High Dose Oestrogen in Life Threatening Obscure Gastrointestinal Bleeding
Keywords:
angiodysplasia, hormonal therapy, oestrogen, obscure gastrointestinal bleedingAbstract
Obscure gastrointestinal bleeding is defined as recurrent or persistent gastrointestinal bleeding in the setting of normal upper and lower endoscopies. There are reported use of numerous pharmacological agents to halt the bleeding, including oestrogen. We report a case of middle age gentleman with multiple comorbidities, presented with life threatening gastrointestinal bleeding. He underwent bidirectional endoscopies and mesenteric angiogram, but failed to localise the bleeding. Red blood cell scintigraphy showed numerous bleeding points in small and large bowels. A 5-day oral high dose oestrogen was prescribed in view of difficulty to manage the bleeding, in which the hemostasis was ultimately achieved.References
ASGE Standards of Practice Committee, Fisher L, Lee Krinsky M, et al. The role of endoscopy in the management of obscure GI bleeding. Gastrointest Endosc. 2010;72:471-9.
Harrison DF. Use of estrogen in treatment of familial hemorrhagic telangiectasia. Laryngoscope. 1982;92:314-20.
Zuckerman GR, Prakash C, Askin MP, et al. AGA technical review: evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterol. 2000;118:201-21.
Bronner MH, Pate MB, Cunningham JT, et al. Estrogenprogesterone therapy for bleeding gastrointestinal telangiectasias in chronic renal failure. An uncontrolled trial. Ann Intern Med. 1986;105:371–4.
Van Cutsem E, Rutgeerts P, Vantrappen G. Treatment of bleeding gastrointestinal vascular malformations with oestrogen-progesterone. Lancet. 1990;335:953–5.
Van Cutsem E, Rutgeerts P, Coremans G, et al. Dose-response study of hormonal therapy in bleeding gastrointestinal vascular malformations (abstr). Gastroenterology. 1993;104:A286.
Barkin JS, Ross BS. Medical therapy for chronic gastrointestinal bleeding of obscure origin. Am J Gastroenterol. 1998;93:1250-4.
Lewis B, Salomon P, Rivera-MacMurray S, et al. Does hormonal therapy have any benefit for bleeding angiodysplasia? J Clin Gastroenterol. 1992;15:99–103.
Junquera F, Feu F, Papo M, et al. A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. Gastroenterol. 2001;121:1073-9.
Apostolopoulos P, Liatsos C, Gralnek IM, et al. Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding. Gastrointest Endosc. 2007;66:1174-81.
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