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Therapeutic barium enema for bleeding colonic diverticula:Four case series and review of the literature

World Journal of Gastroenterology 2008年第41期14卷 6413-6417页

作者： Jun-ichi Iwamoto Yuji Mizokami Koichi Shimokobe Takeshi Matsuoka Yasushi Matsuzaki Department of Gastroenterology Tokyo Medical University Kasumigaura Hospital Chuo 3-20-1 Ami Inashiki

The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.

关键词：灌肠剂结肠炎盲管渗漏症状

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Small-bowel mucosal injuries in low-dose aspirin users with obscure gastrointestinal bleeding

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World Journal of Gastroenterology 2014年第36期20卷 13133-13138页

作者： Junichi Iwamoto Yuji Mizokami Yoshifumi Saito Koichi Shimokobe Akira Honda Tadashi Ikegami Yasushi Matsuzaki Department of Gastroenterology Tokyo Medical University Ibaraki Medical Center Ibaraki 300-0395 Japan Department of Gastroenterology University of Tsukuba Ibaraki 305-8576 Japan

AIM: To investigate the clinical differences between small intestinal injuries in low-dose aspirin(LDA) users and in non-steroidal anti-inflammatory drug(NSAID) users who were examined by capsule endoscopy(CE) for obscure gastrointestinal bleeding(OGIB). METHODS: A total of 181 patients who underwent CE for OGIB were included in this study. Based on clinical records, laboratory data such as hemoglobin levels, major symptoms, underlying diseases, the types and duration of LDA and NSAID use, and endoscopic characteristics of CE were reviewed.RESULTS: Out of a total of 45 cases of erosive lesions, 27 cases were taking LDA or NSAIDs(7 were on NSAIDs, 9 were on LDA alone, 9 were on LDA and thienopyridine, and 2 were on LDA and warfarin).The prevalence of ulcers or erosion during chronic use of LDA, LDA and the anti-platelet drug thienopyridine (clopidogrel or ticlopidine), and NSAIDs were 64.3%, 80.0%, and 75.0%, respectively. Erosive lesions were observed predominantly in chronic LDA users, while ulcerative lesions were detected mainly in NSAID users. However, concomitant use of thienopyridine such as clopidogrel with LDA increased the proportion of ulcers. The erosive lesions were located in the whole of the small intestine(jejunum and ileum), whereas ulcerative lesions were mainly observed in the ileum(P < 0.05). CONCLUSION: Our CE findings indicate that chronic LDA users and NSAID users show different types and locations of small-bowel mucosal injuries. The concomitant use of anti-platelet drugs with LDA tends to exacerbate the injuries from LDA-type to NSAID-type injuries.

关键词： Non-steroidal anti-inflammatory drugs Lowdose aspi

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