Bayudan Alexis Mae, Chen Chien-Huan
Department of Medicine, Washington University School of Medicine, St. Louis, MO 63108, United States.
Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States.
World J Clin Cases. 2020 Aug 6;8(15):3218-3229. doi: 10.12998/wjcc.v8.i15.3218.
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.
To determine the outcome of patients treated with thalidomide for refractory GIB due to GIVM.
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.
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% ( = 5) had no recurrent GIB or transfusion requirement after treatment with thalidomide. Furthermore, 84.6% ( = 11) of patients had a reduction in transfusion requirements and hospitalizations for GIB. Thalidomide was discontinued in 2 patients due to cost ( = 1) and medication interaction ( = 1). Reported adverse reactions included fatigue ( = 3), neuropathy ( = 2), dizziness ( = 1), and constipation ( = 1). Six patients died during follow up due to unknown cause ( = 4) and sepsis ( = 2).
Thalidomide appears to be an effective treatment for refractory GIB due to GIAD or GAVE in a Western population with significant comorbidities.
当内镜治疗失败时，继发于胃肠道血管畸形（GIVM）如胃肠道血管发育异常（GIAD）和胃窦血管扩张（GAVE）的难治性胃肠道出血（GIB）的治疗仍然具有挑战性。最近，沙利度胺已被建议作为难治性GIB的一种治疗选择。
确定接受沙利度胺治疗的因GIVM导致的难治性GIB患者的治疗结果。
经机构审查委员会（IRB）批准，对2012年1月至2018年11月的电子病历进行单中心回顾性研究。纳入年龄>18岁、经药物或内镜治疗后有>3次难治性GIB发作且接受沙利度胺治疗至少3个月的患者。主要终点是开始使用沙利度胺6个月后GIB的复发情况。
15例患者纳入研究，均有严重的心脏、肝脏或肾脏合并症。GIB的病因在10例患者中为GIAD，5例患者中为GAVE。2例患者失访。在随访的13例患者中，38.5%（=5）在接受沙利度胺治疗后没有GIB复发或输血需求。此外，84.6%（=11）的患者GIB的输血需求和住院次数减少。2例患者因费用（=1）和药物相互作用（=1）而停用沙利度胺。报告的不良反应包括疲劳（=3）、神经病变（=2）、头晕（=1）和便秘（=1）。6例患者在随访期间因不明原因（=4）和败血症（=2）死亡。
在有严重合并症的西方人群中，沙利度胺似乎是治疗因GIAD或GAVE导致的难治性GIB的有效方法。
