DOI: 10.12890/2020_002099

The Use of Thalidomide in Severe Refractory Anaemia Due to Gastric Antral Vascular Ectasia (GAVE) in Cirrhosis?

Authors

  • Marcelo Aveiro Department of Internal Medicine, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Tatiana Rodrigues Department of Internal Medicine, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Tiago Rabadão Department of Internal Medicine, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Filipa Ferreira Department of Internal Medicine, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Mariana Teixeira Department of Internal Medicine, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Ana Oliveira Department of Internal Medicine, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Inês Vasconcelos Department of Family Medicine, USF Atlântico Norte, Gafanha da Nazaré, Portugal

marceloaveiro90@gmail.com

Keywords

GAVE, thalidomide, cirrhosis

Abstract

Gastric antral vascular ectasia (GAVE) is a rare cause of upper gastrointestinal bleeding associated with cirrhosis. The first-line treatment is endoscopic therapy with argon plasma coagulation (APC). There is a high recurrence rate, but some evidence suggests that thalidomide could play an important role in controlling refractory anaemia due to GAVE. The authors present the case of a cirrhotic patient with a recent diagnosis of GAVE, who underwent multiple endoscopic treatments and blood transfusions because of haematemesis. The patient started thalidomide and 6 months later, there was no recurrence of haematemesis and haemoglobin levels were stable, with no reported adverse effects.

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References

  1. Su T, Yang L. Gastric antral vascular ectasia: a case report and literature review. World Chinese J Dig 2017;25(5):476–478.
  2. Liberski SM, McGarrity TJ, Hartle RJ, Varano V, Reynolds D. The watermelon stomach: long-term outcome in patients treated with Nd:YAG laser therapy. Gastrointest Endosc 1994;40(5):584–587.
  3. Gostout CJ, Viggiano TR, Ahlquist DA, Wang KK, Larson MV, Balm R. The clinical and endoscopic spectrum of the watermelon stomach. J Clin Gastroenterol 1992;15(3):256–263.
  4. Dulai GS, Jensen DM, Kovacs TOG, Gralnek IM, Jutabha R. Endoscopic treatment outcomes in watermelon stomach patients with and without portal hypertension. Endoscopy 2004;36(1):68–72.
  5. Yamada M, Ichikawa M, Takahara O, Tsuchida T, Ishihara A, Yamada M, et al. Gastroduodenal vascular ectasia in patients with liver cirrhosis. Dig Endosc 1999;11(3):241–245.
  6. Patwardhan VR, Cardenas A. Review article: The management of portal hypertensive gastropathy and gastric antral vascular ectasia in cirrhosis. Aliment Pharmacol Ther 2014;40(4):354–362.
  7. Santos S, Bernardes C, Borges V, Ramos G. Gastric antral vascular ectasia (GAVE) and hereditary hemorrhagic telangiectasia (HHT): two different conditions, one treatment. Ann Hematol 2020;99(2):367–369.
  8. Thonhofer R, Siegel C, Trummer M, Gugl A. Medical versus laser therapy for gastric antral vascular ectasia: comment on the clinical images by Thonhofer et al. Arthritis Rheum 2010;62(11):3517–3518.
  9. D’Amato RJ, Loughnan MS, Flynn E, Folkman J. Thalidomide is an inhibitor of angiogenesis. Proc Natl Acad Sci U S A 1994;91(9):4082–4085.
  10. Rider JA, Klotz AP, Kirsner JB. Gastritis with veno-capillary ectasia as a source of massive gastric hemorrhage. Gastroenterology 1953;24(1):118–123.
  11. Sebastian S, O’Morain CA, Buckley MJM. Review article: Current therapeutic options for gastric antral vascular ectasia. Aliment Pharmacol Ther 2003;18(2):157–165.
  12. Jabbari M, Cherry R, Lough JO, Daly DS, Kinnear DG, Goresky CA. Gastric antral vascular ectasia: the watermelon stomach. Gastroenterology 1984;87(5):1165–1170.
  13. Moss SF, Ghosh P, Thomas DM, Jackson JE, Calam J. Gastric antral vascular ectasia: maintenance treatment with oestrogen-progesterone. Gut 1992;33(5):715–717.
  14. Tran A, Villeneuve JP, Bilodeau M, Willems B, Marleau D, Fenyves D, et al. Treatment of chronic bleeding from gastric antral vascular ectasia (GAVE) with estrogen-progesterone in cirrhotic patients: an open pilot study. Am J Gastroenterol 1999;94(10):2909–2911.
  15. Nardone G, Rocco A, Balzano T, Budillon G. The efficacy of octreotide therapy in chronic bleeding due to vascular abnormalities of the gastrointestinal tract. Aliment Pharmacol Ther 1999;13(11):1429–1436.
  16. Barbara G, De Giorgio R, Salvioli B, Stanghellini V, Corinaldesi R. Unsuccessful octreotide treatment of the watermelon stomach. J Clin Gastroenterol 1998;26(4):345–346.
  17. Bhowmick BK. Watermelon stomach treated with oral corticosteroid. J R Soc Med 1993;86(1):52.
  18. Calam J, Walker RJ. Antral vascular lesion, achlorhydria, and chronic gastrointestinal blood loss: response to steroids. Dig Dis Sci 1980;25(3):236–239.
  19. McCormick PA, Ooi H, Crosbie O. Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis. Gut 1998;42(5):750–752.
  20. Dunne KA, Hill J, Dillon JF. Treatment of chronic transfusion-dependent gastric antral vascular ectasia (watermelon stomach) with thalidomide. Eur J Gastroenterol Hepatol 2006;18(4):455–456.
  21. Karajeh MA, Hurlstone DP, Stephenson TJ, Ray-Chaudhuri D, Gleeson DC. Refractory bleeding from portal hypertensive gastropathy: a further novel role for thalidomide therapy? Eur J Gastroenterol Hepatol 2006;18(5):545–548.
  22. Moser S, Tischer A, Karpi A, Schleicher M, Stavjanik S, Gschwantler M. Evidence that thalidomide is effective in recurrent bleeding from watermelon stomach associated with liver cirrhosis. Endoscopy 2014;46:E384.
  23. Serrano AG, León R, Sayago M, Márquez JL. Thalidomide treatment in cirrhotic patients with severe anemia secondary to vascular malformations. Dig Dis Sci 2012;57(4):1112–1113.
  24. Kamalaporn P, Saravanan R, Cirocco M, May G, Kortan P, Kandel G, et al. Thalidomide for the treatment of chronic gastrointestinal bleeding from angiodysplasias: a case series. Eur J Gastroenterol Hepatol 2009;21(12):1347–1350.
  25. Hanje AJ, Shamp JL, Thomas FB, Meis GM. Thalidomide-induced severe hepatotoxicity. Pharmacotherapy 2006;26(7):1018–1022.

Published

2020-11-18

Issue

Vol. 7 No. 12 (2020)

How to Cite

1.
Aveiro M, Rodrigues T, Rabadão T, Ferreira F, Teixeira M, Oliveira A, et al. The Use of Thalidomide in Severe Refractory Anaemia Due to Gastric Antral Vascular Ectasia (GAVE) in Cirrhosis? EJCRIM [Internet]. 2020 Nov. 18 [cited 2026 Nov. 3];7(12). Available from: https://ejcrim.com/index.php/ejcrim/article/view/2099

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