AIM: To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy(PHG) based on a systematic literature review.METHODS: Computerized search of the literature ...AIM: To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy(PHG) based on a systematic literature review.METHODS: Computerized search of the literature was performed via Pub Med using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS: PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG.PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healin展开更多
目的系统评价4种临床常用蛇毒血凝酶联合质子泵抑制剂(PPI)在非静脉曲张性上消化道出血(NVUGIB)治疗中止血效果及安全性的差异,为临床决策提供循证依据。方法计算机检索PubMed、Web of Science、万方数据、维普网、中国知网数据库中关...目的系统评价4种临床常用蛇毒血凝酶联合质子泵抑制剂(PPI)在非静脉曲张性上消化道出血(NVUGIB)治疗中止血效果及安全性的差异,为临床决策提供循证依据。方法计算机检索PubMed、Web of Science、万方数据、维普网、中国知网数据库中关于白眉蛇毒血凝酶、尖吻蝮蛇血凝酶、蛇毒血凝酶、矛头蝮蛇血凝酶联合PPI治疗NVUGIB的随机对照试验(RCT)或队列研究,检索时间为建库起至2021年12月;由2位研究人员独立筛选文献、提取资料并评价纳入文献质量后,运用ADDIS 1.16.8软件进行贝叶斯网状Meta分析。结果共纳入33项研究,共计3602例患者。网状Meta分析结果显示:在止血有效率方面,与PPI单药治疗比较,4种蛇毒血凝酶类止血药物联合PPI均可显著提高患者的止血有效率(P<0.05);但不同蛇毒血凝酶类止血药物两两比较,差异均无统计学意义(P>0.05);网状Meta分析的最佳概率排序为白眉蛇毒血凝酶联合PPI>矛头蝮蛇血凝酶联合PPI>尖吻蝮蛇血凝酶联合PPI>蛇毒血凝酶联合PPI>PPI单药治疗。在不良反应发生率方面,与PPI单药治疗比较,4种不同蛇毒血凝酶类止血药物联合PPI治疗的不良反应发生率差异无统计学意义(P>0.05),且不同蛇毒血凝酶类止血药物两两比较,差异亦无统计学意义(P>0.05);网状Meta分析的最佳概率排序为蛇毒血凝酶联合PPI>矛头蝮蛇血凝酶联合PPI>白眉蛇毒血凝酶联合PPI>尖吻蝮蛇血凝酶联合PPI>PPI单药治疗。结论与PPI单药治疗相比,4种不同来源的蛇毒血凝酶类止血药物联合PPI用于NVUGIB的疗效更佳,且安全性相当;不同蛇毒血凝酶类止血药物的止血效果、安全性无明显差异。展开更多
目的:探讨急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)Rockall评分高危患者行急诊内镜的诊疗价值.方法:对2011-08/2013-12山西煤炭中心医院消化内科55例ANVUGIB Rockall评分高危患者的...目的:探讨急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)Rockall评分高危患者行急诊内镜的诊疗价值.方法:对2011-08/2013-12山西煤炭中心医院消化内科55例ANVUGIB Rockall评分高危患者的临床资料、治疗方法及治疗结果作回顾性分析研究,其中出血后24-48 h内行急诊内镜检查患者30例,出血后3-5 d行内镜检查患者25例,比较行急诊内镜组与非急诊内镜组的病因检出率、住院花费、住院时间、输血量、死亡率等指标.结果:急诊内镜组与非急诊内镜组的出血病因构成差异无统计学意义(P>0.05);急诊内镜组病因确诊率高于非急诊内镜组(93.33%vs 56.00%)(P=0.001<0.01);急诊内镜组住院时间和住院费用及输血量显著低于非急诊内镜组(10.0 d±6.7 d vs 16.4 d±7.3 d,13034.4元±9967.2元vs 14110.2元±9780.8元,1180.7 m L±634.7 m L vs 1420 m L±725.9 m L)(P<0.05);急诊内镜组死亡率低于非急诊内镜组(6.67%vs 12.00%)(P>0.05).结论:对于ANVUGIB Rockall评分高危患者,行急诊内镜检查虽不能明显降低其死亡率,但可以显著改善其医疗过程,有利于临床,其优势尚待大样本的临床研究.展开更多
文摘AIM: To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy(PHG) based on a systematic literature review.METHODS: Computerized search of the literature was performed via Pub Med using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS: PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG.PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healin
文摘目的系统评价4种临床常用蛇毒血凝酶联合质子泵抑制剂(PPI)在非静脉曲张性上消化道出血(NVUGIB)治疗中止血效果及安全性的差异,为临床决策提供循证依据。方法计算机检索PubMed、Web of Science、万方数据、维普网、中国知网数据库中关于白眉蛇毒血凝酶、尖吻蝮蛇血凝酶、蛇毒血凝酶、矛头蝮蛇血凝酶联合PPI治疗NVUGIB的随机对照试验(RCT)或队列研究,检索时间为建库起至2021年12月;由2位研究人员独立筛选文献、提取资料并评价纳入文献质量后,运用ADDIS 1.16.8软件进行贝叶斯网状Meta分析。结果共纳入33项研究,共计3602例患者。网状Meta分析结果显示:在止血有效率方面,与PPI单药治疗比较,4种蛇毒血凝酶类止血药物联合PPI均可显著提高患者的止血有效率(P<0.05);但不同蛇毒血凝酶类止血药物两两比较,差异均无统计学意义(P>0.05);网状Meta分析的最佳概率排序为白眉蛇毒血凝酶联合PPI>矛头蝮蛇血凝酶联合PPI>尖吻蝮蛇血凝酶联合PPI>蛇毒血凝酶联合PPI>PPI单药治疗。在不良反应发生率方面,与PPI单药治疗比较,4种不同蛇毒血凝酶类止血药物联合PPI治疗的不良反应发生率差异无统计学意义(P>0.05),且不同蛇毒血凝酶类止血药物两两比较,差异亦无统计学意义(P>0.05);网状Meta分析的最佳概率排序为蛇毒血凝酶联合PPI>矛头蝮蛇血凝酶联合PPI>白眉蛇毒血凝酶联合PPI>尖吻蝮蛇血凝酶联合PPI>PPI单药治疗。结论与PPI单药治疗相比,4种不同来源的蛇毒血凝酶类止血药物联合PPI用于NVUGIB的疗效更佳,且安全性相当;不同蛇毒血凝酶类止血药物的止血效果、安全性无明显差异。
文摘目的:探讨急性非静脉曲张性上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANVUGIB)Rockall评分高危患者行急诊内镜的诊疗价值.方法:对2011-08/2013-12山西煤炭中心医院消化内科55例ANVUGIB Rockall评分高危患者的临床资料、治疗方法及治疗结果作回顾性分析研究,其中出血后24-48 h内行急诊内镜检查患者30例,出血后3-5 d行内镜检查患者25例,比较行急诊内镜组与非急诊内镜组的病因检出率、住院花费、住院时间、输血量、死亡率等指标.结果:急诊内镜组与非急诊内镜组的出血病因构成差异无统计学意义(P>0.05);急诊内镜组病因确诊率高于非急诊内镜组(93.33%vs 56.00%)(P=0.001<0.01);急诊内镜组住院时间和住院费用及输血量显著低于非急诊内镜组(10.0 d±6.7 d vs 16.4 d±7.3 d,13034.4元±9967.2元vs 14110.2元±9780.8元,1180.7 m L±634.7 m L vs 1420 m L±725.9 m L)(P<0.05);急诊内镜组死亡率低于非急诊内镜组(6.67%vs 12.00%)(P>0.05).结论:对于ANVUGIB Rockall评分高危患者,行急诊内镜检查虽不能明显降低其死亡率,但可以显著改善其医疗过程,有利于临床,其优势尚待大样本的临床研究.
