Hormonal therapy for bleeding gastrointestinal mucosal vascular abnormalities: a promising alternative.
Recurrent bleeding from an obscure gastrointestinal source is a common but often frustrating clinical challenge. Frequently these bleeds can be attributed to vascular anomalies in the upper or lower gastrointestinal tract. Traditional management has included surgical resection and endoscopic fulguration. However, these methods are often ineffective when vascular lesions are diffuse, difficult to identify, or endoscopically inaccessible. Hormone therapy with a combination of oestrogen and progesterone represents a promising alternative. Since initial reports of success in patients with epistaxis from hereditary haemorrhagic telangiectasia, growing evidence supports its role in reducing bleeding from gastrointestinal vascular anomalies. Existing literature is critically reviewed and management strategies incorporating hormone therapy are suggested.
Marshall
J K
JK
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Hunt
R H
RH
D001165:Arteriovenous Malformations / Q000145:classification / Q000150:complications* / Q000188:drug therapy; D001808:Blood Vessels / Q000002:abnormalities*; D004359:Drug Therapy, Combination; D004967:Estrogens / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D007413:Intestinal Mucosa / Q000098:blood supply*; D011374:Progesterone / Q000627:therapeutic use; D016896:Treatment Outcome
D004967:Estrogens; D006728:Hormones; D011374:Progesterone