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Infección bacteriana en la patogénesis de la hemorragia variceal
J Goulis1, D Patch, A K Burroughs
1Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, London, UK.
Lancet (London, England)
|February 19, 1999
Resumen
Las infecciones bacterianas pueden desencadenar sangrado variceal potencialmente mortal en pacientes con cirrosis. Las endotoxinas de las infecciones aumentan la presión del portal y perjudican la función plaquetaria, lo que lleva a la hemorragia.
Área de la Ciencia:
- Gastroenterología y Gastroenterología.
- Hepatología Hepatología.
- Medicina interna es la medicina interna de las enfermedades.
Sus antecedentes:
- El sangrado variceal es una complicación grave de la cirrosis.
- Predecir el inicio de la hemorragia variceal sigue siendo un desafío.
- Los factores de riesgo existentes no explican completamente los eventos de sangrado impredecibles.
Objetivo del estudio:
- Para investigar el papel de las infecciones bacterianas como desencadenante de la hemorragia variceal.
- Aclarar los mecanismos fisiopatológicos que vinculan la infección bacteriana con el sangrado variceal.
Principales métodos:
- El estudio propone una hipótesis mecanicista que implica la liberación de endotoxinas durante las infecciones bacterianas.
- El mecanismo propuesto implica un aumento de la presión del portal y un deterioro de la hemostasis.
Principales resultados:
- Las infecciones bacterianas liberan endotoxinas, aumentando la presión del portal a través de los productos de la endotelina y la ciclooxigenasa.
- La endotoxina y la endotelina inducen el óxido nítrico y la prostaciclina, inhibiendo la agregación plaquetaria.
- Se supone que este doble efecto de aumento de la presión portal y deterioro de la hemostasis causa sangrado variceal.
Conclusiones:
- Las infecciones bacterianas se postulan como un desencadenante crítico para el sangrado variceal en la cirrosis.
- El mecanismo propuesto implica una compleja interacción de cambios hemodinámicos y hemostáticos.
- La comprensión de este mecanismo puede conducir a nuevas estrategias para prevenir la hemorragia variceal.
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