Aberrant blood vessels are frequently found in the gastrointestinal (GI) tract, where they are probably more common than anywhere else in the. Request PDF on ResearchGate | On May 1, , D. Serralta de Colsa and others published Hemorragia invalidante y recidivante por angiodisplasia intestinal. Gastrointestinal angiodysplasias or angioectasias are one of the most common causes of occult gastrointestinal bleeding. Epidemiology Peak incidence occurs.
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Thalidomide in refractory bleeding due to gastrointestinal angiodysplasias. Talidomida en la hemorragia recidivante por angiodisplasias gastrointestinales.
Department of Digestive Diseases. For each patient, we considered: The data obtained were analysed using descriptive statistics with SPSS v. Mean haemoglobin concentration before onset of treatment was 6. Gastrointestinal bleeding and chronic ferropenic anaemia resulting from vascular lesions of the digestive tract sometimes pose a difficult therapeutic challenge due to the location and multiplicity of such lesions.
Gastrointestinal angiodysplasia | Radiology Reference Article |
This causes the deterioration in the quality of life of patients and a significant use of sanitary resources 1. The presence of high levels of vascular endothelial growth factor VEGF promotes aberrant angiogenesis and formation of angiodysplasias with a vascular endothelium lacking in smooth muscle cells and therefore prone to ruptures.
Thalidomide is a drug with a potent anti angiogenic effect which inhibits VEGF and reduces its level significantly 1. So far, few reports have been published of clinical cases showing the efficacy of thalidomide in the treatment of gastrointestinal bleeding due to angiodysplasias 1,2 or severe proctitis following radiotherapy 3.
We angjodisplasia out a prospective study of a series of intesttinal patients with gastrointestinal bleeding and severe ferropenic anaemia who did not respond to endoscopic argon plasma coagulation treatment or somatostatin analogue therapy. All patients antiodisplasia informed about thalidomide treatment and gave their informed consent to take part in the study.
We excluded from the study female patients in fertile age, patients with active infection at the onset of therapy and patients with hepatic cirrhosis as underlying pathology.
For each patient, we considered the following parameters: The diagnosis of gastrointestinal angiodysplasias was obtained through upper and lower gastrointestinal endoscopy. Angiodysplasia of the small intestine was diagnosed by means of video capsule endoscopy with push enteroscopy or double-balloon enteroscopy in aangiodisplasia of therapy.
Table I shows the general characteristics of the patients. However, the treatment was discontinued after 3 days in one patient due to gastrointestinal intolerance to the drug and after one week in another patient due to fever and thrombophlebitis after cat scratching. Figure 1 angiodizplasia the evolution of haemoglobin concentration two months after onset of therapy in which we can observe a significant increase which continues until end of therapy.
Another patient showed signs compatible with axonal sensitive polyneuropathy which prompted withdrawal of thalidomide. The symptoms resolved once the treatment had finished. None of the patients required transfusions during the study period. Thalidomide shows anti-inflammatory, immunomodulatory and anti-angiogenic properties and inhibits VEGF production, which is considered a key factor for the formation of the vascular endothelium in the initial stages of angiogenesis.
Thalidomide is a recent and promising therapeutic option in patients with gastrointestinal bleeding and anaemia secondary to vascular malformations.
Thalidomide is contraindicated in the case of patients with peripheral neuropathy, in pregnant women due to its teratogenic effects and in patients with active infections due to its immunosuppressive property and its ability to inhibit of tumour necrosis factor alpha.
It must be used with caution in patients with angiodisplasja, cardiovascular or liver diseases, as severe cases of hepatotoxicity have been reported in the literature 4.
Angiodysplasia of the gastrointestinal tract.
Endoscopic capsule examination shows a reduction in the number, size and colour of vascular lesions in patients receiving thalidomide treatment, and control of haemorrhage during a mean follow up period of years without necessity of transfusions. In general, the adverse side effects reported in the literature are not severe fatigue, peripheral neuropathy, skin rash and resolved after withdrawal of the drug.
Moreover, as thalidomide acts in the origin of these lesions through VEGF inhibition, it prevents the development of future angiodysplasias 5. So far, few reports have assessed the efficacy of thalidomide in the treatment of gastrointestinal bleeding due to angiodysplasia with the exception of a few isolated cases 6,7being our series of patients the largest reported in the medical literature.
Thalidomide has also proved to be effective in the management of refractory bleeding due to gastropathy in patients with portal hypertension 8severe postradiotherapy proctitis 3 and has also been satisfactorily employed in a patient with Von Willebrand disease and bleeding due to small bowel angiodysplasia who had not responded to previous treatment with tranexamic acid, desmopressin, octreotide, recombinant factor VII and endoscopic argon plasma coagulation 9.
It has been demonstrated that VEGF inhibition depends on the dose of thalidomide administered 1.
As a result, the quality of life of patients improves and discomfort diminishes. Although there is no study published on the analysis of costs, undoubtedly the above mentioned intesinal also entail significant economic saving. Several points must still be clarified: According to the results of our study, the maximum haemoglobin level is reached approximately two months after onset of treatment, although the last two months may contribute to the complete elimination of angiodysplasias.
Optimum dose, comparison of thalidomide treatment with somatostatin analogue therapy, endoscopic treatment, etc. In view of the results obtained, we think it will be necessary to reconsider the role thalidomide plays in the treatment of this type of inetstinal.
At present it is used as third- or fourth-line treatment applied to refractory lesions Due to the small samples included in the reports published in the scientific literature on this subject, it will probably be necessary to carry out multicentric studies to clear all these doubts and definitely establish thalidomide as a new and promising therapeutic option for these patients angiodissplasia Efficacy of thalidomide for refractory gastrointestinal bleeding angiodisplasiaa vascular malformations.
Thalidomide for the treatment of chronic gastrointestinal bleeding from angiodysplasias: Eur J Gastroenterol Hepatol ; Thalidomide in refractory haemorrhagic radiation induced proctitis. Macroscopic appearance of intestinal angiodysplasias under antiangiogenic treatment with thalidomide.
ANGIODISPLASIA INTESTINAL PDF
Hemorragia invalidante y recidivante por angiodisplasia intestinal: Rev Esp Enferm Dig ; Eficacia de la talidomida en la hemorragia digestiva por angiodisplasias. Rev Esp Enferm Dig Refractory bleeding from portal hypertensive gastropathy: A further novel role for thalidomide therapy?
Somatostatin analogues for bleeding gastrointestinal angiodysplasias: Dig Dis Sci ; Introduction Gastrointestinal bleeding and chronic ferropenic anaemia resulting from vascular lesions of the digestive tract sometimes pose a difficult therapeutic challenge due to the location and multiplicity of such lesions. Material and methods We carried out a prospective study of a series of multitransfused patients with gastrointestinal bleeding and severe ferropenic anaemia who did not respond to endoscopic argon plasma coagulation treatment or somatostatin analogue therapy.
Discussion Thalidomide shows anti-inflammatory, immunomodulatory and anti-angiogenic properties and inhibits VEGF production, which is considered a key factor for the formation of the vascular endothelium in the initial stages of angiogenesis.