Fujimori S. Tranexamic acid may be a useful pharmacotherapy for endoscopically resistant small bowel angiodysplasia. World J Gastroenterol 2023; 29(7): 1131-1138 [PMID: 36926669 DOI: 10.3748/wjg.v29.i7.1131]
Corresponding Author of This Article
Shunji Fujimori, AGAF, MD, PhD, Director, Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, 1715, Kamagari, Inzai-City, Chiba 270-1694, Japan. s-fujimori@nms.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
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/
World J Gastroenterol. Feb 21, 2023; 29(7): 1131-1138 Published online Feb 21, 2023. doi: 10.3748/wjg.v29.i7.1131
Tranexamic acid may be a useful pharmacotherapy for endoscopically resistant small bowel angiodysplasia
Shunji Fujimori
Shunji Fujimori, Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba 270-1694, Japan
Author contributions: Fujimori S contributed to the writing of this paper.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shunji Fujimori, AGAF, MD, PhD, Director, Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, 1715, Kamagari, Inzai-City, Chiba 270-1694, Japan. s-fujimori@nms.ac.jp
Received: November 5, 2022 Peer-review started: November 5, 2022 First decision: November 17, 2022 Revised: November 23, 2022 Accepted: January 31, 2023 Article in press: January 31, 2023 Published online: February 21, 2023
Abstract
Small bowel angiodysplasia (SBAD) is reported to account for nearly 50% of cases of small bowel bleeding. When SBAD occurs frequently, it is difficult to treat all the angiodysplasias endoscopically, and gastrointestinal bleeding often recurs. Hormone therapy, somatostatin analogs, thalidomide and vascular endothelial growth factor (VEGF)-neutralizing antibodies have been reported to reduce gastrointestinal angiodysplasia (GIAD) bleeding. However, there is no strong evidence to recommend them. Also, there are no guidelines for their use. Hereditary hemorrhagic telangiectasia (HHT) is a hereditary disease caused by abnormalities in VEGF, resulting in multiple GIADs. A treatment guideline has been created for GIAD in HHT, and the use of tranexamic acid, an antifibrinolytic agent, is the first recommendation pharmacotherapy for GIAD with gastrointestinal bleeding that is difficult to treat endoscopically. It has been reported that fibrinolysis is accelerated in GIAD patients who are not HHT, similar to HHT patients. The use of tranexamic acid for gastric antral vascular ectasia in GIAD has been reported to be useful. However, there are very few reports of its use for SBAD. There are concerns with tranexamic acid use regarding the development of thrombosis/embolism, but there are few reports of such side effects. Future clinical trials including tranexamic acid for SBAD are desired.
Core Tip: It is difficult to treat all multiple small bowel angiodysplasias (SBAD) endoscopically. Four main types of drugs, including somatostatin analogs, hormone therapy, thalidomide, and vascular endothelial growth factor-neutralizing antibodies, have been reported for use in gastrointestinal angiodysplasias (GIAD). However, there is no recommended pharmacotherapy for SBAD. Tranexamic acid is recommended for patients with GIAD in hereditary hemorrhagic telangiectasia who are difficult to treat endoscopically. Investigation of the use of tranexamic acid for SBAD is desired.
