title: Chronic subcutaneous octreotide decreases gastrointestinal blood loss in blue rubber-bleb nevus syndrome.
abstract: BACKGROUND
  A patient affected by blue rubber-bleb nevus syndrome had chronic gastrointestinal bleeding requiring weekly blood transfusions. Despite multiple surgical and endoscopic procedures to treat the venous malformations, the patient continued to bleed primarily from lesions in the small bowel. Therefore, this patient was treated with octreotide, a somatostatin analog known to decrease splanchnic blood flow and that is used for acute and chronic gastrointestinal bleeding.
  
  
  METHODS
  Octreotide therapy, 5.7 microg/kg subcutaneously twice daily, was initiated, and the patient was followed up clinically. Complete blood counts, blood glucose concentration, pancreatic enzyme concentration, liver function tests, and growth hormone concentration were monitored during treatments.
  
  
  RESULTS
  During the 4 weeks after initiation of octreotide therapy, hemoglobin concentration was maintained without the need for transfusions. Octreotide decreased the patient's monthly need for blood transfusion from 52 +/- 7 mL. kg-1. mo-1 of packed red blood cells to 23 +/- 7 mL. kg-1. mo-1. She had no detectable side effects or growth inhibition. Other medical interventions including -epsilonaminocaproic acid, nadolol, and total parenteral nutrition with bowel rest were not as effective as octreotide alone.
  
  
  CONCLUSIONS
  Octreotide decreased the patient's need for blood transfusions. Possible mechanisms include altering blood flow to the gastrointestinal tract and direct effects on the venous malformations.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical School Center for Pediatric Gastroenterology and Nutrition, Children's Medical Center of Dallas, Dallas, Texas, USA.
authors.forename: D
authors.initials: D
authors.lastname: Gonzalez
authors.forename: B J
authors.initials: BJ
authors.lastname: Elizondo
authors.forename: S
authors.initials: S
authors.lastname: Haslag
authors.forename: G
authors.initials: G
authors.lastname: Buchanan
authors.forename: J S
authors.initials: JS
authors.lastname: Burdick
authors.forename: P C
authors.initials: PC
authors.lastname: Guzzetta
authors.forename: B A
authors.initials: BA
authors.lastname: Hicks
authors.forename: J M
authors.initials: JM
authors.lastname: Andersen
mesh_terms: D018798:Anemia, Iron-Deficiency; D001803:Blood Transfusion; D002648:Child; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology; D018329:Nevus, Blue / Q000150:complications*; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000150:complications*; D013577:Syndrome; D016896:Treatment Outcome; D014680:Veins / Q000002:abnormalities
chemical_list: D005765:Gastrointestinal Agents; D015282:Octreotide