Angiodysplasia medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
If the bleeding is from multiple or inaccessible sites, systemic therapy with [[medication]] may be necessary. 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. If the bleeding is from multiple or inaccessible sites, systemic therapy with [[medication]] may be necessary. 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. If the bleeding is from multiple or inaccessible sites, systemic therapy with medication may be necessary. 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[1] and thalidomide,[2]
References
- ↑ 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.