Treatment of chronic bleeding from gastric antral vascular ectasia (GAVE) with estrogen-progesterone in cirrhotic patients: an open pilot study.

Abstract

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.

• Authors: A Tran, J P Villeneuve, M Bilodeau, B Willems, D Marleau, D Fenyves, R Parent, G Pomier-Layrargues
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 94 Issue 10 Pg. 2909-11 (Oct 1999) ISSN: 0002-9270 [Print] United States
• PMID: 10520843 (Publication Type: Journal Article)

Chemical References

• Estradiol Congeners
• Progesterone Congeners
• Ethinyl Estradiol
• Norethindrone Acetate
• Norethindrone

Topics

• Aged
• Aged, 80 and over
• Chronic Disease
• Drug Evaluation
• Drug Therapy, Combination
• Estradiol Congeners (administration & dosage)
• Ethinyl Estradiol (administration & dosage)
• Gastric Antral Vascular Ectasia (complications)
• Gastrointestinal Hemorrhage (drug therapy)
• Humans
• Liver Cirrhosis (complications)
• Middle Aged
• Norethindrone (administration & dosage, analogs & derivatives)
• Norethindrone Acetate
• Pilot Projects
• Progesterone Congeners (administration & dosage)
• Recurrence