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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. <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. Injection sclerotherapy using sclerosants like sodium tetradecyl sulfate or ethanolamine is another option, but rarely used. 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.)
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| 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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| ==References== | | ==References== |
Revision as of 23:31, 6 September 2021