Somatostatin Therapy Ameliorates Chronic and Refractory Gastrointestinal Bleeding Caused by Diffuse Angiodysplasia in a Patient on Anticoagulation Therapy

Abstract

We present a patient receiving chronic anticoagulant treatment with recurrent and intractable gastrointestinal bleeding due to diffuse angiodysplasia. Following failure of previous medical and surgical treatment, and in light of the patient's need for chronic anticoagulation due to mechanical heart valve, she was treated with somatostatin analogue, octreotide s.c. 100 microg on alternate days for 28 months. Treatment significantly decreased the occurrence of bleeding episodes, the need for hospitalization and blood transfusion requirements despite continued anticoagulant therapy. Octreotide treatment should be considered in patients with refractory gastrointestinal bleeding due to angiodysplasia in particular in those who need anticoagulant treatment.

Radiofrequency ablation using Barrx^® for the endoscopic treatment of gastric antral vascular ectasia: a series of three cases and a review of the literature on treatment options

“…Unlike published trials on hormones, most of the data regarding octreotide as a treatment option for GAVE have come from isolated case reports or case series only. To date, there are 18 published cases of the use of octreotide 21–29. The mean follow-up time in these cases was 20.1 (range: 0.1–64) months, and the doses of octreotide ranged from 100 μg subcutaneously twice daily to 500 μg subcutaneously twice daily.…”

Gastrointestinal Angiodysplasia in Three Saudi Children

“…However, intra-arterial vasopressin can control massive lower gastrointestinal bleeding in 70% to 91% of patients, but bleeding recurs after discontinuation of vasopressin in 22% to 71% of patients 10. Octreotide treatment should be considered in patients with refractory gastrointestinal bleeding due to angiodysplasia, in particular in those who need anticoagulant treatment 14. Octerotide has shown a beneficial response in the long-term management of patients with gastrointestinal angiodysplasia 1516…”

Octreotide as an adjunct in the management of arterial gastrointestinal bleeding: Should it be considered in refractory cases of obscure origin?

“…[1] Clinical approaches to obscure GI bleeding are schematically shown in Figure 2, with the recurrent yet diagnostically “negative” scenarios being most appropriate for therapeutic use of octreotide (the “green zone” as highlighted in the figure). Somatostatin is a cyclic peptide secreted in the GI tract.…”

“…[12] Some have termed it “obscure gastrointestinal hemorrhage” (OGH) or obscure overt bleeding. [3] Potential sources of GI bleeding are summarized in Figure 1.…”