[Octreotide long acting release for severe obscure gastrointestinal haemorrhage in elderly patients with serious comorbidities].
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.
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ABSTRACT: We report the challenging case of an 81-year-old woman on dual antiplatelet therapy with recurrent strokes, who presented with severe obscure gastrointestinal bleeding. A thorough diagnostic work-up, including capsule endoscopy, double balloon enteroscopy, arteriography, exploratory laparotomy and mouth-to-anus intraoperative enteroscopy, failed to reveal the source of the bleeding. During a 2-year period, the patient required 117 packed red blood cell units, despite withdrawal of antiplatelet drugs and empirical therapy with high-dose somatostatin analogues. The patient was administered an increasing dosage of thalidomide, up to 300 mg/day, with thromboembolism prophylaxis for 3 months, with no clinical response. The bleeding stopped for 3 months after heparin was discontinued, but thalidomide had to be withdrawn owing to adverse effects. Since bleeding recurred a month later, the patient underwent another 3-month course of thalidomide. The patient has not required further blood transfusion after a 1-year follow-up.Gastroenterología y Hepatología. 01/2013; 36(1):35–38.
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ABSTRACT: Gastrointestinal angiodysplasias (GIADs) may be the cause of recurrent bleeding, despite endoscopic treatment. To evaluate the effect of long-acting somatostatin analogues on blood transfusion requirements, in patients with refractory bleeding due to GIADs. Consecutive patients with recurrent bleeding from GIADs were enrolled. They received somatostatin analogue treatment for at least 6 months. The efficacy was evaluated in terms of blood transfusions, frequency of bleeding episodes and haemoglobin level during 6 months of treatment (Period During) compared to a 6-months' period before treatment (Period Before). Fifteen patients were enrolled from 2007 to 2010. The median duration of somatostatin analogue treatment was 12 months (range: 6-36). The number of transfusions significantly decreased in Period During compared with Period Before [median number: 2 (0-14) vs. 10 (6-24); P < 0.001]. The percentage of patients who experienced a bleeding event was lower during somatostatin analogues treatment (20% vs. 73%; P = 0.01). The mean haemoglobin level was significantly higher when somatostatin analogues were offered [median: 10 g/dL (9-13) vs. 7 (5-8.5); P < 0.001]. None of the patients discontinued treatment due to side effects. Long-acting somatostatin analogues treatment decreased transfusion needs in patients with refractory bleeding from gastrointestinal angiodysplasias. Bleeding episodes were limited and haemoglobin improved during treatment. Long-acting somatostatin analogues may represent an option for the management of patients with chronic bleeding due to gastrointestinal angiodysplasias.Alimentary Pharmacology & Therapeutics 07/2012; 36(6):587-93. · 4.55 Impact Factor
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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; · 4.55 Impact Factor