Octreotide Use in Gastric Antral Vascular Ectasia

Abstract

Background Gastric antral vascular ectasia (GAVE) accounts for 4% of non‐variceal gastrointestinal bleeding. Argon Plasma Coagulation, an endoscopic therapy, is the treatment of choice, followed by medications and surgery. There is limited evidence for drug therapies, such as corticosteroids, hormones, tranexamic acid, thalidomide and octreotide, to treat GAVE. Aim To describe a case of octreotide use in GAVE. Clinical details A 78‐year‐old female with repeat gastrointestinal bleeds required frequent hospitalisation for investigations and blood and iron transfusions. She was eventually diagnosed with GAVE but multiple endoscopic treatments were ineffective. She was unsuitable for surgery because of her advanced age and comorbidities. She was initiated on octreotide 200 micrograms 3 times daily with ongoing maintenance on 100 micrograms 3 times daily. Outcome Prior to initiation of octreotide (June 2011 to May 2012), the patient was transfused with 53 units of blood, 5.9 g of iron and spent 151 days in hospital. Post initiation of octreotide (June 2012 to April 2013), she only required 13 units of blood, 1.9 g of iron and spent 38 days in hospital. Conclusion Successful use of octreotide in this patient with GAVE contributes to the limited available evidence.

Educating for Peace

“…Inthisarticle,theauthorpresentsapeace-centeredprocessofteachingmarketingthatshehas implementedduring2002-2016academicyearswithherundergraduateandgraduatebusinessstudents invariousmarketingcoursesintheUnitedStates,HongKongandChina.Heryearsofpersonaland professionalstudyandreflectiveteachinghaveledhertodevelopthisprocess.Peaceisdefinedas"the harmonyofallenergiesoflife,theirbalance,andtherecognitionofalltheoppositesandconflicts" (Haring,1986,p.8).Itisaprocessandwillbeshapedbyaperson'sperspectiveaboutreality,human nature,andmeaningsoflife (Lupovici,2013).Itneedsspiritualdisciplinesandneedsthepractices ofempathy.Shehasyearsofresearchabouthumanrightsinhighereducation (Lam,Lam,andLam, 2006)andhasadvocatedempathyasanotherparadigminthestudyofcorporatesocialresponsibility andsustainability (CookandLam,2013;LamandWong,2018;Lam,2000Lam, ,2007Lam, ,2009aLam, ,2009bLam, , 2010aLam, ,2010bLam, ,2010cLam, ,2011aLam, ,2011bLam, ,2011cLam, ,2012aLam, ,2012bLam, ,2013aLam, ,2013bLam, ,2013cLam, ,2013dLam, ,2013e,2014aLam, , 2014bLam, ,2014cLam, ,2014dLam, ,2015Lam, ,2016Lam, ,2017Lam, ,2018.Thisprocessaffirmspersonhoodthroughthepractices ofmindfulnessandmeditation (Eshelman,Lam,andCook,2012).Thisprocessneedseducatorsand studentstopracticecriticalreflectionskillsanddevelopvirtuestogetherinalovingcommunity.Itis theauthor'scontentionthattheprocesswillequipherstudentsto"takeresponsibilityforfairlyand honestlycommunicatingaproduct'sattributesandbenefitswhilebalancingthedemandforexciting creativityandemotionalenthusiasmwithinthenatureoftruthfulrelationships"betweenorganizations andcustomers (Thompson,2002),andtolearntobeopentoself-deceptivepracticesintheirlives.…”