Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1978 Apr;37(2):183–186. doi: 10.1136/ard.37.2.183

Oesophageal variceal bleeding in Felty's syndrome associated with nodular regenerative hyperplasia.

L M Blendis, D Lovell, C G Barnes, S Ritland, D Cattan, P Vesin
PMCID: PMC1001187  PMID: 306226

Abstract

Four patients with Felty's syndrome developed massive upper gastrointestinal bleeding due to oesophageal varices. The underlying hepatic pathology in all 4 was nodular regenerative hyperplasia. This appears to be a difficult histological diagnosis to make, having been initially reported as normal on percutaneous biopsy or as fibrosis or cirrhosis on wedge biopsy. This series brings the total number of cases reported in the English literature of this association to 12, suggesting a definite symptom complex. The portal hypertension seems to be due to a combination of increased splenic blood flow and postsinusoidal resistance. The clinical importance of this syndrome is that the appropriate therapy for bleeding oesophageal varices appears to be shunt procedure such as a splenorenal shunt with splenectomy, which should be well tolerated.

Full text

PDF
183

Images in this article

185Image
on p.185
185Image
on p.185

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnes C. G., Turnbull A. L., Vernon-Roberts B. Felty's syndrome. A clinical and pathological survey of 21 patients and their response to treatment. Ann Rheum Dis. 1971 Jul;30(4):359–374. doi: 10.1136/ard.30.4.359. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blendis L. M., Ansell I. D., Jones K. L., Hamilton E., Williams R. Liver in Felty's syndrome. Br Med J. 1970 Jan 17;1(5689):131–135. doi: 10.1136/bmj.1.5689.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blendis L. M., Banks D. C., Ramboer C., Williams R. Spleen blood flow and splanchnic haemodynamics in blood dyscrasia and other splenomegalies. Clin Sci. 1970 Jan;38(1):73–84. doi: 10.1042/cs0380073. [DOI] [PubMed] [Google Scholar]
  4. Blendis L. M., Jones K. L., Hamilton E. B., Williams R. Familial Felty's syndrome. Ann Rheum Dis. 1976 Jun;35(3):279–281. doi: 10.1136/ard.35.3.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Blendis L. M., Parkinson M. C., Shilkin K. B., Williams R. Nodular regenerative hyperplasia of the liver in Felty's syndrome. Q J Med. 1974 Jan;43(169):25–32. [PubMed] [Google Scholar]
  6. Boyer J. L., Hales M. R., Klatskin G. "Idiopathic" portal hypertension due to occlusion of intrahepatic portal veins by organized thrombi. A study based on postmortem vinylite-injection corrosion and dissection of the intrahepatic vasculature in 4 cases. Medicine (Baltimore) 1974 Jan;53(1):77–91. doi: 10.1097/00005792-197401000-00003. [DOI] [PubMed] [Google Scholar]
  7. Harris M., Rash R. M., Dymock I. W. Nodular, non-cirrhotic liver associated with portal hypertension in a patient with rheumatoid arthritis. J Clin Pathol. 1974 Dec;27(12):963–966. doi: 10.1136/jcp.27.12.963. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Klofkorn R. W., Steigerwald J. C., Mills D. M., Smyth C. J. Esophageal varices in Felty's syndrome: A case report and review of the literature. Arthritis Rheum. 1976 Mar-Apr;19(2):150–154. doi: 10.1002/art.1780190204. [DOI] [PubMed] [Google Scholar]
  9. Knowles D. M., 2nd, Kaye G. I., Godman G. C. Nodular regenerative hyperplasia of the liver. Gastroenterology. 1975 Sep;69(3):746–751. [PubMed] [Google Scholar]
  10. Reisman T., Levi J. U., Zeppa R., Clark R., Morton R., Schiff E. R. Noncirrhotic portal hypertension in Felty's syndrome. Am J Dig Dis. 1977 Feb;22(2):145–148. doi: 10.1007/BF01072959. [DOI] [PubMed] [Google Scholar]
  11. Ritland S. Cirrhosis of the liver in Felty's syndrome. Scand J Rheumatol. 1973;2(1):29–32. [PubMed] [Google Scholar]
  12. STEINER P. E. Nodular regenerative hyperplasia of the liver. Am J Pathol. 1959 Sep-Oct;35:943–953. [PMC free article] [PubMed] [Google Scholar]
  13. Stauffer J. Q., Lapinski M. W., Honold D. J., Myers J. K. Focal nodular hyperplasia of the liver and intrahepatic hemorrhage in young women on oral contraceptives. Ann Intern Med. 1975 Sep;83(3):301–306. doi: 10.7326/0003-4819-83-3-301. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES