title: Recurrent obscure gastrointestinal bleeding: dilemmas and success with pharmacological therapies. Case series and review.
abstract: The present article describes three difficult cases of recurrent bleeding from obscure causes, followed by a review of the pitfalls and pharmacological management of obscure gastrointestinal bleeding. All three patients underwent multiple investigations. An intervening complicating diagnosis or antiplatelet drugs may have compounded longterm bleeding in two of the cases. A bleeding angiodysplasia was confirmed in one case but was aggravated by the need for anticoagulation. After multiple transfusions and several attempts at endoscopic management in some cases, long-acting octreotide was associated with decreased transfusion requirements and increased hemoglobin levels in all three cases, although other factors may have contributed in some. In the third case, however, the addition of low-dose thalidomide stopped bleeding for a period of at least 23 months.
authors.affiliation: Division of Gastroenterlogy, Department of Medicine, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec, Canada. aszilagy@gas.jgh.mcgill.ca
authors.forename: Majid
authors.initials: M
authors.lastname: Almadi
authors.forename: Peter M
authors.initials: PM
authors.lastname: Ghali
authors.forename: Andre
authors.initials: A
authors.lastname: Constantin
authors.forename: Jacques
authors.initials: J
authors.lastname: Galipeau
authors.forename: Andrew
authors.initials: A
authors.lastname: Szilagyi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016888:Angiodysplasia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000792:Angiography; D000818:Animals; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D053704:Capsule Endoscopy; D003113:Colonoscopy; D017809:Fatal Outcome; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery; D015282:Octreotide / Q000627:therapeutic use; D011474:Prosthesis Design; D012008:Recurrence; D013792:Thalidomide / Q000627:therapeutic use; D014148:Tranexamic Acid / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D000933:Antifibrinolytic Agents; D005765:Gastrointestinal Agents; D013792:Thalidomide; D014148:Tranexamic Acid; D015282:Octreotide