Gastrointestinal
vascular malformations can cause haemorrhage requiring multiple transfusions. Surgical or endoscopic
therapy are ineffective when the
vascular malformations are spread diffusely over the gastrointestinal tract, when lesions escape identification or are not accessible for treatment. Several reports suggest that oestrogen-
progesterone therapy is effective in the treatment of
epistaxis in hereditary haemorrhagic
telangiectasia. The aim of our studies is to test the hypothesis that oestrogen-
progesterone is an effective treatment for
bleeding gastrointestinal
vascular malformations in patients with a very high transfusion need and in whom surgical or endoscopic treatment failed or could not be performed. The mean transfusion requirement prior to entering the studies amounted to 35.4 units packed per patient. In an uncontrolled trial oestrogen-
progesterone therapy diminished significantly transfusion requirements from 3.4 units packed cells per patient per month to 0.1 units packed cells (p = 0.02). Haemorrhage ceased totally in 3 of 7 patients. A double-blind randomized placebo-controlled, cross-over trial shows that
therapy with 0.050 mg
ethinyloestradiol and 1 mg
norethisterone is very effective in reducing transfusion requirements: 2.8 versus 11.2 units packed cells over a 6 month treatment period (p = 0.002). Only 3 of 13 patients treated with
ethinyloestradiol and
norethisterone required transfusions for persistent
bleeding, while 12 of 13 patients in the placebo group had transfusion requirements (p = 0.001). After stopping hormonal
therapy, no transfusions were needed for a mean of 10 months. This indicates a long-lasting effect of
ethinyloestradiol and
norethisterone on
bleeding and transfusion requirements.(ABSTRACT TRUNCATED AT 250 WORDS)