Treatment of chronic bleeding from gastric antral vascular ectasia (GAVE) with estrogen-progesterone in cirrhotic patients: an open pilot study.
OBJECTIVE
Gastric antral vascular ectasia (GAVE) is a rare cause of chronic bleeding in cirrhotic patients. Treatment of GAVE with surgical or nonsurgical portal decompression, beta-blockers, or endoscopic therapy provides disappointing results. In the present study, we evaluated the efficacy of estrogen-progesterone therapy, which has been reported to control chronic bleeding in gastrointestinal vascular malformations, such as Osler-Weber Rendu disease or angiodysplasia, in GAVE-related chronic bleeding.


METHODS
Six cirrhotic patients who bled chronically from GAVE were included. Three had alcoholic cirrhosis, two cryptogenic cirrhosis, and one primary biliary cirrhosis. Grade 1 esophageal varices were noted in four patients. Bleeding could not be controlled by beta-blockers, and endoscopic therapy was not considered given the extension of the antral vascular lesions.


RESULTS
Before the start of therapy, transfusion requirements averaged 3.5 units/month over a 1.5-11 month period of observation. Patients were then treated with a combination of ethynil estradiol 30 microg and noretisterone 1.5 mg daily. During follow-up (range 3-12 months), bleeding did not recur in four patients; in one patient, treatment with estrogen progesterone decreased the need for transfusions from 4 units/month to 1.4 unit/month; this patient stopped the treatment inadvertently after 6 months and severe anemia recurred with a need for 4 units of blood in the following month; reintroduction of the treatment resulted in an increase of hemoglobin levels without the need for blood transfusions during the following 4 months. In the last patient, a 5-month treatment did not improve chronic bleeding.


CONCLUSIONS
The present study suggests that estrogen-progesterone therapy is useful in the treatment of chronic bleeding related to GAVE; however, these findings require confirmation by a controlled trial.
Tran
A
A
Liver Unit, Saint-Luc Hospital, and University of Montreal, Canada.
Villeneuve
J P
JP
Bilodeau
M
M
Willems
B
B
Marleau
D
D
Fenyves
D
D
Parent
R
R
Pomier-Layrargues
G
G
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D045166:Estradiol Congeners / Q000008:administration & dosage*; D004997:Ethinyl Estradiol / Q000008:administration & dosage*; D020252:Gastric Antral Vascular Ectasia / Q000150:complications*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008875:Middle Aged; D009640:Norethindrone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077563:Norethindrone Acetate; D010865:Pilot Projects; D045167:Progesterone Congeners / Q000008:administration & dosage*; D012008:Recurrence
D045166:Estradiol Congeners; D045167:Progesterone Congeners; D004997:Ethinyl Estradiol; D000077563:Norethindrone Acetate; D009640:Norethindrone