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==Medical Therapy== | ==Medical Therapy== | ||
If the anemia is severe, [[blood transfusion]] is required before any other intervention is considered. [[Endoscopy|Endoscopic]] treatment is an initial possibility, where cautery or [[argon plasma coagulation]] (APC) laser treatment is applied through the endoscope. [[Cauterization]] may be helpful in stopping the bleeding at endoscopically accessible sites. Mechanical hemostasis using hemoclips or endoclips may be used for localized lesions. If the bleeding is from multiple or inaccessible sites, systemic therapy with [[medication]] may be necessary. <ref name="pmid16111979">{{cite journal| author=Moparty B, Raju GS| title=Role of hemoclips in a patient with cecal angiodysplasia at high risk of recurrent bleeding from antithrombotic therapy to maintain coronary stent patency: a case report. | journal=Gastrointest Endosc | year= 2005 | volume= 62 | issue= 3 | pages= 468-9 | pmid=16111979 | doi=10.1016/s0016-5107(05)01634-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16111979 }} </ref> <ref name="pmid16650560">{{cite journal| author=Pishvaian AC, Lewis JH| title=Use of endoclips to obliterate a colonic arteriovenous malformation before cauterization. | journal=Gastrointest Endosc | year= 2006 | volume= 63 | issue= 6 | pages= 865-6 | pmid=16650560 | doi=10.1016/j.gie.2005.10.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16650560 }} </ref> First-line options include the antifibrinolytics [[tranexamic acid]] or [[aminocaproic acid]]. Estrogens can be used to stop bleeding from angiodysplasia. Estrogens cause mild hypercoaguability of the blood. Estrogen side effects can be dangerous and unpleasant in both sexes. Changes in voice and [[gynecomastia|breast swelling]] is bothersome in men, but older women often report improvement of [[libido]] and [[menopause|perimenopausal]] symptoms. (The worries about [[hormone replacement therapy]]/HRT, however, apply here as well.) | If the anemia is severe, [[blood transfusion]] is required before any other intervention is considered. [[Endoscopy|Endoscopic]] treatment is an initial possibility, where cautery or [[argon plasma coagulation]] (APC) laser treatment is applied through the endoscope. [[Cauterization]] may be helpful in stopping the bleeding at endoscopically accessible sites. <ref name="pmid8781937">{{cite journal| author=Askin MP, Lewis BS| title=Push enteroscopic cauterization: long-term follow-up of 83 patients with bleeding small intestinal angiodysplasia. | journal=Gastrointest Endosc | year= 1996 | volume= 43 | issue= 6 | pages= 580-3 | pmid=8781937 | doi=10.1016/s0016-5107(96)70195-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8781937 }} </ref> Mechanical hemostasis using hemoclips or endoclips may be used for localized lesions. If the bleeding is from multiple or inaccessible sites, systemic therapy with [[medication]] may be necessary. <ref name="pmid16111979">{{cite journal| author=Moparty B, Raju GS| title=Role of hemoclips in a patient with cecal angiodysplasia at high risk of recurrent bleeding from antithrombotic therapy to maintain coronary stent patency: a case report. | journal=Gastrointest Endosc | year= 2005 | volume= 62 | issue= 3 | pages= 468-9 | pmid=16111979 | doi=10.1016/s0016-5107(05)01634-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16111979 }} </ref> <ref name="pmid16650560">{{cite journal| author=Pishvaian AC, Lewis JH| title=Use of endoclips to obliterate a colonic arteriovenous malformation before cauterization. | journal=Gastrointest Endosc | year= 2006 | volume= 63 | issue= 6 | pages= 865-6 | pmid=16650560 | doi=10.1016/j.gie.2005.10.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16650560 }} </ref> First-line options include the antifibrinolytics [[tranexamic acid]] or [[aminocaproic acid]]. Estrogens can be used to stop bleeding from angiodysplasia. Estrogens cause mild hypercoaguability of the blood. Estrogen side effects can be dangerous and unpleasant in both sexes. Changes in voice and [[gynecomastia|breast swelling]] is bothersome in men, but older women often report improvement of [[libido]] and [[menopause|perimenopausal]] symptoms. (The worries about [[hormone replacement therapy]]/HRT, however, apply here as well.) | ||
In difficult cases, there have been positive reports about [[octreotide]]<ref>{{cite journal |author=Junquera F, Saperas E, Videla S, Feu F, Vilaseca J, Armengol JR, Bordas JM, Piqué JM, Malagelada JR |title=Long-term efficacy of octreotide in the prevention of recurrent bleeding from gastrointestinal angiodysplasia |journal=Am. J. Gastroenterol. |volume=102 |issue=2 |pages=254-60 |year=2007 |pmid=17311647 |doi=10.1111/j.1572-0241.2007.01053.x}}</ref> and thalidomide,<ref>{{cite journal |author=Shurafa M, Kamboj G |title=Thalidomide for the treatment of bleeding angiodysplasias |journal=Am. J. Gastroenterol. |volume=98 |issue=1 |pages=221-2 |year=2003 |pmid=12526972 |doi=10.1111/j.1572-0241.2003.07201.x}}</ref> | In difficult cases, there have been positive reports about [[octreotide]]<ref>{{cite journal |author=Junquera F, Saperas E, Videla S, Feu F, Vilaseca J, Armengol JR, Bordas JM, Piqué JM, Malagelada JR |title=Long-term efficacy of octreotide in the prevention of recurrent bleeding from gastrointestinal angiodysplasia |journal=Am. J. Gastroenterol. |volume=102 |issue=2 |pages=254-60 |year=2007 |pmid=17311647 |doi=10.1111/j.1572-0241.2007.01053.x}}</ref> and thalidomide,<ref>{{cite journal |author=Shurafa M, Kamboj G |title=Thalidomide for the treatment of bleeding angiodysplasias |journal=Am. J. Gastroenterol. |volume=98 |issue=1 |pages=221-2 |year=2003 |pmid=12526972 |doi=10.1111/j.1572-0241.2003.07201.x}}</ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
If the anemia is severe, blood transfusion is required before any other intervention is considered. Endoscopic treatment is an initial possibility, where cautery or argon plasma coagulation (APC) laser treatment is applied through the endoscope. Cauterization may be helpful in stopping the bleeding at endoscopically accessible sites. [1] Mechanical hemostasis using hemoclips or endoclips may be used for localized lesions. If the bleeding is from multiple or inaccessible sites, systemic therapy with medication may be necessary. [2] [3] First-line options include the antifibrinolytics tranexamic acid or aminocaproic acid. Estrogens can be used to stop bleeding from angiodysplasia. Estrogens cause mild hypercoaguability of the blood. Estrogen side effects can be dangerous and unpleasant in both sexes. Changes in voice and breast swelling is bothersome in men, but older women often report improvement of libido and perimenopausal symptoms. (The worries about hormone replacement therapy/HRT, however, apply here as well.)
In difficult cases, there have been positive reports about octreotide[4] and thalidomide,[5]
References
- ↑ Askin MP, Lewis BS (1996). "Push enteroscopic cauterization: long-term follow-up of 83 patients with bleeding small intestinal angiodysplasia". Gastrointest Endosc. 43 (6): 580–3. doi:10.1016/s0016-5107(96)70195-5. PMID 8781937.
- ↑ Moparty B, Raju GS (2005). "Role of hemoclips in a patient with cecal angiodysplasia at high risk of recurrent bleeding from antithrombotic therapy to maintain coronary stent patency: a case report". Gastrointest Endosc. 62 (3): 468–9. doi:10.1016/s0016-5107(05)01634-2. PMID 16111979.
- ↑ Pishvaian AC, Lewis JH (2006). "Use of endoclips to obliterate a colonic arteriovenous malformation before cauterization". Gastrointest Endosc. 63 (6): 865–6. doi:10.1016/j.gie.2005.10.020. PMID 16650560.
- ↑ Junquera F, Saperas E, Videla S, Feu F, Vilaseca J, Armengol JR, Bordas JM, Piqué JM, Malagelada JR (2007). "Long-term efficacy of octreotide in the prevention of recurrent bleeding from gastrointestinal angiodysplasia". Am. J. Gastroenterol. 102 (2): 254–60. doi:10.1111/j.1572-0241.2007.01053.x. PMID 17311647.
- ↑ Shurafa M, Kamboj G (2003). "Thalidomide for the treatment of bleeding angiodysplasias". Am. J. Gastroenterol. 98 (1): 221–2. doi:10.1111/j.1572-0241.2003.07201.x. PMID 12526972.