Gastrointestinal
bleeding (GB) due to
angiodysplasias can cause severe, recurrent
bleeding, especially in elderly patients. Angiodysplastic bleedings in the gastrointestinal tract have been associated with
aortic stenosis and, more recently,
hypertrophic obstructive cardiomyopathy, caused by an acquired coagulopathy known as Heyde's syndrome. Multiple factors are involved in the pathogenesis of angiodysplastic
bleeding including genetic factors and increased levels of vascular intestinal
growth factor at tissue levels. Endoscopic coagulation
therapy is the primary treatment but often fails to resolve
bleeding, especially in patients with large numbers of
angiodysplasias. In patients with
aortic stenosis and GB, the main treatment is aortic valve replacement but the patients may be unfit to undergo surgery due to the complicating
anemia. In this case story, we present a patient with severe, GB due to hypertrophic subvalvular obstructive
cardiomyopathy. Endoscopic procedures with
argon beaming were performed without effect on
bleeding. The patient was treated with a combination of both
thalidomide and
octreotide. Within 3 months, the patient recovered from the
anemia and was able to undergo transcoronary
ethanol ablation. No further
bleeding episodes occurred, and
thalidomide and
octreotide were arrested. To our knowledge, this case report is the first to describe how this new
drug combination therapy is an effective treatment of GB from
angiodysplasias and can be used to bridge to surgical or endovascular treatment.