Images in Clinical Rheumatology
Upper Gastrointestinal Bleeding (Watermelon Stomach) in a Patient With Limited Scleroderma (CREST Syndrome)
Hemorragia digestiva alta (estómago de sandía) en paciente con esclerodermia limitada (síndrome de CREST)
Ana Isabel Turrión Nievesa,b,
, Henry Moruno Cruza, M. Liz Romero Bogadoa, Ana Perez Gómeza
Corresponding author
a Servicio de ESI-Reumatología, Departamento de Medicina Especialidades Médicas, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
b Unidad Docente de Anatomía y Embriología Humanas, Departamento de Cirugía y Ciencias Médico Sociales, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
Read
8506
Timeswas read the article
2420
Total PDF
6086
Total HTML
Share statistics
array:24 [ "pii" => "S2173574317300904" "issn" => "21735743" "doi" => "10.1016/j.reumae.2016.05.012" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "939" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2017;13:361-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 708 "formatos" => array:3 [ "EPUB" => 76 "HTML" => 459 "PDF" => 173 ] ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S1699258X16300559" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2016.05.011" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "939" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2017;13:361-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6431 "formatos" => array:3 [ "EPUB" => 185 "HTML" => 4922 "PDF" => 1324 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Reumatología clínica en imágenes</span>" "titulo" => "Hemorragia digestiva alta (estómago de sandía) en paciente con esclerodermia limitada (síndrome de CREST)" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "361" "paginaFinal" => "362" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Upper gastrointestinal bleeding (watermelon stomach) in a patient with limited scleroderma (CREST syndrome)" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 863 "Ancho" => 925 "Tamanyo" => 97414 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imágenes endoscópicas de ectasia vascular antral lineales.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Isabel Turrión Nieves, Henry Moruno Cruz, M. Liz Romero Bogado, Ana Perez Gómez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana Isabel" "apellidos" => "Turrión Nieves" ] 1 => array:2 [ "nombre" => "Henry" "apellidos" => "Moruno Cruz" ] 2 => array:2 [ "nombre" => "M. Liz" "apellidos" => "Romero Bogado" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Perez Gómez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574317300904" "doi" => "10.1016/j.reumae.2016.05.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317300904?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16300559?idApp=UINPBA00004M" "url" => "/1699258X/0000001300000006/v1_201710191241/S1699258X16300559/v1_201710191241/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574317301302" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.03.002" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1030" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2017;13:363-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 450 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 280 "PDF" => 127 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Miescher Syndrome: An Uncommon Cause of Recurrent Swelling of the Lips" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "363" "paginaFinal" => "364" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Miescher: una causa poco frecuente de tumefacción labial" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andrés González-García, Ignacio Barbolla Díaz, Walter Alberto Sifuentes Giraldo, José Luis Patier-de la Peña" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Andrés" "apellidos" => "González-García" ] 1 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Barbolla Díaz" ] 2 => array:2 [ "nombre" => "Walter Alberto" "apellidos" => "Sifuentes Giraldo" ] 3 => array:2 [ "nombre" => "José Luis" "apellidos" => "Patier-de la Peña" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X17300578" "doi" => "10.1016/j.reuma.2017.03.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17300578?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317301302?idApp=UINPBA00004M" "url" => "/21735743/0000001300000006/v1_201710250854/S2173574317301302/v1_201710250854/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574317300916" "issn" => "21735743" "doi" => "10.1016/j.reumae.2016.05.013" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "940" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2017;13:359-60" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 569 "formatos" => array:3 [ "EPUB" => 74 "HTML" => 311 "PDF" => 184 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Calcinosis Universalis in Adult-onset Dermatomyositis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "359" "paginaFinal" => "360" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calcinosis <span class="elsevierStyleItalic">universalis</span> en paciente con dermatomiositis" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 929 "Ancho" => 1500 "Tamanyo" => 177729 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Calcinosis universalis in abdomen and pelvis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Novella Navarro, María del Mar Muñoz Gómez, Juan Salvatierra Ossorio" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Novella Navarro" ] 1 => array:2 [ "nombre" => "María del Mar" "apellidos" => "Muñoz Gómez" ] 2 => array:2 [ "nombre" => "Juan" "apellidos" => "Salvatierra Ossorio" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X16300560" "doi" => "10.1016/j.reuma.2016.05.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16300560?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317300916?idApp=UINPBA00004M" "url" => "/21735743/0000001300000006/v1_201710250854/S2173574317300916/v1_201710250854/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Upper Gastrointestinal Bleeding (Watermelon Stomach) in a Patient With Limited Scleroderma (CREST Syndrome)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "361" "paginaFinal" => "362" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Isabel Turrión Nieves, Henry Moruno Cruz, M. Liz Romero Bogado, Ana Perez Gómez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ana Isabel" "apellidos" => "Turrión Nieves" "email" => array:1 [ 0 => "anaturrion@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Henry" "apellidos" => "Moruno Cruz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M. Liz" "apellidos" => "Romero Bogado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Ana" "apellidos" => "Perez Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de ESI-Reumatología, Departamento de Medicina Especialidades Médicas, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad Docente de Anatomía y Embriología Humanas, Departamento de Cirugía y Ciencias Médico Sociales, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemorragia digestiva alta (estómago de sandía) en paciente con esclerodermia limitada (síndrome de CREST)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 790 "Ancho" => 949 "Tamanyo" => 113780 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Endoscopic image of vascular ectasia treated with argon plasma coagulation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 52-year-old man with a 20-year history of limited scleroderma, as well as antiphospholipid syndrome. He was positive for antinuclear antibodies (1:2560), with a centromere pattern, and for lupus anticoagulant, and was receiving oral anticoagulants due to thrombosis in a lower limb.</p><p id="par0010" class="elsevierStylePara elsevierViewall">He was admitted to the hospital with an episode of blood in stool and evidence of anemia. Endoscopic study revealed vascular-like lesions in antrum converging as they neared the pylorus, compatible with watermelon stomach<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In the presence of active bleeding, he was treated with argon plasma coagulation<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Gastric antral vascular ectasia (GAVE) is a rare, but serious, cause of upper gastrointestinal bleeding (4% of all gastric hemorrhages). The endoscopic findings are characteristic: linear images, oriented radially and converging on the pylorus (watermelon stomach<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4</span></a>).</p><p id="par0020" class="elsevierStylePara elsevierViewall">This condition is associated with underlying chronic diseases, mostly with liver cirrhosis. In autoimmune diseases, it is related to the presence of Raynaud's phenomenon, and is the form most widely reported of the limited subtype of scleroderma (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia [CREST syndrome]).<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> The largest series of patients with GAVE includes 45 individuals, 62% of whom also had a connective tissue disease, predominantly with Raynaud's phenomenon (31%) and sclerodactyly (20%).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of GAVE are unknown; one hypothesis is that the histological changes, especially in the lamina propria, are due to a fibromuscular proliferation, vascular dilatation and thrombosis, caused by the vascular disease associated with this condition.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> It can be suspected in patients with scleroderma and iron deficiency anemia who do not respond to iron supplements.</p><p id="par0030" class="elsevierStylePara elsevierViewall">At the present time, we are unable to avoid its development and, given the presence of bleeding, the treatment with the best results is endoscopic, including the use of laser ablation, argon plasma coagulation or cold. With respect to the possible surgical solution, like antrectomy, it can be utilized if other therapies fail.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a> There are medical treatments if endoscopy cannot be performed, but they are usually associated with more severe adverse effects.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-01-16" "fechaAceptado" => "2016-05-26" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Turrión Nieves AI, Moruno Cruz H, Romero Bogado ML, Perez Gómez A. Hemorragia digestiva alta (estómago <span class="elsevierStyleItalic">watermelon</span>) en paciente con esclerodermia limitada (síndrome de CREST). Reumatol Clin. 2017;13:361–362.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 863 "Ancho" => 925 "Tamanyo" => 97414 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Endoscopic images of gastric antral vascular ectasia.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 790 "Ancho" => 949 "Tamanyo" => 113780 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Endoscopic image of vascular ectasia treated with argon plasma coagulation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Watermelon stomach following and preceding systemic sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "O. Elkayam" 1 => "M. Oumanski" 2 => "M. Yaron" 3 => "D. Caspi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/sarh.2000.9623" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2000" "volumen" => "30" "paginaInicial" => "127" "paginaFinal" => "131" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11071584" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of gastric antral vascular ectasia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Fuccio" 1 => "A. Mussetto" 2 => "L. Laterza" 3 => "L.H. Eusebi" 4 => "F. Bazzoli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4253/wjge.v5.i1.6" "Revista" => array:6 [ "tituloSerie" => "World J Gastrointest Endosc" "fecha" => "2013" "volumen" => "5" "paginaInicial" => "6" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23330048" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastrointestinal complications: the most frequent internal complications of systemic sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Forbes" 1 => "I. Marie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2009" "volumen" => "48" "numero" => "Suppl 3" "paginaInicial" => "iii36" "paginaFinal" => "iii39" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastric antral vascular ectasia: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Kar" 1 => "S. Mitra" 2 => "J.M. Resnick" 3 => "C.F. Torbey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3121/cmr.2012.1036" "Revista" => array:6 [ "tituloSerie" => "Clin Med Res" "fecha" => "2013" "volumen" => "11" "paginaInicial" => "80" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23262190" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence, correlates and outcomes of gastric antral vascular ectasia in systemic sclerosis: a EUSTAR case-control study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Ghrenassia" 1 => "J. Avouac" 2 => "D. Khanna" 3 => "C.T. Derk" 4 => "O. Distler" 5 => "Y.A. Suliman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.130386" "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2014" "volumen" => "41" "paginaInicial" => "99" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24293584" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastric antral vascular ectasia in systemic sclerosis: current concepts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.H. Parrado" 1 => "H.N. Lemus" 2 => "P.X. Coral-Alvarado" 3 => "G. Quintana López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2015/762546" "Revista" => array:5 [ "tituloSerie" => "Int J Rheumatol" "fecha" => "2015" "volumen" => "2015" "paginaInicial" => "762546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26633973" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical and endoscopic spectrum of the watermelon stomach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.J. Gostout" 1 => "T.R. Viggiano" 2 => "D.A. Ahlquist" 3 => "K.K. Wang" 4 => "M.V. Larson" 5 => "R. Balm" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "1992" "volumen" => "15" "paginaInicial" => "256" "paginaFinal" => "263" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1479175" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastric antral vascular ectasia (GAVE): an update on clinical presentation, pathophysiology and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.P. Selinger" 1 => "Y.S. Ang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000124339" "Revista" => array:6 [ "tituloSerie" => "Digestion" "fecha" => "2008" "volumen" => "77" "paginaInicial" => "131" "paginaFinal" => "137" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18391491" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical and endoscopic therapies for angiodysplasia and gastric antral vascular ectasia: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Swanson" 1 => "A. Mahgoub" 2 => "R. MacDonald" 3 => "A. Shaukat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cgh.2013.08.038" "Revista" => array:6 [ "tituloSerie" => "Clin Gastroenterol Hepatol" "fecha" => "2014" "volumen" => "12" "paginaInicial" => "571" "paginaFinal" => "582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24013107" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Refractory gastric antral vascular ectasia: a new endoscopic approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Zulli" 1 => "A. del Prete" 2 => "M. Romano" 3 => "F. Esposito" 4 => "M.R. Amato" 5 => "P. Esposito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Rev Med Pharmacol Sci" "fecha" => "2015" "volumen" => "19" "paginaInicial" => "4119" "paginaFinal" => "4122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26592837" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001300000006/v1_201710250854/S2173574317300904/v1_201710250854/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001300000006/v1_201710250854/S2173574317300904/v1_201710250854/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317300904?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 14 | 27 |
| 2024 October | 89 | 50 | 139 |
| 2024 September | 126 | 32 | 158 |
| 2024 August | 138 | 47 | 185 |
| 2024 July | 117 | 40 | 157 |
| 2024 June | 105 | 53 | 158 |
| 2024 May | 109 | 39 | 148 |
| 2024 April | 101 | 43 | 144 |
| 2024 March | 103 | 47 | 150 |
| 2024 February | 65 | 34 | 99 |
| 2024 January | 86 | 24 | 110 |
| 2023 December | 73 | 28 | 101 |
| 2023 November | 79 | 22 | 101 |
| 2023 October | 86 | 39 | 125 |
| 2023 September | 95 | 39 | 134 |
| 2023 August | 60 | 11 | 71 |
| 2023 July | 80 | 23 | 103 |
| 2023 June | 79 | 28 | 107 |
| 2023 May | 90 | 25 | 115 |
| 2023 April | 84 | 11 | 95 |
| 2023 March | 124 | 46 | 170 |
| 2023 February | 103 | 37 | 140 |
| 2023 January | 99 | 23 | 122 |
| 2022 December | 167 | 44 | 211 |
| 2022 November | 105 | 48 | 153 |
| 2022 October | 139 | 37 | 176 |
| 2022 September | 87 | 56 | 143 |
| 2022 August | 128 | 52 | 180 |
| 2022 July | 98 | 48 | 146 |
| 2022 June | 108 | 52 | 160 |
| 2022 May | 183 | 53 | 236 |
| 2022 April | 172 | 70 | 242 |
| 2022 March | 230 | 68 | 298 |
| 2022 February | 249 | 47 | 296 |
| 2022 January | 158 | 78 | 236 |
| 2021 December | 97 | 38 | 135 |
| 2021 November | 119 | 50 | 169 |
| 2021 October | 88 | 52 | 140 |
| 2021 September | 82 | 48 | 130 |
| 2021 August | 67 | 79 | 146 |
| 2021 July | 68 | 39 | 107 |
| 2021 June | 95 | 35 | 130 |
| 2021 May | 98 | 48 | 146 |
| 2021 April | 195 | 103 | 298 |
| 2021 March | 120 | 28 | 148 |
| 2021 February | 91 | 36 | 127 |
| 2021 January | 88 | 29 | 117 |
| 2020 December | 77 | 29 | 106 |
| 2020 November | 48 | 22 | 70 |
| 2020 October | 42 | 26 | 68 |
| 2020 September | 70 | 32 | 102 |
| 2020 August | 55 | 28 | 83 |
| 2020 July | 41 | 36 | 77 |
| 2020 June | 53 | 26 | 79 |
| 2020 May | 57 | 18 | 75 |
| 2020 April | 27 | 22 | 49 |
| 2020 March | 21 | 15 | 36 |
| 2020 February | 2 | 0 | 2 |
| 2019 November | 1 | 0 | 1 |
| 2019 October | 1 | 0 | 1 |
| 2019 May | 4 | 0 | 4 |
| 2019 February | 1 | 0 | 1 |
| 2019 January | 5 | 0 | 5 |
| 2018 December | 4 | 0 | 4 |
| 2018 July | 1 | 0 | 1 |
| 2018 May | 6 | 2 | 8 |
| 2018 April | 1 | 0 | 1 |
| 2018 March | 42 | 7 | 49 |
| 2018 February | 103 | 19 | 122 |
| 2018 January | 90 | 30 | 120 |
| 2017 December | 88 | 34 | 122 |
| 2017 November | 79 | 34 | 113 |
| 2017 October | 20 | 17 | 37 |
| 2017 September | 3 | 9 | 12 |
| 2017 August | 4 | 11 | 15 |
| 2017 July | 4 | 10 | 14 |
Show all
