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      Complicaciones vasculares asociadas a la enfermedad inflamatoria intestinal Translated title: Vascular complications associated with inflammatory bowel disease

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          Abstract

          Los fenómenos tromboembólicos son una manifestación extraintestinal bien conocida de la enfermedad inflamatoria intestinal, pero rara en la practica clínica. Estudios histológicos y hematológicos sugieren que el síndrome de hipercoagulabilidad presente en esta enfermedad está involucrado en la patogénesis de la enfermedad inflamatoria intestinal. De todas maneras el mecanismo exacto de hipercoagulabilidad aún no es bien conocido. Durante la fase de actividad de la enfermedad hay un aumento de los niveles de factor VIII, fibrinógeno, plaquetas, Factor V y un descenso en los niveles de antitrombina III. Hay una correlación clara entre estas alteraciones hematológicas y la actividad de la enfermedad. Presentamos dos pacientes con enfermedad inflamatoria intestinal y síndrome de hipercoagulabilidad. Se revisa la literatura y se comentan los mecanismos patogénicos.

          Translated abstract

          Thromboembolic episode is a well known extraintestinal manifestation of inflammatory bowel disease, but it is a clinical rare complication. Histological and hematological studies suggest that a hypercoagulable state is involved in the pathogenesis of inflammatory bowel disease. However, the exact mechanism of hypercoagulability is still unknown. During the acute recurrences there is an increase of factor VIII, fibrinogen, platelet, factor V and decrease of antithrombin III. Hematologic disorders seem markedly correlated with the activity of the disease. We report on two patients with Inflammatory bowel disease and hypercoagulable state. We review the literature and discuss about the pathogenic mechanisms of such complication.

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          Most cited references39

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          Vascular complications of inflammatory bowel disease.

          During an 11-year period from January 1970 to December 1980, 7,199 patients at our institution had chronic ulcerative colitis or Crohn's disease. Thromboembolic complications developed in 92 (1.3%) of these patients. An additional 4 patients had cutaneous vasculitis, and 17 had an arteritis-associated diagnosis. Of the thromboembolic complications, 61 were deep vein thromboses or pulmonary emboli. The mortality among patients with thromboembolic complications was high (25%). Sixty percent of the patients had a thrombocytosis unaffected by sulfasalazine or corticosteroid therapy. In 73% of the patients, the erythrocyte sedimentation rate was increased, and when measured, fibrinogen and factor VIII were commonly elevated. Peripheral arterial thrombosis, coronary thrombosis, and mesenteric and portal vein thrombosis were predominantly postsurgical complications, but 77% of peripheral venous thromboses occurred spontaneously. The role of anticoagulation and surgical intervention in the management of hypercoagulation in patients with inflammatory bowel disease is discussed.
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            Pathogenesis of Crohn's disease: multifocal gastrointestinal infarction.

            In a prospective study, specimens of resected small and large intestine from fifteen patients with Crohn's disease were prepared by heparin-saline vascular perfusion, followed by either resin casting of the mesenteric vascular supply and tissue maceration or glutaraldehyde perfusion-fixation, resin casting, and tissue clearance. The specimens were examined by macrophotography, histopathology, and either scanning or transmission electronmicroscopy. A pathogenetic sequence of events in Crohn's disease was seen--vascular injury, focal arteritis, fibrin deposition, arterial occlusion mainly at the level of the muscularis propria, followed by tissue infarction or neovascularisation. These features were confined to segments of intestine affected by Crohn's disease and did not occur in normal bowel. The findings suggest that Crohn's disease is mediated by multifocal gastrointestinal infarction. This pathogenetic process is compatible with many of the clinical features of Crohn's disease, and its recognition has important implications for the identification of the primary cause of the illness and advances in clinical management.
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              Inherited disorders of coagulation appear to protect against inflammatory bowel disease.

              Crohn's disease and ulcerative colitis seem to be rarely associated with inherited diseases of coagulation. Histological and hematologic studies suggest that thrombotic mesenteric microvascular occlusion is involved in the pathogenesis of inflammatory bowel disease. The aim of this study was to perform a national survey to determine the prevalence of inflammatory bowel disease among patients with inherited disorders of coagulation. Using a postal and telephone questionnaire survey sent to directors of all 129 hemophilia centers in the United Kingdom, the number of patients with inflammatory bowel disease and either hemophilia or von Willebrand's disease was determined. The expected number of cases of inflammatory bowel disease in this population was estimated using published data. Of 6433 patients with hemophilia and 3129 patients with von Willebrand's disease, 4 cases of Crohn's disease were reported compared with expected 11.97-16.58 cases (standardized morbidity ratio, 0.33-0.24; 95% confidence interval, 0.90-0.01; P < 0.05). Ulcerative colitis also occurred significantly less frequently than expected: 9 observed cases in comparison with expected 19.43-31.35 cases (standardized morbidity ratio, 0.46-0.29; 95% confidence interval, 0.91-0.01; P < 0.025). This epidemiological study provides further evidence that thrombosis and vascular occlusion may be important in the pathogenesis of inflammatory bowel disease.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ami
                Anales de Medicina Interna
                An. Med. Interna (Madrid)
                Arán Ediciones, S. L. (Madrid )
                0212-7199
                February 2003
                : 20
                : 2
                : 33-36
                Affiliations
                [1 ] Universidad de Murcia Spain
                Article
                S0212-71992003000200008
                10.4321/s0212-71992003000200008
                79350cc2-6d1d-4f04-9cb8-4f0964448568

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                Inflammatory bowel disease,Extraintestinal manifestations,Hypercoagulability,Enfermedad inflamatoria intestinal,Manifestaciones extraintestinales,Hipercoagulabilidad

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