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[Upper gastrointestinal bleeding secondary to Dieulafoy's lesion: differential features]

Fernando Borda Celaya1, Edurne Amorena Muro, Francisco Juanmartiñena Fernández

  • 1Servicio de Aparato Digestivo, Hospital de Navarra, Pamplona, Navarre, Spain. bordafernando@yahoo.es

Gastroenterologia Y Hepatologia
|June 24, 2008
PubMed

Insights

Dieulafoy's lesions (DL) present with more frequent active bleeding and gastric location compared to gastroduodenal ulcers. Higher comorbidity in DL patients contributes to increased mortality despite similar endoscopic treatment success.

Area of Science:

  • Gastroenterology
  • Endoscopy
  • Internal Medicine

Background:

  • Dieulafoy's lesion (DL) is a rare but significant cause of upper gastrointestinal bleeding.
  • Distinguishing DL from more common gastroduodenal ulcers is crucial for appropriate management.

Purpose of the Study:

  • To compare the clinical features and outcomes of upper gastrointestinal bleeding caused by Dieulafoy's lesions versus gastroduodenal ulcers.
  • To identify differential diagnostic and prognostic factors between these two conditions.

Main Methods:

  • A comparative study involving 31 patients with bleeding Dieulafoy's lesions and 31 with gastroduodenal ulcer bleeding.
  • Analysis of patient characteristics, bleeding patterns, clinical severity, diagnostic procedures, and treatment outcomes.
  • Application of univariate and multivariate statistical analyses.

Main Results:

  • Dieulafoy's lesions were associated with higher comorbidity rates (80% vs. 42%), predominantly gastric location (87% vs. 39%), and active bleeding during endoscopy (81% vs. 29%).
  • Diagnosis of DL required more gastroscopies (30% vs. 3.2%), and endoscopic treatment was necessary in a higher proportion of DL cases (97% vs. 39%).
  • Multivariate analysis confirmed gastric location, active bleeding, and comorbidity as significant predictors for DL.

Conclusions:

  • Dieulafoy's lesions exhibit distinct features including higher rates of active bleeding, gastric location, and patient comorbidity compared to gastroduodenal ulcers.
  • Diagnosis of DL can be challenging, often necessitating repeat endoscopies.
  • While endoscopic treatment success rates were similar, the higher mortality in DL patients is likely attributable to increased comorbidity and reduced bleeding tolerance.
Abstract

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