From the Guidelines
Gastrointestinal bleeding from a stomach neurofibroma is typically caused by ulceration or erosion of the tumor into blood vessels within the gastric mucosa, leading to bleeding. The management of gastrointestinal bleeding from a stomach neurofibroma requires a multidisciplinary approach, prioritizing stabilization of the patient through intravenous fluids, blood transfusions if necessary, and acid suppression therapy using proton pump inhibitors, such as pantoprazole 40mg IV twice daily or omeprazole 40mg IV twice daily 1.
Key Considerations
- Endoscopic evaluation is essential for diagnosis and may allow for endoscopic interventions like epinephrine injection, thermal coagulation, or clip placement to control active bleeding.
- For definitive management, surgical resection of the neurofibroma is often necessary, with the approach (partial gastrectomy, wedge resection, or endoscopic submucosal dissection) depending on the size, location, and extent of the tumor.
- Neurofibromas are benign tumors arising from the nerve sheath, and those occurring in the stomach are rare but can be associated with neurofibromatosis type 1 (NF1).
Treatment Approach
- The initial management focuses on resuscitation, maintenance of hemodynamic stability, and triage (in-patient versus intensive care unit care), as outlined in the recent American College of Gastroenterology practice guidelines and an American Gastroenterological Association expert statement 1.
- Esophagogastroduodenoscopy is the usual first-line diagnostic and therapeutic investigation, with video capsule endoscopy sometimes used if the bleeding site is suspected to be below the ligament of Treitz 1.
- High-dose intravenous proton-pump inhibition is recommended in patients who have undergone successful endoscopic therapy, as suggested by consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding 1.
Follow-up Care
- Following treatment, patients should undergo surveillance endoscopy at intervals determined by their gastroenterologist.
- Those with NF1 require comprehensive follow-up for monitoring of other potential manifestations of the disease.
From the Research
Causes of Gastrointestinal (GI) Bleeding from a Stomach Neurofibroma
- The cause of GI bleeding from a stomach neurofibroma can be attributed to the tumor's potential to erode the mucosal lining, leading to bleeding 2.
- Neurofibromas of the stomach can occur in the course of Recklinghausen's disease, and sporadic gastric neurofibroma can also cause bleeding from the gastrointestinal tract 3.
- The tumor may look like an ulcer and can be a cause of abdominal pain, nausea, and bleeding from the gastrointestinal tract 3.
- Massive retrogastric bleeding can be caused by a neurofibroma arising from the gastric wall 2.
Associated Conditions and Symptoms
- Neurofibromas are associated with Recklinghausen's disease, also known as type 1 Neurofibromatosis (NF1) 4, 3.
- Patients with NF1 are at a higher risk of developing gastrointestinal stromal tumors (GISTs), which can also cause GI bleeding 4.
- Symptoms of GI bleeding from a stomach neurofibroma can include hematemesis, melena, and hematochezia 4, 5.
Diagnosis and Treatment
- Diagnosis of a stomach neurofibroma can be challenging and may require a combination of endoscopic ultrasound, computed tomography, and histopathological examination with immunohistochemistry 3.
- Treatment of a stomach neurofibroma typically involves excision of the tumor, which can be performed laparoscopically 4, 3.
- Endoscopic management of GI bleeding from a non-variceal source, such as a stomach neurofibroma, can include injection, thermal, and mechanical methods 5.