Thalidomide for the treatment of severe intestinal bleeding

It was with great interest that we read the article by Bauditz et al. [1] about the role of thalidomide in severe recurrent intestinal bleeding due to angiodysplasia. This article discussed the role of thalidomide as an anti-inflammatory agent and an inhibitor of angiogenesis.

A 72-year-old man with a family history of Rendu–Osler–Weber (ROW) syndrome (grandfather, father, and two siblings) and with recurrent epistaxis was first hospitalized in our department 2 years ago, due to severe iron deficiency anemia (hemoglobin 6.7 g/dL, mean corpuscular volume 75 fL, and 7 ng/mL of ferritin). The diagnosis of ROW syndrome was made following upper and lower endoscopy and video capsule enteroscopy. Hundreds of telangiectases were seen from the esophagus to the colon, some of which were actively bleeding, especially in the small bowel. Arteriovenous malformations were ruled out by computed tomography angiography.

We tried conventional therapies (argon plasma thermocoagulation and hormonal treatment) without success. The patient was repeatedly hospitalized due to severe anemia, and required blood transfusions totalling approximately 75 units each year.

As well as the Bauditz article, there are others in the literature that also point out the benefits of thalidomide. Three of them are in patients with angiodysplasias [2] [3] [4], and two are in patients with ROW syndrome [4] [5].

After the patient had spent 3 months in hospital receiving 9 units of blood each month, we also decided to try thalidomide, 100 mg/day per os. (The process of obtaining permission to start thalidomide treatment was complicated and long – about 2 – 3 months.)

Although the patient still requires regular blood transfusions, they are required less frequently (2 – 3 per month). We also started octreotide, 50 μg/12 hours as adjuvant therapy.

Based on the previous articles and from our own experience, we think that thalidomide might be a rescue therapy in severe cases of ROW syndrome or angiodysplasias.

Competing interests: None

References

• 1 Bauditz J, Lochs H, Voderholzer W. Macroscopic appearance of intestinal angiodysplasias under antiangiogenic treatment with thalidomide.  Endoscopy. 2006;  38 1036-1039
• 2 Shurafa M, Kamboj G. Thalidomide for treatment of bleeding angiodysplasias (letter to the editor).  Am J Gastroenterol. 2003;  98 221-222
• 3 Bauditz J, Schachschal G, Wedel S, Lochs H. Thalidomide for treatment of severe intestinal bleeding.  Gut. 2004;  53 609-612
• 4 Pérez-Encinas M, Rabunal Martinez M J, Bello Lopez J L. Is thalidomide effective for the treatment of gastrointestinal bleeding in hereditary hemorrhagic telangiectasia?.  Haematologica. 2002;  87 ELT 34
• 5 Kurstin R. Using thalidomide in a patient with epithelioid leiomyosarcoma and Osler-Weber-Rendu disease.  Oncology. 2002;  16 21-24