Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2020; 8(15): 3218-3229
Published online Aug 6, 2020. doi: 10.12998/wjcc.v8.i15.3218
Thalidomide for refractory gastrointestinal bleeding from vascular malformations in patients with significant comorbidities
Alexis Mae Bayudan, Chien-Huan Chen
Alexis Mae Bayudan, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63108, United States
Chien-Huan Chen, Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States
Author contributions: Chen CH designed the research; Bayudan AM performed database generation; all authors performed statistical analysis and wrote the paper. Both authors approved the final version.
Institutional review board statement: The study was reviewed and approved by the Washington University Institutional Review Board.
Informed consent statement: As this is a retrospective study, all participants were waived of written informed consent by our IRB.
Conflict-of-interest statement: Both authors have no conflicts of interest.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chien-Huan Chen, MD, PhD, Professor, Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Ave, Box 8124, St. Louis, MO 63110, United States. chen330@wustl.edu
Received: February 8, 2020
Peer-review started: February 8, 2020
First decision: May 22, 2020
Revised: June 15, 2020
Accepted: July 15, 2020
Article in press: July 15, 2020
Published online: August 6, 2020
Abstract
BACKGROUND

Refractory gastrointestinal bleeding (GIB) secondary to gastrointestinal vascular malformations (GIVM) such as gastrointestinal angiodysplasia (GIAD) and gastric antral vascular ectasia (GAVE) remains challenging to treat when endoscopic therapy fails. Recently thalidomide has been suggested as a treatment option for refractory GIB.

AIM

To determine the outcome of patients treated with thalidomide for refractory GIB due to GIVM.

METHODS

IRB approved, single center, retrospective review of electronic medical records from January 2012 to November 2018. Patients age > 18 years old, who had > 3 episodes of GIB refractory to medical or endoscopic therapy, and who had been treated with thalidomide for at least 3 mo were included. The primary endpoint was recurrence of GIB 6 mo after initiation of thalidomide.

RESULTS

Fifteen patients were included in the study, all with significant cardiac, hepatic, or renal comorbidities. The cause of GIB was GIAD in 10 patients and GAVE in 5 patients. Two patients were lost to follow up. Of the 13 patients followed, 38.5% (n = 5) had no recurrent GIB or transfusion requirement after treatment with thalidomide. Furthermore, 84.6% (n = 11) of patients had a reduction in transfusion requirements and hospitalizations for GIB. Thalidomide was discontinued in 2 patients due to cost (n = 1) and medication interaction (n = 1). Reported adverse reactions included fatigue (n = 3), neuropathy (n = 2), dizziness (n = 1), and constipation (n = 1). Six patients died during follow up due to unknown cause (n = 4) and sepsis (n = 2).

CONCLUSION

Thalidomide appears to be an effective treatment for refractory GIB due to GIAD or GAVE in a Western population with significant comorbidities.

Keywords: Vascular malformation, Thalidomide, Refractory gastrointestinal bleeding, Gastric antral vascular ectasia, Angiodysplasia

Core tip: Gastrointestinal vascular malformations (GIVM) consist of several types such as gastrointestinal angiodysplasias (GIAD) and gastric antral vascular ectasias (GAVE). Refractory gastrointestinal bleeding secondary to GIVM such as GIAD and GAVE remains challenging to treat when endoscopic therapy fails. Thalidomide appears to be an effective treatment for refractory gastrointestinal bleeding due to GIAD or GAVE in a Western population with significant comorbidities.