消化道血管異常增生－消化道出血的疾病

Gastrointestinal Angiodysplasia - A Gastrointestinal Bleeding Disease

10.3966/168232812018062802005

蔡宛庭(Wan-Ting Tsai)；蘇培元(Pei-Yuan Su)；林益卿(I-Ching Lin)

消化道出血 ； 血管異常增生 ； 慢性貧血 ； angiodysplasia ； chronic anemia ； gastrointestinal bleeding

台灣家庭醫學雜誌

28卷2期（2018 / 06 / 01）

94 - 100

繁體中文

消化道血管異常增生(angiodysplasia)是造成老年病患消化道出血常見的原因之一。血管異常增生在消化道的任何部位都可能發生，其中，以大腸病灶最為常見，大部分的血管異常增生沒有症狀，但有些可能造成不同程度的貧血。由於大部分患者的症狀並不明顯，以致於診斷率較實際罹病率低。本文介紹一個81歲女性，十多年來反覆消化道出血及慢性貧血，此次因血便兩天而住院，經過多次胃鏡、大腸鏡及膠囊內視鏡、血管攝影等檢查，在小腸和大腸皆有看到血管異常增生；經過腎上腺素注射、氬離子電凝術(Argon plasma coagulation)、血管夾(hemoclip)、熱探針燒灼(heater probe)的治療，仍無法有效止血，甚至需要住進加護病房觀察、不斷輸血的個案，在接受thalidomide治療後，反覆消化道出血的狀況漸趨改善。本文將深入探討消化道血管異常增生的病生理學、流行病學、及其診斷與治療。期望藉由本文，提醒醫師臨床上遇到反覆性消化道出血的病人，應考慮消化道血管異常增生，熟悉各項診斷，以利後續的治療。

A major cause of gastrointestinal bleeding, especially in patients aged 60 and over, gaastrointestinal angiodysplasia can be found in any part of the gastrointestinal tract but often in colon. Most cases of gastrointestinal angiodysplasia remain asymptomatic, while some of them can cause gastrointestinal bleeding and anemia in variable severity. Endoscopy is usually the first choice of diagnosis of gastrointestinal angiodysplasia, and it can offer management at the same time. If lesions are located in small bowels or behind the folds in the gastrointestinal tract, endoscopy examination might be repeated in patients with negative finding but obscure gastrointestinal bleeding. This article presented the case of an 81-year-old woman who had intermittent and recurrent bloody stool for 2 days with underlying chronic anemia. The patient received repeated pan-endoscopy, colonoscopy, and wireless capsule endoscope and angiography for small bowel which showed distal ileum and cecalangiodysplasia. Treatment of endoscope with argon plasma coagulation and hemoclip were performed and the medication of thalidomide was prescribed after admission, resulting in the gradual relief of the symptom of recurrent gastrointestinal tract bleeding. The pathophysiology, epidemiology, risk factor, diagnosis and treatment of gastrointestinal angiodysplasia are discussed in this article.

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