Barkin J S, Ross B S
University of Miami, School of Medicine/Mt. Sinai Medical Center, Division of Gastroenterology, Florida 33140, USA.
Am J Gastroenterol. 1998 Aug;93(8):1250-4. doi: 10.1111/j.1572-0241.1998.404_i.x.
The aim of this study was to evaluate the effectiveness and safety of combined hormonal therapy in patients with recurring occult gastrointestinal bleeding of obscure origin.
This was a prospective longitudinal observational study. The setting was an outpatient private practice affiliated with a large university-based hospital. A total of 43 patients, comprising 14 men and 29 women with a mean age of 74 yr (range 48-86 yr), were included. They had a history of recurrent gastrointestinal bleeding of unknown origin for a period of > 1 yr and had required multiple hospitalizations and transfusions. Patients were initially treated with one Enovid 5-mg tablet containing 5 mg norethynodrel and 75 microg of mestranol. Enovid became commercially unavailable and treatment was changed to Ortho-Novum 1/50, containing 1 mg norethindrone and 0.05 milligrams of mestranol, given one tablet b.i.d. Patients were treated and followed for a mean time of 535 days (range 25-1551 days). All patients acted as their own controls and were followed for compliant behavior with periodic hematocrit, serial stool hemoccults, medication counts, and clinical histories regarding transfusion requirements or hospitalization for bleeding or anemia.
Of 43 patients who initially entered the study, 38 were treated with combination hormonal therapy. The remaining five patients were treated with estrogen alone. In 25 patients, initial enteroscopy revealed AVMs in the stomach or proximal small bowel and these were cauterized. In the remaining 18 patients no source of bleeding was found. None of the 38 patients who were treated with combination hormonal therapy rebled as long as they continued their prescribed dosage. All five of the patients treated with estrogen alone had rebleeding episodes. There was no statistical difference with respect to AVM cauterization in the rebleeding rate between those patients who underwent cauterization of their AVMs and those who did not. Side effects of combination hormonal therapy occurred in 11 patients and all were considered to be mild. Seven of these 11 patients (64%) elected to continue treatment.
In this long-term observational study, combination hormonal therapy was shown to stop rebleeding in patients with occult gastrointestinal bleeding of obscure origin.
本研究旨在评估联合激素疗法对不明原因复发性隐匿性胃肠道出血患者的有效性和安全性。
这是一项前瞻性纵向观察性研究。研究地点为一家附属于大型大学医院的门诊私人诊所。共纳入43例患者，其中男性14例，女性29例，平均年龄74岁（范围48 - 86岁）。他们有不明原因的复发性胃肠道出血病史超过1年，且需要多次住院和输血。患者最初服用一片含5 mg炔诺孕酮和75 μg炔雌醇甲醚的Enovid 5 mg片剂。Enovid停产后来改为服用含1 mg炔诺酮和0.05 mg炔雌醇甲醚的Ortho - Novum 1/50，每日两次，每次一片。患者接受治疗并随访平均535天（范围25 - 1551天）。所有患者均作为自身对照，通过定期检测血细胞比容、连续大便潜血试验、药物计数以及关于输血需求或因出血或贫血住院的临床病史来随访其依从行为。
最初纳入研究的43例患者中，38例接受了联合激素疗法。其余5例患者仅接受雌激素治疗。25例患者初次肠镜检查发现胃或近端小肠有动静脉畸形（AVM），并对其进行了烧灼治疗。其余18例患者未发现出血源。接受联合激素疗法的38例患者只要继续按规定剂量服药就没有再次出血。仅接受雌激素治疗的5例患者均有再次出血事件。接受AVM烧灼治疗的患者与未接受烧灼治疗的患者在再出血率方面，就AVM烧灼情况而言无统计学差异。联合激素疗法的副作用发生在11例患者中，所有副作用均被认为是轻度的。这11例患者中有7例（64%）选择继续治疗。
在这项长期观察性研究中，联合激素疗法被证明可使不明原因隐匿性胃肠道出血患者停止再次出血。
