[Severe gastrointestinal hemorrhage secondary to diffuse angiodysplasia: efficacy of estrogen-progesterone treatment].
BACKGROUND
Vascular abnormalities are being reported with increasing frequency as a cause of major lower gastrointestinal hemorrhage in the elderly. They are occasionally very difficult to treat by conventional means.


METHODS
A 66-year-old white man with a history of type 2 diabetes mellitus, coronary artery disease, congestive heart failure, severe peripheral arterial occlusion disease and chronic renal insufficiency presented for five years recurrent major bleeding due to gastrointestinal angiodysplasia, requiring repeated transfusions. He was treated with efficacy using ethinyl-estradiol (30 micrograms) and norethisterone acetate (1 mg) given orally once daily. After six months of treatment, transfusion requirements fell to 0 unit and the patient's hemoglobin was stable at 13 g/dl. Attempts to stop hormone therapy (by the patient himself, without complaint of side effects) led to a fall in hemoglobin.


CONCLUSIONS
Hormonal therapy should be considered when multiple degenerative mucosal vascular bleeding lesions are beyond the reach of therapeutic endoscopy leading to high transfusion needs and when surgical risk is unacceptably high.
Cacoub
P
P
Service de Médecine interne, Hôpital La Pitié-Salpêtrière, Paris. patrice.cacoub@psl.ap-hop-paris.fr
Sbaï
A
A
Benhamou
Y
Y
Godeau
P
P
Piette
J C
JC
D000368:Aged; D016888:Angiodysplasia / Q000150:complications* / Q000188:drug therapy; D001803:Blood Transfusion; D045166:Estradiol Congeners / Q000627:therapeutic use*; D004997:Ethinyl Estradiol / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D009640:Norethindrone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077563:Norethindrone Acetate; D011374:Progesterone / Q000627:therapeutic use*; D012307:Risk Factors
D045166:Estradiol Congeners; D004997:Ethinyl Estradiol; D011374:Progesterone; D000077563:Norethindrone Acetate; D009640:Norethindrone