Efficacy of pharmacologic treatment for treating gastrointestinal angiodysplasias-related bleeding: a systematic review and meta-analysis

Abstract

Introduction We evaluated the efficacy of pharmacologic treatments for patients with overt or occult bleeding due to gastrointestinal angiodysplasias (GIADs). Methods A systematic computer-aided literature search across Medline, Cochrane, Scopus and Embase databases was performed. Studies evaluating pharmacologic treatments for patients presenting with GIADs-related overt or occult bleeding were included. Post-treatment rebleeding was the primary outcome. Need for red blood cells (RBC) transfusion, post-treatment hemoglobin levels and adverse events rate comprised secondary outcomes. Results are presented as odds ratio (OR), mean difference (MD) or pooled rates (%) with 95% confidence intervals (95%CI). Results Four types of pharmacologic treatment were identified (25 studies): somatostatin analogs, hormonal therapy, thalidomide and angiogenesis inhibitors. Pharmacologic treatment of any kind led to significantly reduced bleeding episodes [OR (95% CI), 0.08 (0.04–0.18)]. No pharmacologic treatment was superior to others (P = 0.46). Overall, pooled rebleeding rate post-treatment was 34% (26–43%). Similarly, significantly fewer patients required RBC transfusion during the post-treatment period [0.03 (0.03–0.07)], with no differences among various treatments (P = 0.83), yielding an overall pooled transfusion rate of 33% (19–46%). Administration of pharmacological treatment led to significant improvement in terms of hemoglobin levels [MD (95% CI), 3.21 g/dL (2.42–3.99)]. The pooled rate of adverse events was 32% (22–42%). Conclusion In patients with GIADs administration of any pharmacologic treatment significantly decreases rebleeding episodes and transfusions leading to higher hemoglobin values. One-third of them experience at least one adverse event related to the treatment.

Efficacy and safety of thalidomide in gastrointestinal angiodysplasias: systematic review and meta-analysis with trial sequential analysis of randomized controlled trials

“…Our findings are consistent with previous meta-analyses that included both RCTs and observational studies. 5 Pharmacologic treatment of GI angiodysplasias showed a significant reduction in the incidence of rebleeding [odds ratio (OR) = 0.08, 95% CI: 0.04–0.18, I 2 = 50%], and improvement in hemoglobin levels (MD = 3.21 g/dl, 95% CI: 2.42–3.99). Moreover, no participants discontinued treatment due to adverse effects.…”

“… 3 And the small bowel is the most common site of GI angiodysplasias, accounting for approximately 80% of cases, followed by colon (44%) and the stomach (32%). 4 , 5 GI angiodysplasias contribute to about 60% of small bowel bleeding cases. 6 Bleeding tends to be recurrent, can pose a life-threatening risk due to the need for large transfusions and potential emergent hemostatic interventions.…”

Glanzmann's thrombasthenia associated with gastrointestinal angiodysplasias successfully treated with bevacizumab

“…Related to this, a recent systematic review and meta-analysis evaluated the efficacy of treatment GIADs related bleeding with somatostatin analogues, hormonal therapies, thalidomide and bevacizumab. Despite all showing comparable efficacy, thalidomide was proven to have the highest risk of side effects as well as a higher rebleeding rate following treatment in comparison to bevacizumab [15].…”

Management of small bowel angioectasias diagnosed during video capsule endoscopy

“…A recent meta-analysis of 25 studies revealed that somatostatin analogs, hormonal therapy, thalidomide and angiogenesis inhibitors all reduced bleeding episodes (OR 0.08, 95%CI 0.04-0.18), transfusion requirements (OR 0.03, 95%CI 0.03-0.07), and hemoglobin drops, and no pharmacological treatment was superior to the others (P=0.83) [ 77 ]. However, the choice of pharmacological agent should be guided by a knowledge of patient characteristics and side-effect profile.…”