small ulcers in the lower lip of the mouth and small cracks in the perianal area.Combined with his medical history,physical examination,laboratory examinations with high C-reactive protein(CRP),platelet count(PLT),erythrocyte sedimentation rate(ESR)and fecal calprotectin levels,imaging examinations and pathology,a diagnosis of CD was taken into consideration.According to the pediatric CD activity index 47.5,methylprednisolone(40 mg QD)was given intravenously.The abdominal pain disappeared,and CRP,PLT,and ESR levels decreased significantly after the treatment.Unfortunately,he had a large amount of bloody stool again after 1 wk of methylprednisolone treatment,and his hemoglobin level decreased quickly.Although infliximab(IFX)(5 mg/kg)was given as a combination therapy regimen,he still had bloody stool with his hemoglobin level decreasing from 112 g/L to 80 g/L in a short time,so-called SLGIB.With informed consent,accelerated IFX(5 mg/kg)induction was given 7 days after initial presentation.The bleeding then stopped.Eight weeks after the treatment,repeat colonoscopy showed mucosal healing;thus far,no recurrent bleeding has occurred,and the patient is symptom-free.CONCLUSION This case highlights the importance of accelerated IFX induction in SLGIB secondary to CD,especially after steroid hormone treatment.
文摘Objective To explore the incidence and risk factors of severe bleeding after percutaneous renal biopsy(PRB)in patients with advanced chronic kidney disease(CKD).Methods The study was a retrospective cohort analysis.The data were collected from patients with advanced CKD who were hospitalized in the Department of Nephrology,Nanfang Hospital,Southern Medical University and underwent PRB between January 2010 and December 2020.Severe bleeding after PRB was defined by any of thefollowingcriteria:a postoperativeehemoglobin decrease of≥20 g/L within 48 hours,a maximum diameter of perirenal hematoma≥5 cm postoperatively,or the need for posterior pituitary hormone,blood transfusion,or renal vascular intervention post-surgery.The occurrence of severe bleeding following PRB served as the primary endpoint for this study.Logistic regression model was used to analyze the risk factors associated with severebleeding in patients with advanced1CKD undergoing PRB.Results A total of 895 patients aged(46.1±14.1)years were encompassed in the study.Among them,60.1%(538/895)were male,15.9%(142/895)were afflicted with diabetes,and 57.9%(518/895)suffered from hypertension.The estimated glomerular filtration rate(eGFR)was(40.1±13.2)ml min=1.(1.73 m²)-1,and the 24-hour urine protein excretion was 2.5(1.1,4.9)g.After PRB,22.9%(205/895)of the patients encountered severe bleeding,including 30 patients(14.6%)who received postoperative somatostatin,10 patients(4.9%)who underwent postoperative blood transfusion,1 patient(0.5%)who underwent postoperative renal vascular intervention for hemostasis,and no fatalities occurred.Compared to the non-severe bleeding group,patients in the severe bleeding group after PRB exhibited a higher proportion of hypertension[64.4%(132/205)vs.55.9%(386/690),X=4.627,P=0.031].Additionally,preoperative serum creatinine levels and mean arterial pressure were significantly elevated[(193.9±106.6)μmol/L vs.(180.8±102.6)μmol/L,t=-2.559,P=0.011;(95.8±10.9)mmHg vs.(93.9±11.0)mmHg,t=-2.134,P=0.033].Furthermore,platelet counts were lower in the severe bleeding group[(227.5±70.3)×10/Lvs.(247.5±74.8)×10/L,t=-3.788,P<0.001].No statistically significant differences were observed between the two groups regarding age,gender distribution,prevalence of diabetes mellitus,as well as preoperative serum albumin level,hemoglobin concentration,other coagulation function indicators and pathological histological type(all P>0.05).Multivariate logistic regression analysis indicated that body mass index(OR=0.936,95%CI 0.891-0.984,P=0.010),eGFR(0R=0.985,95%CI 0.971-0.999,P=0.034),serum albumin level(0R=1.041,95%CI 1.011-1.072,P=0.007),24 hours urinary protein excretion(0R=1.092,95%CI 1.030-1.158,P=0.003),and platelet count(OR=0.996,95%CI 0.994-0.999,P=0.002)were independently associated with the severe bleeding following PRB in patients with advanced CKD.In the PRB cohort analyzed,the six most prevalent renal histological types were as follows:IgA nephropathy(46.3%,414/895),membranous nephropathy(11.1%,99/895),focal segmental glomerulosclerosis(8.5%,76/895),diabetic nephropathy(7.6%,68/895),sclerotic kidney disease(6.9%,62/895),and vascular sclerosis of the kidneys(4.9%,44/895).Conclusion Patients with advanced CKD exhibit a heightened risk of severe bleeding following PRB,estimated at approximately 22.9%.Independent risk factors for the occurrence of severe bleeding complications in these patients include low body mass index,reduced eGFR,decreased platelet count,elevated serum albumin,and increased urinary protein level.
文摘Objective To analyze the diagnostic value of bedside capsule endoscopy in patients with acute or severeggastrointestinal bleeding.Methods Clinical data from patients who underwent bedside capsule endoscopy due to acute or severe suspected gastrointestinal bleeding in Nanfang Hospital,Southern Medical University from June 2018 to September 2021 were analyzed retrospectively.The efficacy of capsule endoscopy in detecting upper gastrointestinal tract and small intestinal bleeding was evaluated.Results A total of 74 patients underwent bedside capsule endoscopy for suspected acute or severe gastrointestinal bleeding.Five patients were excluded due to failure of examination due to retention of capsule endoscope in the gastric lumen,and 69 were included in the study,of whom 54 patients with a definitive diagnosis of gastrointestinal hemorrhage.The positive detection rate of the capsule endoscopy was 83.33%(45/54),including 17 cases of ulcer,5 cases of erosion,5 cases of vascular malformation,4 protrusion mass,4 diverticulum,5 obscure gastrointestinal bleeding,1 stenosis,1 active mucosal blood exudation,1 gastric retention,1 mucosal swelling,and 1 mucosal wrinkle change.The sensitivity and specificity of capsule endoscopy in the diagnosis of upper gastrointestinal bleeding were 92.31%(12/13)and 75.00%(3/4)respectively.The sensitivity and specificity of capsule endoscopy for diagnosing small intestinal bleeding were 80.49%(33/41)and 90.91%(10/11)respectively.Conclusion Bedside capsule endoscopy demonstrates high sensitivity and specificity in the diagnosis of gastrointestinal bleeding,showing potential advantages in bedside applications for acute and severe gastrointestinal bleeding.
