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World J Gastroenterol. Mar 21, 2016; 22(11): 3158-3164
Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3158
Effective treatment of gastrointestinal bleeding with thalidomide - Chances and limitations
Juergen Bauditz
Juergen Bauditz, Department of Internal Medicine, Helios Klinik Anhalt/Zerbst, 39261 Zerbst, Germany
Juergen Bauditz, Department of Gastroenterology, Hepatology and Infectiology, Charité Campus Mitte, Charité University Hospital, 10117 Berlin, Germany
Author contributions: Bauditz J solely contributed to this paper.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Juergen Bauditz, Department of Internal Medicine, Helios Klinik Anhalt/Zerbst, Friedrich-Naumann Street 53, 39261 Zerbst, Germany. juergen.bauditz@helios-kliniken.de
Telephone: +49-3923-739151 Fax: +49-3923-739291
Received: July 15, 2015
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
Abstract

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.

Keywords: Thalidomide, Angiodysplasia, Vascular malformation, Gastrointestine, Bleeding, Therapy, Angiogenesis, Vascular endothelial growth factor

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.