Digestive Tract

Telangiectases of the digestive tract are similar in size and appearance to those of the nasal and oral mucosa and may affect the esophagous, stomach, duodenum, small bowel, and colon. The actual prevalence of digestive telangi-ectases is still unknown because of the difficulty of performing endoscopy of the entire digestive tract and because nonsymptomatic telangiectasic lesions are probably present in a larger proportion of patients than those currently diagnosed.

Hemorrhaging from gastrointestinal (GI) telangiectases tends to appear in the fourth or fifth decade of life, affecting 13-33% of HHT patients.[18] However, this is probably an underestimation of the problem as most episodes of hemorrhaging are attributed to epistaxis rather than to a genuine GI bleeding.

While the endoscopic diagnosis of GI telangiectases in the upper digestive tract and colon is relatively uncomplicated, the investigation of the source of small bowel bleeding is more complex. Recently, the wireless-capsule endoscopy has been performed to study HHT patients with obscure and uncontrolled GI bleeding.[19]

The management of the GI bleeding in HHT patients is difficult, especially when the telangiectases are multiple and diffused throughout the entire digestive tract. Photocoagulation or laser procedures are effective in the short term, but less satisfactory over longer periods. Pharmacological therapy with estrogen and progesterone has been demonstrated to reduce the need for transfusions in HHT patients with GI bleeding, but the mechanism responsible for this effect is unknown as yet.[1]

Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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