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. 2020 Aug 6;8(15):3218-3229.
doi: 10.12998/wjcc.v8.i15.3218.

Thalidomide for refractory gastrointestinal bleeding from vascular malformations in patients with significant comorbidities

Alexis Mae Bayudan  1 , Chien-Huan Chen  2
Affiliations

Thalidomide for refractory gastrointestinal bleeding from vascular malformations in patients with significant comorbidities

Alexis Mae Bayudan et al. World J Clin Cases. .

Abstract

Background: Refractory gastrointestinal bleeding (GIB) secondary to gastrointestinal vascular malformations (GIVM) such as gastrointestinal angiodysplasia (GIAD) and gastric antral vascular ectasia (GAVE) remains challenging to treat when endoscopic therapy fails. Recently thalidomide has been suggested as a treatment option for refractory GIB.

Aim: To determine the outcome of patients treated with thalidomide for refractory GIB due to GIVM.

Methods: IRB approved, single center, retrospective review of electronic medical records from January 2012 to November 2018. Patients age > 18 years old, who had > 3 episodes of GIB refractory to medical or endoscopic therapy, and who had been treated with thalidomide for at least 3 mo were included. The primary endpoint was recurrence of GIB 6 mo after initiation of thalidomide.

Results: Fifteen patients were included in the study, all with significant cardiac, hepatic, or renal comorbidities. The cause of GIB was GIAD in 10 patients and GAVE in 5 patients. Two patients were lost to follow up. Of the 13 patients followed, 38.5% (n = 5) had no recurrent GIB or transfusion requirement after treatment with thalidomide. Furthermore, 84.6% (n = 11) of patients had a reduction in transfusion requirements and hospitalizations for GIB. Thalidomide was discontinued in 2 patients due to cost (n = 1) and medication interaction (n = 1). Reported adverse reactions included fatigue (n = 3), neuropathy (n = 2), dizziness (n = 1), and constipation (n = 1). Six patients died during follow up due to unknown cause (n = 4) and sepsis (n = 2).

Conclusion: Thalidomide appears to be an effective treatment for refractory GIB due to GIAD or GAVE in a Western population with significant comorbidities.

Keywords: Angiodysplasia; Gastric antral vascular ectasia; Refractory gastrointestinal bleeding; Thalidomide; Vascular malformation.

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Conflict of interest statement

Conflict-of-interest statement: Both authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Units of packed red blood cell transfused before and after initiation of thalidomide.
Figure 2
Figure 2
Endoscopic pictures of gastric antral vascular ectasia before and after treatment with thalidomide. A: Gastric antral vascular ectasia (GAVE) with visible bleeding prior to initiation of thalidomide; B: GAVE 3 mo after initiation of thalidomide; C: GAVE 8 mo after initiation of thalidomide.
See this image and copyright information in PMC

References

    1. Junquera F, Saperas E, de Torres I, Vidal MT, Malagelada JR. Increased expression of angiogenic factors in human colonic angiodysplasia. Am J Gastroenterol. 1999;94:1070–1076. - PubMed
    1. Feng N, Chen H, Fu S, Bian Z, Lin X, Yang L, Gao Y, Fang J, Ge Z. HIF-1α and HIF-2α induced angiogenesis in gastrointestinal vascular malformation and reversed by thalidomide. Sci Rep. 2016;6:27280. - PMC - PubMed
    1. Nardone G, Compare D, Martino A, Rocco A. Pharmacological treatment of gastrointestinal bleeding due to angiodysplasias: A position paper of the Italian Society of Gastroenterology (SIGE) Dig Liver Dis. 2018;50:542–548. - PubMed
    1. Draper KV, Huang RJ, Gerson LB. GI bleeding in patients with continuous-flow left ventricular assist devices: a systematic review and meta-analysis. Gastrointest Endosc. 2014;80:435–446.e1. - PubMed
    1. Chalasani N, Cotsonis G, Wilcox CM. Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. Am J Gastroenterol. 1996;91:2329–2332. - PubMed