In modern medicine, Dielafua syndrome is considered to be a rather rare pathology. As a rule, it occurs in people of a relatively young age, both female and male. There is still controversy in the medical world whether there is a relationship between the patient’s lifestyle, nutrition and congenital weakness of the small submucosal arteries in the cardiac section of the stomach (which are the cause of the development of Dhelafua symptoms). The Dielafua Triad is the main criterion for diagnosing this disease. Medicine refers to these criteria three symptoms: pain, muscle tension and hyperesthesia of the skin in the right iliac region.
Who is Dielafua and why is the syndrome named after him
Paul Georges Dielafua is a famous doctor from France who worked in Paris. Over the years of his work, he made many discoveries, in particular, he studied the arteriovenous malformation. In simple terms, this process over time leads to the development of gastric or intestinal bleeding. This is a very dangerous condition that requires immediate medical attention. Thanks to the research of Paul Dielafua, medicine opened the door to knowledge, which later helped save the lives of hundreds of thousands of patients.
In 1890, Paul Dielafua became a member of the French Honorary Medical Academy, and 11 years later he headed it.
Dielafua's syndrome was named so because it was this person who made the main contribution to his study, proposing a theory and finding evidence for it. The syndrome appears due to the abnormal development of the vessels of the stomach layer under the mucosa, while erosion of the large artery is simultaneously diagnosed, as a result, there is a sad clinical picture: the formation of an ulcer, which leads to profuse internal bleeding, which, in turn, leads to death.
Dieulafoys disease was first described on the basis of studies by Paul Dielafua in 1884. He made a detailed description in 1898, highlighting it as a separate nosological form - “simple ulceration”.
Features of the syndrome in modern gastroenterology
Speaking about Dielafua's syndrome, it should be emphasized that in gastroenterology, gastric and intestinal bleeding is a fairly common case, and 144 syndromes and conditions can precede it. Disease (ulcer, erosion, syndrome - pathology is called differently, and any of the names will be true, these are synonyms) Dielafua is in fact one of the many precursor conditions that eventually lead to vascular rupture and subsequent bleeding in the submucous membrane of the stomach.
About self-diagnosis at home is out of the question! Dielafua's ulcer in the practice of surgeons is one of the most difficult and dangerous conditions. If there is even the slightest suspicion of the possibility of developing gastric bleeding, it should be as soon as possible to ensure the possibility of obtaining qualified medical help.
How the disease manifests itself in the initial stage
In 82-85% of all cases, the source that provokes the development of bleeding is deployed at a distance of approximately 5-6 centimeters from the esophageal-gastric anastomosis. Usually (in most cases) on a relatively small curvature of the stomach. In the description of the clinical picture of patients with Djelafua's syndrome, the pathology of the esophagus, damage to the small and large intestines, in rare cases, various pathologies of the gallbladder, impaired outflow of bile, and in some cases damage to the rectum, also often appear.
Diagnosis of the syndrome is often quite difficult in the early stages of development. In most cases, the disease does not manifest itself, the patient does not have most of the symptoms that are characteristic of gastroenterological pathologies. The patient does not complain of belching, indigestion, nausea, or indigestion. However, one should be wary if the patient sometimes expresses the following complaints:
- tingling in the stomach;
- vomiting with an admixture of blood;
- diarrhea with an admixture of sucrose;
- frequent gagging after eating;
- the inability to concentrate on something other than a feeling of discomfort and aching pain in the stomach (this condition is constant and exhausting).
However, these symptoms are only general, and it cannot be stated with certainty that even when taken together, they can signal the development of Djelafua syndrome. ICD 10 marks an acute bleeding stomach ulcer (and this is a direct consequence of the syndrome) with the code K25.0. This is a condition that requires immediate hospitalization.
Stages of the development of the disease
Since the diagnosis of pathology is quite complicated even for experienced doctors (until internal bleeding opens), it is difficult to determine the stages. Nevertheless, pathology can be divided into three stages of development:
- at the first stage, the vessels of the submucosal layer of the stomach expand and thin;
- the second begins with small bleeding, which the patient most often leaves without any attention;
- in the third stage, severe bleeding develops, which threatens the patient's life - urgent surgical intervention is required.
The main symptoms of the disease
As a rule, a patient with an anastomotic ulcer (Delafua syndrome) enters the operating table suddenly even for himself. An ulcer forms and begins to bleed already in the last stages of the disease. Prior to this, the patient may not experience any health problems and deny the presence of pathology.
When bleeding begins, the symptoms are:
- severe weakness, lack of performance;
- vomit with blood;
- nausea and vomiting;
- burning sensation in the solar plexus;
- collapse;
- hypotension;
- the chair acquires a tarry texture and color;
- general symptoms of severe blood loss in Dielafoie’s disease are observed.
Blue vesicular nevus is a skin lesion that is characteristic of people with venous weakness. Such people have a theoretically higher risk of developing the syndrome than those who do not have this kind of skin rash. If the patient has found a combination of the above symptoms and he has a blue nevus , this is an occasion to undergo an endoscopy.
Methods of gastroenterological diagnosis
It is possible to identify problems with the vessels if you are regularly examined by good specialists. After this, the patient is prescribed a course of vasoconstrictor drugs, but this is not a guarantee that the person will not develop the last stage (bleeding) of the Dielafua syndrome. Cases from practice show that for vessels and arteries of the submucosal layer of the stomach, taking venotonics is practically useless, and their cost is quite high for the average citizen.
If FGDS is carried out by an experienced and competent specialist, then he can see the eroded artery among the normal colored gastric mucosa. During active bleeding, a column of arterial blood can be detected.
Against the background of the development of the syndrome, a general blood test can show normochromic anemia.
Causes of the disease
Why does Dielafua syndrome develop? The endoscopic picture (when conducting an endoscopy study) most often shows the presence of eroded arteries, but often they are so insignificant or so few (for the development of bleeding, one or more is usually enough) that the doctor may simply not notice them. This is especially true for newcomers to gastroenterology.
What are the reasons that arteries and blood vessels in the submucosal layer of the stomach become thinner and erosion form on them? The opinion of official medicine is such that the reason lies either in the hereditary factor or in the patient’s habit of abusing alcoholic beverages against the background of unhealthy diet. To date, these two reasons are recognized as the main ones in the development of Dielafua syndrome. If a person suspects that he can get this ailment through the hereditary line, then a regular gastroenterologist should undergo an endoscopic examination of endoscopy, as well as take a general and biochemical blood test at least once a year.
Dielafua syndrome - what to do?
If a gastroenterologist has reported a possible development of bleeding due to the syndrome, then you should ask him to prescribe drugs for prevention. Some doctors prescribe venotonics, the use of which on a regular basis helps to strengthen the wall and arteries. Other doctors believe that only a strict diet and a healthy lifestyle can prevent the development of ulcers and bleeding.
First of all, do not panic. You just need to regularly undergo an examination, listen to your condition and completely abandon bad habits.
Will drugs help with pathology
To date, there is no such drug that could with a 100% probability prevent the development of ulcers and subsequent bleeding.
The best “drug” for this is the absence of chronic stress, a healthy diet, deep sleep, refusal to use even small doses of alcoholic beverages. Taking venotonics can only partially reduce the risk of developing an ulcer.
The consequences of gastric bleeding
The most serious consequence is death from blood loss. At first, blood will be released in small quantities and simply digested. Attentive patients may notice that something strange is happening to the stool, but rarely does anyone value it.
After erosion increases in size, it can be argued that this is the terminal stage. This condition is life-threatening and must be managed surgically in a hospital setting.
Prehospital phase of therapy
First aid is to help reduce bleeding. For this, drugs that can reduce blood coagulation can be prescribed. They are usually administered parenterally. An accurate diagnosis can only be made in a hospital setting. If it is not possible to deliver the patient to the hospital, 100 ml of a 6% solution of epsilonaminocaproic acid should be administered.
Sometimes, in order to slow down the course of the disease, calcium chloride is used, although there is no evidence that it can alleviate the condition at least temporarily with Djelafua syndrome.
The patient should put something cold on the stomach, for example, an ice bottle or a damp towel. The patient should be completely at rest. Any burden to the patient is prohibited. If there is a suspicion of internal bleeding, then you should refuse to take any food until the moment the examination is carried out and an accurate diagnosis is made.
Delafua ulcer: modern treatment methods
After the cause of the malaise was precisely established and it turned out to be a Dielafoit ulcer, the patient should agree to surgical intervention. There are no conservative treatments for bleeding, and procrastination can be fatal.
As a rule, the patient enters the department in a state of hemorrhagic shock. Even an experienced doctor can not immediately understand what is the source of bleeding. Therefore, before the operation, additional studies may be required. Sometimes bleeding is first stopped by endoscopic methods.
The alleged site of bleeding is washed with chilled water, after which a damaged vessel protrudes above the mucous membrane. The damaged vessel is coagulated. Blood stop can be achieved by applying clips; for this manipulation, a rotating clip clipper is used.
The relationship between alcoholism and the onset of the disease
Regular alcohol abuse brings the body a large number of chronic diseases. The stomach, its mucous and submucous layer suffer no less than the liver, which is forced to process the decay products of ethyl alcohol.
Studies have shown that among people who suffer from chronic alcoholism, the percentage of deaths from stomach bleeding is several times higher than among people who have a sober and healthy lifestyle. Smoking also extremely negatively affects the state of blood vessels and arteries throughout the body.