[Octreotide long acting release for severe obscure gastrointestinal haemorrhage in elderly patients with serious comorbidities].

Unidad de Aparato Digestivo, Hospital San Pedro de Alcántara, Cáceres, España.
Medicina Clínica (Impact Factor: 1.25). 09/2009; 133(17):667-70.
Source: PubMed

ABSTRACT Octreotide LAR has shown preliminary promising results in the treatment of recurrent obscure gastrointestinal haemorrhage.
Eleven patients with severe comorbidities were treated with continuous octreotide LAR 20mg once a month. No changes were performed in concomitant drugs. Haemoglobin levels, blood transfusions, hospital admissions and adverse effects were recorded every three months.
Median age and follow-up were 74 yr (65-86) and 15 months (5-48). Five patients were on acenocoumarol therapy and other five on antiplatelet drugs. Eight patients (72%) had diffuse small bowel angiodysplasia and 4 patients died during follow-up. Only two patients (18%) remained free of transfusions but it resulted for the first year in an outstanding decrease in the need of red cell packets (14 (9-49) vs 4 (0-9), p=0,002) and in admission days related to gastrointestinal bleeding (27 (10-99) vs 7(0-23), p=0,001). No side effects were reported.
Octreotide LAR is an effective, safe and comfortable palliative therapy for severe obscure gastrointestinal bleeding. Medical resources saving and improved quality of life may warrant its use irrespective of comorbidities or life expectancy.

  • Source
    Revista medica de Chile 07/2011; 139(7):909-913. DOI:10.4067/S0034-98872011000700012 · 0.37 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Angiodysplasia (AD) of the gastrointestinal (GI) tract is an important condition that can cause significant morbidity and -rarely - mortality. To provide an up-to-date comprehensive summary of the literature evaluating this disease entity with a particular focus on pathogenesis as well as current and emerging diagnostic and therapeutic modalities. Recommendations for treatment will be made on the basis of the current available evidence and consensus opinion of the authors. A systematic literature search was performed. The search strategy used the keywords 'angiodysplasia' or 'arteriovenous malformation' or 'angioectasia' or 'vascular ectasia' or 'vascular lesions' or 'vascular abnormalities' or 'vascular malformations' in the title or abstract. Most AD lesions (54-81.9%) are detected in the caecum and ascending colon. They may develop secondary to chronic low-grade intermittent obstruction of submucosal veins coupled with increased vascular endothelial growth factor-dependent proliferation. Endotherapy with argon plasma coagulation resolves bleeding in 85% of patients with colonic AD. In patients who fail (or are not suitable for) other interventions, treatment with thalidomide or octreotide can lead to a clinically meaningful response in 71.4% and 77% of patients respectively. Angiodysplasia is a rare, but important, cause of both overt and occult GI bleeding especially in the older patients. Advances in endoscopic imaging and therapeutic techniques have led to improved outcomes in these patients. The choice of treatment should be decided on a patient-by-patient basis. Further research is required to better understand the pathogenesis and identify potential therapeutic targets.
    Alimentary Pharmacology & Therapeutics 10/2013; 39(1). DOI:10.1111/apt.12527 · 4.55 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Gastrointestinal angiodysplasias are an important cause of bleeding difficult to manage especially in older patients. Aim To retrospectively evaluate the long-term efficacy of long acting release-octreotide in controlling angiodysplasia bleeding. Methods 98 patients with a history of bleeding due to gastrointestinal angiodysplasias lasting over 2 years were retrospectively selected among those treated from January 2000 to December 2008. All patients had received octreotide 0.1 mg tid for 28 days and, then from day 14, long acting release-octreotide 20 mg monthly, for 6 months. Results The mean follow-up was 78 months. In all patients mean haemoglobin levels significantly increased and the number of bleeding episodes, hospitalizations, patients requiring blood transfusions and units of transfused red cells significantly decreased, compared to the two-year observation period before starting therapy. According to outcome patients were classified as: 40 full responders (40.8%), 32 relapsers (32.6%) and 26 poor responders (26.5%). At multivariate analysis age >65 years, male sex, chronic antiplatelet therapy, chronic obstructive pulmonary disease and chronic renal failure were the only covariates independently associated with poor response to therapy. Conclusion Our study suggests that long acting release-octreotide could be used as rescue therapy to control bleeding due to gastrointestinal angiodysplasias in patients not suitable for endoscopic or surgical treatments.
    Digestive and Liver Disease 08/2014; 46(8). DOI:10.1016/j.dld.2014.04.011 · 2.89 Impact Factor