Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3158
Peer-review started: July 17, 2015
First decision: August 31, 2015
Revised: November 30, 2015
Accepted: January 30, 2016
Article in press: January 30, 2016
Published online: March 21, 2016
Processing time: 242 Days and 16.1 Hours
For more than 50 years bleeding from gastrointestinal angiodysplasias has been treated by hormonal therapy with estrogens and progesterons. After a randomized study finally demonstrated that hormones have no effect on bleeding events and transfusion requirements, therapy has switched to endoscopic coagulation. However, angiodysplasias tend to recur over months to years and endoscopy often has to be repeated for long time periods. Thalidomide, which caused severe deformities in newborn children in the 1960s, is now increasingly used after it was shown to suppress tumor necrosis factor alpha, inhibit angiogenesis and to be also effective for treatment of multiple myeloma. In 2011 thalidomide was proven to be highly effective for treatment of bleeding from gastrointestinal angiodysplasias in a randomized study. Further evidence by uncontrolled studies exists that thalidomide is also useful for treatment of bleeding in hereditary hemorrhagic telangiectasia. In spite of this data, endoscopic therapy remains the treatment of choice in many hospitals, as thalidomide is still notorious for its teratogenicity. However, patients with gastrointestinal bleeding related to angiodysplasias are generally at an age in which women have no child-bearing potential. Teratogenicity is therefore no issue for these elderly patients. Other side-effects of thalidomide like neurotoxicity may limit treatment options but can be monitored safely.
Core tip: Traditionally, bleeding from gastrointestinal angiodysplasias has been treated by hormonal therapy. After a randomized study finally demonstrated that hormones are not efficient, treatment has switched to endoscopic coagulation techniques. Thalidomide was recently proven to be highly effective for treatment of bleeding from gastrointestinal angiodysplasias and is also useful for bleeding in hereditary hemorrhagic telangiectasia. However, thalidomide is rarely used as it is still notorious for its teratogenicity. Patients with gastrointestinal bleeding related to angiodysplasias are generally old and teratogenicity is not an important issue. Other side-effects of thalidomide like neurotoxicity may limit treatment options but can be monitored safely.