Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.
Department of Gastroenterology, Tallaght Hospital, Dublin, Ireland.
United European Gastroenterol J. 2016 Feb;4(1):70-6. doi: 10.1177/2050640614559121. Epub 2015 Nov 5.
Small bowel angiodysplasias account for over 50% of causes of small bowel bleeding and carry a worse prognosis than lesions located elsewhere in the gastrointestinal tract. Re-bleeding rates are high even after first-line endoscopic therapy and are associated with high levels of morbidity for affected patients. Small trials of long-acting somatostatin analogues have shown promising results but have not yet been assessed in patients with refractory small bowel disease.
The purpose of this study was to assess the effect of long-acting somatostatin analogues in reducing re-bleeding rates and transfusion requirements, and improving haemoglobin levels in patients with refractory small bowel angiodysplasia.
Patients with refractory small bowel angiodysplasia were treated with 20 mg of long-acting octreotide for a minimum of three months. Response was assessed according to: rates of re-bleeding, haemoglobin levels, transfusion requirements, and side effects.
A total of 24 patients were initially treated and 20 received at least three doses. Rates of complete, partial and non-response were 70%, 20% and 10% respectively. Average haemoglobin rates increased from 9.19 g/dl to 11.35 g/dl (p = 0.0027, 95% confidence interval (CI) -3.5 to -1.1) in the group overall and 70% remained transfusion-free after a mean treatment duration of 8.8 months. The rate of adverse events was higher than previously reported at 30%.
Long-acting somatostatin analogues offer a therapeutic advantage in a significant proportion of patients with small bowel angiodysplasia. With careful patient selection and close observation, a long-acting somatostatin analogue should be considered in all patients with persistent anaemia attributable to refractory disease in conjunction with other standard treatments.
小肠血管发育不良占小肠出血原因的 50%以上，其预后比胃肠道其他部位的病变差。即使在一线内镜治疗后，再次出血的发生率仍然很高，并且会使受影响的患者发病率升高。长效生长抑素类似物的小型试验显示出了有希望的结果，但尚未在难治性小肠疾病患者中进行评估。
本研究旨在评估长效生长抑素类似物在降低再出血率和输血需求、提高难治性小肠血管发育不良患者的血红蛋白水平方面的效果。
对难治性小肠血管发育不良患者给予 20mg长效奥曲肽治疗，至少 3 个月。根据以下标准评估反应：再出血率、血红蛋白水平、输血需求和副作用。
共有 24 名患者最初接受了治疗，其中 20 名患者至少接受了 3 剂治疗。完全、部分和无反应的比例分别为 70%、20%和 10%。总体而言，血红蛋白水平从 9.19g/dl 平均增加到 11.35g/dl（p=0.0027，95%置信区间（CI）-3.5 至-1.1），70%的患者在平均治疗持续时间为 8.8 个月后无需输血。不良事件发生率高于之前报道的 30%。
长效生长抑素类似物在相当一部分小肠血管发育不良患者中提供了治疗优势。通过仔细选择患者并密切观察，对于持续性贫血归因于难治性疾病的所有患者，应在其他标准治疗的基础上考虑使用长效生长抑素类似物。
