Efficacy of Thalidomide for Refractory Gastrointestinal Bleeding From Vascular Malformation

Ge, Zhi‐Zheng; Chen, Huimin; Gao, Yun‐Jie; Liu, Wen–Zhong; Xu, Chen; Tan, Haisong; Chen, Hai–Ying; Wei, Wei; Fang, Jing‐Yuan; Xiao, Shu–Dong

doi:10.1053/j.gastro.2011.07.018

Cited by 200 publications

(169 citation statements)

References 33 publications

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“…Following thalidomide treatment, there was a reduction in gastrointestinal bleeding, and plasma VEGF levels decreased significantly compared to levels before treatment, with the decrease more significant in responders than non-responders. 16 Bevacizumab is a reasonable agent to consider for the treatment of HHT, based on the molecular mechanisms involved in both angiogenesis and HHT. In our patient, initiation of bevacizumab resulted in rapid resolution of bleeding.…”

Section: Discussionmentioning

confidence: 99%

Blessing for the Bleeder: Bevacizumab in Hereditary Hemorrhagic Telangiectasia

Epperla

Hocking

2014

Clinical Medicine & Research

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Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder characterized by uncontrolled multisystem angiogenesis with epistaxis, gastrointestinal bleeding, iron-deficiency anemia, and arteriovenous malformations, and is often associated with increased levels of vascular endothelial growth factor (VEGF). Bevacizumab, a VEGF inhibitor, reduces epistaxis, telangiectasias, and irondeficiency anemia. We present the case of a woman with HHT and chronic gastrointestinal bleeding who required iron supplementation and multiple blood transfusions. Bevacizumab resulted in marked symptom improvement and transfusion-independence. Our report describes the dose schedule and calls for a randomized, controlled trial demonstrating the value of bevacizumab therapy.

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Section: Discussionmentioning

confidence: 99%

Blessing for the Bleeder: Bevacizumab in Hereditary Hemorrhagic Telangiectasia

Epperla

Hocking

2014

Clinical Medicine & Research

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“…Medical treatment of angiectasias are at present reserved for patients refractory to endoscopic therapy, and somatostatin analogues are usually the first choice with thalidomide coming second. 21,22 Value of Thalidomide in angiectasias is significantly strengthened by a recent randomized study that provides evidence of effectiveness 23 , but the drug is not approved in the U.S. or in Europe for treatment of angiectasias. Hormone therapy has been abandoned with negative results from a randomized trial.…”

Section: Treatment Of Small Bowel Bleedingmentioning

confidence: 99%

Interventional balloon-enteroscopy

Albert¹

2012

jig

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“…Somatostatin analogues have a better side-effect profile than other drugs such as anti-angiogenic drug [44,45] and hormonal treatment [46]. The main side effects include gastrointestinal disturbances, hypothyroidism, gallstone disease and pancreatic enzyme insufficiency [30,47].…”

Section: Discussionmentioning

confidence: 99%

Refractory Anaemia Secondary to Small Bowel Angioectasias - Comparison between Endotherapy Alone versus Combination with Somatostatin Analogues

Zammit

Sidhu

Sanders

2017

JGLD

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Background & Aims: Patients with small bowel angioectasias (SBAs) can be difficult to manage as they are generally elderly with multiple co-morbidities. Angioectasias are multiple and tend to recur. Argon plasma coagulation (APC), despite being a commonly used method to treat these patients has an associated persistent rate of re-bleeding necessitating additional treatment to manage these patients.Methods: All patients with refractory iron deficiency anaemia secondary to SBAs were retrospectively subdivided into two groups. Patients in group 1 were managed with double balloon enteroscopy (DBE) and APC alone and those in group 2 received Lanreotide in addition to DBE and APC.Results: A total of 49 patients were included in this study: group 1: 37 patients (75.5%), group 2: 12 patients (24.5%). All had significant comorbidities and the mean duration of anaemia was 114.3, SD 307.0 months. Significant improvements in haemoglobin (Hb) (11g/L vs 3.2g/L p=0.043), transfusion requirements per month (0.8 vs 4.7 p=0.052) and mean bleeding episodes (1.08 vs 2.6 p=0.032) were demonstrated in group 2 when compared to group 1. One patient developed symptomatic gallstone disease and one patient stopped Lanreotide due to a lack of response.Conclusions: This is the first study comparing endotherapy to a combination of endotherapy and pharmacotherapy. It shows a significantly better outcome in patients receiving a combination of endotherapy and Lanreotide. Lanreotide can be a safe additional treatment in patients not responding to APC alone.Abbreviations: APC: argon plasma coagulation; CE: capsule endoscopy; DBE double balloon enteroscopy; Hb: hemoglobin; OGIB: over gastrointestinal bleeding; SBAs: small bowel angioectasias.

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Efficacy of Thalidomide for Refractory Gastrointestinal Bleeding From Vascular Malformation

Cited by 200 publications

References 33 publications

Blessing for the Bleeder: Bevacizumab in Hereditary Hemorrhagic Telangiectasia

Blessing for the Bleeder: Bevacizumab in Hereditary Hemorrhagic Telangiectasia

Interventional balloon-enteroscopy

Refractory Anaemia Secondary to Small Bowel Angioectasias - Comparison between Endotherapy Alone versus Combination with Somatostatin Analogues

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