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Chapter 6 - Gastrointestinal Ischemia and Vascular Disorders

Published online by Cambridge University Press:  06 June 2020

By
Romulo Celli  and
Xuchen Zhang
Edited by
Roger M. Feakins
Roger M. Feakins
Affiliation:
Royal Free London NHS Foundation Trust, London, UK
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Summary

An ever increasing number of drugs are known to cause gastrointestinal injury. The histological features are often non-specific and a single drug can induce many different patterns, necessitating close collaboration between pathologists and clinicians to reach a correct diagnosis. However, there may be some histological clues that are helpful in the diagnosis of drug-induced injury.

Keywords

gastrointestinal tractdrug-inducedNSAID-injuryiatrogenic injurymedication-induced side-effectsenteropathycolitischemotherapy
Type
Chapter
Information
Non-Neoplastic Pathology of the Gastrointestinal Tract
A Practical Guide to Biopsy Diagnosis
 , pp. 84 - 101
Publisher: Cambridge University Press
Print publication year: 2020

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References

Gurvits, GE. Black esophagus: acute esophageal necrosis syndrome. World J Gastroenterol. 2010;16(26):3219–25.Google Scholar
Gurvits, GE, Shapsis, A, Lau, N, Gualtieri, N, Robilotti, JG. Acute esophageal necrosis: a rare syndrome. J Gastroenterol. 2007;42(1):29–38.CrossRefGoogle ScholarPubMed
Altenburger, DL, Wagner, AS, Li, S, Garavaglia, J. A case of black esophagus with histopathologic description and characterization. Arch Pathol Lab Med. 2011;135(6):797–8.Google Scholar
Grudell, AB, Mueller, PS, Viggiano, TR. Black esophagus: report of six cases and review of the literature, 1963–2003. Dis Esophagus. 2006;19(2):105–10.CrossRefGoogle ScholarPubMed
Tang, SJ, Daram, SR, Wu, R, Bhaijee, F. Pathogenesis, diagnosis, and management of gastric ischemia. Clin Gastroenterol Hepatol. 2014;12(2):246–52.CrossRefGoogle ScholarPubMed
Somin, M, Korotinski, S, Attali, M, Franz, A, Weinmann, EE, Malnick, SD. Three cases of chronic mesenteric ischemia presenting as abdominal pain and Helicobacter pylori-negative gastric ulcer. Dig Dis Sci. 2004;49(11–12):1990–5.CrossRefGoogle ScholarPubMed
Herman, J, Chavalitdhamrong, D, Jensen, DM, Cortina, G, Manuyakorn, A, Jutabha, R. The significance of gastric and duodenal histological ischemia reported on endoscopic biopsy. Endoscopy. 2011;43(4):365–8.Google Scholar
Force, T, MacDonald, D, Eade, OE, Doane, C, Krawitt, EL. Ischemic gastritis and duodenitis. Dig Dis Sci. 1980;25(4):307–10.CrossRefGoogle ScholarPubMed
Cherry, RD, Jabbari, M, Goresky, CA, Herba, M, Reich, D, Blundell, PE. Chronic mesenteric vascular insufficiency with gastric ulceration. Gastroenterology. 1986;91(6):1548–52.Google Scholar
McKinsey, JF, Gewertz, BL. Acute mesenteric ischemia. Surg Clin North Am. 1997;77(2):307–18.Google Scholar
Cudnik, MT, Darbha, S, Jones, J, Macedo, J, Stockton, SW, Hiestand, BC. The diagnosis of acute mesenteric ischemia: a systematic review and meta-analysis. Acad Emerg Med. 2013;20(11):1087–100.Google Scholar
Reinus, JF, Brandt, LJ, Boley, SJ. Ischemic diseases of the bowel. Gastroenterol Clin North Am. 1990;19(2):319–43.Google Scholar
Chang, JB, Stein, TA. Mesenteric ischemia: acute and chronic. Ann Vasc Surg. 2003;17(3):323–8.Google Scholar
Mitsudo, S, Brandt, LJ. Pathology of intestinal ischemia. Surg Clin North Am. 1992;72(1):43–63.CrossRefGoogle ScholarPubMed
Morson, BC. Ischaemic colitis. Postgrad Med J. 1968;44(515):665–7.CrossRefGoogle ScholarPubMed
Khor, TS, Lauwers, GY, Odze, RD, Srivastava, A. “Mass-forming” variant of ischemic colitis is a distinct entity with predilection for the proximal colon. Am J Surg Pathol. 2015;39(9):1275–81.CrossRefGoogle ScholarPubMed
Fousekis, F, Aggeli, P, Gkogkos, S, Christou, P, Pappas-Gogos, G. Rectal ischemia causes mass formation, masquerading as rectal cancer. Oxf Med Case Reports. 2018;2018(9):296–8.CrossRefGoogle ScholarPubMed
Gramlich, TL, Hunter, SB. Focal polypoid ischemia of the colon: atheroemboli presenting as a colonic polyp. Arch Pathol Lab Med. 1994;118(3):308–9.Google Scholar
Rist, CB, Watts, JC, Lucas, RJ. Isolated ischemic necrosis of the cecum in patients with chronic heart disease. Dis Colon Rectum. 1984;27(8):548–51.Google Scholar
Cakar, E, Ersoz, F, Bag, M, et al. Isolated cecal necrosis: our surgical experience and a review of the literature. Ulus Cerrahi Derg. 2014;30(4):214–8.Google Scholar
Schuler, JG, Hudlin, MM. Cecal necrosis: infrequent variant of ischemic colitis. Report of five cases. Dis Colon Rectum. 2000;43(5):708–12.Google Scholar
Dirican, A, Unal, B, Bassulu, N, Tatli, F, Aydin, C, Kayaalp, C. Isolated cecal necrosis mimicking acute appendicitis: a case series. J Med Case Rep. 2009;3:7443.CrossRefGoogle ScholarPubMed
Cerilli, LA, Greenson, JK. The differential diagnosis of colitis in endoscopic biopsy specimens: a review article. Arch Pathol Lab Med. 2012;136(8):854–64.CrossRefGoogle ScholarPubMed
Willeke, P, Domagk, D, Floer, M, et al. Ischaemic colitis mimicking inflammatory bowel disease in a young adult receiving oral anticoagulation. Scand J Gastroenterol. 2005;40(7):878–80.CrossRefGoogle Scholar
Price, AB, Morson, BC. Inflammatory bowel disease: the surgical pathology of Crohn’s disease and ulcerative colitis. Hum Pathol. 1975;6(1):7–29.Google Scholar
Yantiss, RK, Das, KM, Farraye, FA, Odze, RD. Alterations in the immunohistochemical expression of Das-1 and CG-3 in colonic mucosal biopsy specimens helps distinguish ulcerative colitis from Crohn disease and from other forms of colitis. Am J Surg Pathol. 2008;32(6):844–50.CrossRefGoogle ScholarPubMed
Foutch, PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol. 1993;88(6):807–18.Google ScholarPubMed
Gunjan, D, Sharma, V, Rana, SS, Bhasin, DK. Small bowel bleeding: a comprehensive review. Gastroenterol Rep (Oxf). 2014;2(4):262–75.Google ScholarPubMed
Regula, J, Wronska, E, Pachlewski, J. Vascular lesions of the gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2008;22(2):313–28.Google Scholar
Filograna, L, Filograna, E, D’Onofrio, A, Flor, N, Haddad, Y, Floris, R. Colonic angiodysplasia on CT colonography: case report and characteristic imaging findings. Radiol Case Rep. 2017;12(4):693–6.CrossRefGoogle Scholar
Weaver, GA, Alpern, HD, Davis, JS, Ramsey, WH, Reichelderfer, M. Gastrointestinal angiodysplasia associated with aortic valve disease: part of a spectrum of angiodysplasia of the gut. Gastroenterology. 1979;77(1):1–11.CrossRefGoogle ScholarPubMed
Vesoulis, Z, Naik, N, Maseelall, P. Histopathologic changes are not specific for diagnosis of gastric antral vascular ectasia (GAVE) syndrome: a review of the pathogenesis and a comparative image analysis morphometric study of GAVE syndrome and gastric hyperplastic polyps. Am J Clin Pathol. 1998;109(5):558–64.Google Scholar
Payen, JL, Cales, P, Voigt, JJ, et al. Severe portal hypertensive gastropathy and antral vascular ectasia are distinct entities in patients with cirrhosis. Gastroenterology. 1995;108(1):138–44.CrossRefGoogle ScholarPubMed
Dulai, GS, Jensen, DM. Treatment of watermelon stomach. Curr Treat Options Gastroenterol. 2006;9(2):175–80.Google Scholar
Tsokos, M, Turk, EE. Esophageal variceal hemorrhage presenting as sudden death in outpatients. Arch Pathol Lab Med. 2002;126(10):1197–200.Google Scholar
Sharara, AI, Rockey, DC. Gastroesophageal variceal hemorrhage. N Engl J Med. 2001;345(9):669–81.CrossRefGoogle ScholarPubMed
Biecker, E. Gastrointestinal bleeding in cirrhotic patients with portal hypertension. ISRN Hepatol. 2013;2013:541836.CrossRefGoogle ScholarPubMed
Cubillas, R, Rockey, DC. Portal hypertensive gastropathy: a review. Liver Int. 2010;30(8):1094–102.Google Scholar
Fuccio, L, Mussetto, A, Laterza, L, Eusebi, LH, Bazzoli, F. Diagnosis and management of gastric antral vascular ectasia. World J Gastrointest Endosc. 2013;5(1):6–13.Google Scholar
Thuluvath, PJ, Yoo, HY. Portal Hypertensive gastropathy. Am J Gastroenterol. 2002;97(12):2973–8.CrossRefGoogle ScholarPubMed
Lemmers, A, Evrard, S, Demetter, P, et al. Gastrointestinal polypoid lesions: a poorly known endoscopic feature of portal hypertension. United Eur Gastroenterol J. 2014;2(3):189–96.CrossRefGoogle ScholarPubMed
Naveau, S, Bedossa, P, Poynard, T, Mory, B, Chaput, JC. Portal hypertensive colopathy: a new entity. Dig Dis Sci. 1991;36(12):1774–81.Google Scholar
Naveau, S, Leger-Ravet, MB, Houdayer, C, Bedossa, P, Lemaigre, G, Chaput, JC. Nonhereditary colonic angiodysplasias: histomorphometric approach to their pathogenesis. Dig Dis Sci. 1995;40(4):839–42.Google Scholar
Lamps, LW, Hunt, CM, Green, A, Gray, GF, Jr., Washington, K. Alterations in colonic mucosal vessels in patients with cirrhosis and noncirrhotic portal hypertension. Hum Pathol. 1998;29 (5):527–35.Google Scholar
Shudo, R, Yazaki, Y, Sakurai, S, Uenishi, H, Yamada, H, Sugawara, K. Duodenal erosions, a common and distinctive feature of portal hypertensive duodenopathy. Am J Gastroenterol. 2002;97(4):867–73.Google Scholar
Zeitoun, JD, Chryssostalis, A, Terris, B, Prat, F, Gaudric, M, Chaussade, S. Portal hypertensive duodenal polyp: a case report. World J Gastroenterol. 2007;13(9):1451–2.CrossRefGoogle ScholarPubMed
Gurung, A, Jaffe, PE, Zhang, X. Duodenal polyposis secondary to portal hypertensive duodenopathy. World J Gastrointest Endosc. 2015;7(17):1257–61.Google Scholar
Urrunaga, NH, Rockey, DC. Portal hypertensive gastropathy and colopathy. Clin Liver Dis. 2014;18(2):389–406.Google Scholar
Al-Busafi, SA, McNabb-Baltar, J, Farag, A, Hilzenrat, N. Clinical manifestations of portal hypertension. Int J Hepatol. 2012;2012:203794.Google Scholar
Lee, YT, Walmsley, RS, Leong, RW, Sung, JJ. Dieulafoy’s lesion. Gastrointest Endosc. 2003;58(2):236–43.CrossRefGoogle ScholarPubMed
Baxter, M, Aly, EH. Dieulafoy’s lesion: current trends in diagnosis and management. Ann R Coll Surg Engl. 2010;92(7):548–54.Google Scholar
Miko, TL, Thomazy, VA. The caliber persistent artery of the stomach: a unifying approach to gastric aneurysm, Dieulafoy’s lesion, and submucosal arterial malformation. Hum Pathol. 1988;19(8):914–21.CrossRefGoogle ScholarPubMed
Kim, JK, Jo, BJ, Lee, KM, et al. Dieulafoy’s lesion of jejunum: presenting small bowel mass and stricture. Yonsei Med J. 2005;46(3):445–7.Google Scholar
Huang, HL, Leung, CY, Cheng, CJ. Mass-like Dieulafoy’s lesion associated with advanced gastric cancer at the antrum of stomach: a case report and literature review. Diagn Pathol. 2017;12(1):73.Google Scholar
Yoshikumi, Y, Mashima, H, Suzuki, J, et al. A case of rectal Dieulafoy’s ulcer and successful endoscopic band ligation. Can J Gastroenterol. 2006;20(4):287–90.CrossRefGoogle ScholarPubMed
Cavett, CM, Selby, JH, Hamilton, JL, Williamson, JW. Arteriovenous malformation in chronic gastrointestinal bleeding. Ann Surg. 1977;185(1):116–21.CrossRefGoogle ScholarPubMed
Kim, BK, Han, HS, Lee, SY, Kim, CH, Jin, CJ. Cecal polypoid arteriovenous malformations removed by endoscopic biopsy. J Korean Med Sci. 2009;24(2):342–5.Google Scholar
Maeng, L, Choi, KY, Lee, A, Kang, CS, Kim, KM. Polypoid arteriovenous malformation of colon mimicking inflammatory fibroid polyp. J Gastroenterol. 2004;39(6):575–8.Google Scholar
D’Arienzo, A, Manguso, F, D’Armiento, FP, et al. Colonoscopic removal of a polypoid arteriovenous malformation. Dig Liver Dis. 2001;33(5):435–7.Google Scholar
Patel, AD, Schneider, Y, Saumoy, M, et al. Idiopathic myointimal hyperplasia of the mesenteric veins. ACG Case Rep J. 2016;3(4):e84.Google Scholar
Korenblit, J, Burkart, A, Frankel, R, et al. Refractory pancolitis: a novel presentation of idiopathic myointimal hyperplasia of mesenteric veins. Gastroenterol Hepatol (N Y). 2012;8(10):696–700.Google Scholar
Yantiss, RK, Cui, I, Panarelli, NC, Jessurun, J. Idiopathic myointimal hyperplasia of mesenteric veins: an uncommon cause of ischemic colitis with distinct mucosal features. Am J Surg Pathol. 2017;41(12):1657–65.Google Scholar
McDonald, J, Wooderchak-Donahue, W, VanSant Webb, C, Whitehead, K, Stevenson, DA, Bayrak-Toydemir, P. Hereditary hemorrhagic telangiectasia: genetics and molecular diagnostics in a new era. Front Genet. 2015;6:1.Google Scholar
Vase, P, Grove, O. Gastrointestinal lesions in hereditary hemorrhagic telangiectasia. Gastroenterology. 1986;91(5):1079–83.Google Scholar
Proctor, DD, Henderson, KJ, Dziura, JD, Longacre, AV, White, RI, Jr. Enteroscopic evaluation of the gastrointestinal tract in symptomatic patients with hereditary hemorrhagic telangiectasia. J Clin Gastroenterol. 2005;39(2):115–9.Google Scholar
Jackson, SB, Villano, NP, Benhammou, JN, Lewis, M, Pisegna, JR, Padua, D. Gastrointestinal manifestations of hereditary hemorrhagic telangiectasia (HHT): a systematic review of the literature. Dig Dis Sci. 2017;62(10):2623–30.Google Scholar
Nelson, AD, Mouchli, MA, Valentin, N, et al. Ehlers Danlos syndrome and gastrointestinal manifestations: a 20-year experience at Mayo Clinic. Neurogastroenterol Motil. 2015;27(11):1657–66.Google Scholar
Solomon, JA, Abrams, L, Lichtenstein, GR. GI manifestations of Ehlers-Danlos syndrome. Am J Gastroenterol. 1996;91(11):2282–8.Google Scholar
Baichi, MM, Arifuddin, RM, Mantry, PS. Gastrointestinal bleeding in a patient with Ehlers-Danlos syndrome: an endoscopic dilemma. Dig Dis Sci. 2005;50(7):1342–3.Google Scholar
Kato, M, Shinzaki, S, Tsujii, Y, et al. Gastrointestinal: Huge submucosal hematoma of the stomach arising in a patient with vascular type Ehlers-Danlos syndrome. J Gastroenterol Hepatol. 2018;33(9):1563.Google Scholar
Pepin, M, Schwarze, U, Superti-Furga, A, Byers, PH. Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type. N Engl J Med. 2000;342(10):673–80.Google Scholar
Lidar, M, Lipschitz, N, Langevitz, P, Shoenfeld, Y. The infectious etiology of vasculitis. Autoimmunity. 2009;42(5):432–8.Google Scholar
Diep, JT, Kerr, LD, Sarebahi, S, Tismenetsky, M. Opportunistic infections mimicking gastrointestinal vasculitis in systemic lupus erythematosus. J Clin Rheumatol. 2007;13(4):213–6.Google Scholar
Guarner, J, Brandt, ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev. 2011;24(2):247–80.Google Scholar
Jennette, JC, Falk, RJ, Bacon, PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1–11.Google Scholar
Geboes, K, Dalle, I. Vasculitis and the gastrointestinal tract. Acta Gastroenterol Belg. 2002;65(4):204–12.Google Scholar
Soowamber, M, Weizman, AV, Pagnoux, C. Gastrointestinal aspects of vasculitides. Nat Rev Gastroenterol Hepatol. 2016;14(3):185–94.Google Scholar
Louie, CY, DiMaio, MA, Charville, GW, Berry, GJ, Longacre, TA. Gastrointestinal tract vasculopathy: clinicopathology and description of a possible “new entity” with protean features. Am J Surg Pathol. 2018;42(7):866–76.Google Scholar
Saraga, E, Bouzourenne, H. Enterocolic (lymphocytic) phlebitis: a rare cause of intestinal ischemic necrosis: a series of six patients and review of the literature. Am J Surg Pathol. 2000;24(6):824–9.Google Scholar
Laco, J, Orhalmi, J, Bartova, J, Zimandlova, D. Enterocolic lymphocytic phlebitis as a newly recognized manifestation of IgG4-related disease. Int J Surg Pathol. 2015;23(2):165–9.Google Scholar
Comtesse, S, Friemel, J, Fankhauser, R, Weber, A. Enterocolic lymphocytic phlebitis of the cecal pole and appendix vermiformis with increase of IgG4-positive plasma cells. Virchows Arch. 2014;464(1):113–6.Google Scholar
Abraham, SC, Solem, CA, Hauser, SC, Smyrk, TC. Chronic antral ulcer associated with gastroduodenal lymphocytic phlebitis. Am J Surg Pathol. 2004;28(12):1659–63.CrossRefGoogle ScholarPubMed
Ngo, N, Chang, F. Enterocolic lymphocytic phlebitis: clinicopathologic features and review of the literature. Arch Pathol Lab Med. 2007;131(7):1130–4.CrossRefGoogle ScholarPubMed

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