Related Experiment Videos
Colonic vascular ectasias and aortic stenosis: coincidence or causal relationship?
Insights
Aortic stenosis may cause gastrointestinal bleeding by altering arterial pulse waves in the colon. This study suggests vascular ectasias are linked to abnormal pulse patterns, not venous obstruction.
Area of Science:
- Cardiology
- Gastroenterology
- Vascular Medicine
Background:
- Gastrointestinal hemorrhage is a known complication in patients with aortic stenosis.
- The underlying mechanism for colonic vascular ectasias in these patients remains unclear.
- Previous hypotheses focused on venous outflow obstruction.
Purpose of the Study:
- To investigate the relationship between aortic stenosis and colonic vascular ectasias.
- To explore the role of arterial pulse wave abnormalities in the pathogenesis of gastrointestinal bleeding.
- To differentiate between arterial and venous causes of colonic vascular ectasias.
Main Methods:
- Evaluation of 11 patients with colonic vascular ectasias and gastrointestinal hemorrhage, all exhibiting aortic stenosis.
- Mesenteric vessel pulse wave analysis in two patients.
- Retrospective review of 3,623 patient records for gastrointestinal hemorrhage in conjunction with aortic or mitral stenosis.
Main Results:
- Abnormal peripheral pulse wave patterns associated with aortic stenosis were transmitted to the ileocolic artery.
- A significantly higher incidence of gastrointestinal hemorrhage was observed in patients with aortic stenosis (21/1,811) compared to mitral stenosis (1/1,812).
- The association between aortic stenosis and gastrointestinal hemorrhage was statistically significant (chi-square = 18, p < 0.001).
Conclusions:
- Colonic vascular ectasias and associated bleeding in patients with aortic stenosis are likely caused by pathological arterial inflow pulse wave abnormalities.
- Findings challenge the traditional hypothesis of chronic intermittent submucosal venous outflow obstruction.
- Arterial hemodynamics play a crucial role in the development of these vascular lesions.
Abstract:
Eleven patients with vascular ectasias of the colon and associated gastrointestinal hemorrhage were evaluated. All had the clinical features associated with aortic stenosis. In two patients, the configuration of the pulse wave in the mesenteric vessel was studied. In both, the abnormal peripheral pulse wave pattern associated with aortic stenosis was also transmitted to the ileocolic artery, where it differed quite clearly from the pattern in control patients. In a parallel study, the computer records of 3,623 patients with aortic or mitral stenosis admitted to the Mount Sinai Hospital over a 10 year period were reviewed for the presence of cryptogenic gastrointestinal hemorrhage. Twenty-one of 1,811 patients with aortic stenosis but only 1 of 1,812 patients with mitral stenosis had concomitant gastrointestinal hemorrhage (chi-square = 18, p less than 0.001). These data suggest that the cause of colonic vascular ectasias should be attributed to pathologic abnormalities of the arterial inflow pulse wave, rather than to chronic intermittent submucosal venous outflow obstruction.