High incidence of Dieulafoy's lesions in upper gastrointestinal bleeding associated with polyarteritis--clinical examination of patients of polyarteritis nodosa with rapidly progressive glomerulonephritis.
OBJECTIVE
Polyarteritis nodosa (PN) has been classified into polyarteritis (PA) and microscopic polyarteritis (MA) histologically. To clarify of the characteristics of upper gastrointestinal bleeding lesions in PN, we investigated the patients of PN with rapidly progressive glomerulonephritis (RPGN) presenting with upper gastrointestinal bleeding.


METHODS
The subjects of this study were 21 patients of PN with RPGN (PA: 11, MA: 10) who presented with upper gastrointestinal bleeding. The bleeding lesions and their locations were examined endoscopically in the study subjects, and the relationship of the bleeding to the severity of renal failure, the necessity of hemodialysis (HD), presence/ absence of H. pylori infection and the gender of the patients were analyzed.


RESULTS
The bleeding lesions were endoscopically identified as esophageal ulcers in 2 cases, gastric ulcers in 15 cases and duodenal ulcers in 4 cases, respectively. In 10 of the 15 cases with gastric ulcers, the ulcer assumed the form of Dieulafoy's lesions affecting the gastric body, and the underlying disease was PA in all the 10 cases. In the remaining 5 cases of gastric ulcers and 2 cases of esophageal ulcer with underlying MA or 4 cases of duodenal ulcers, in whom assumed the bleeding form of oozing from the marginal zone of ulcers. In all of the 4 cases of duodenal ulcers, and the 1 case with underlying PA and the other cases with MA, no correlation was found between the onset of the upper gastrointestinal bleeding and the severity of renal failure or the necessity for HD, presence of H. pylori infection, or the gender of the patients.


CONCLUSIONS
Dieulafoy's lesions are the most frequent sources of upper gastrointestinal bleeding in cases of PA.
Ohara
Tadashi
T
Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara-shi, Tochigi 329-2763, Japan. tohara@iuhw.ac.jp
Kanoh
Yuhsaku
Y
Taguma
Yoshio
Y
Hashimoto
Hiroshi
H
Suzuki
Hidekazu
H
Sakai
Yuji
Y
Kondo
Fukuo
F
Kameyama
Jin-ichi
J
Tani
Norio
N
Yoshino
Keiichi
K
Kitajima
Masaki
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001158:Arteries / Q000473:pathology; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000473:pathology; D004935:Esophageal Diseases / Q000175:diagnosis / Q000473:pathology; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply*; D005921:Glomerulonephritis / Q000175:diagnosis* / Q000473:pathology; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis* / Q000473:pathology; D010488:Polyarteritis Nodosa / Q000175:diagnosis* / Q000473:pathology; D014456:Ulcer / Q000175:diagnosis / Q000473:pathology