From the Guidelines
Yes, there are medical treatments for angiodysplasia, with endoscopic therapy being the primary approach, accompanied by iron replacement, as recommended by the most recent guidelines 1.
Treatment Options
- Endoscopic therapy: techniques such as argon plasma coagulation, electrocoagulation, or laser photocoagulation during an endoscopy procedure are used to treat the abnormal blood vessels.
- Iron supplementation: ferrous sulfate 325 mg 2-3 times daily is often necessary to treat anemia resulting from chronic blood loss.
- Medical therapy: somatostatin analogues, such as octreotide, may be effective in reducing bleeding and transfusion requirements, especially in patients with multiple lesions 2.
- Antiangiogenic therapy: thalidomide may be considered for refractory cases, but its use should be reserved for patients who have failed other forms of therapy and should be given by experienced providers due to potential adverse reactions 2.
Key Considerations
- The choice of treatment depends on the severity of the angiodysplasia, the presence of anemia, and the patient's overall health status.
- Endoscopic treatment should be accompanied by iron replacement to improve outcomes 1.
- Medical therapy should be reserved for compassionate treatment in refractory cases when iron replacement and endoscopic therapy are ineffective 1.
Recent Guidelines
- The American Gastroenterological Association (AGA) recommends the use of a ferritin cut-off value of 45 mg/dL in individuals with anemia to diagnose iron deficiency 1.
- The AGA also recommends a multidisciplinary approach to managing iron deficiency anemia, including gastroenterologists, hematologists, and nutritionists 1.
From the Research
Medical Treatment for Angiodysplasia
- There are various medical treatments available for angiodysplasia, including estrogen and progesterone therapy, octreotide, and thalidomide 3.
- However, the evidence for these treatments is limited, and well-designed randomized controlled trials are needed to study their efficacy and complications 3.
- Estrogen and progesterone therapy did not significantly reduce bleeding episodes in patients with angiodysplasias, and increased mortality compared to conservative therapy 3.
- Octreotide was found to be effective in reducing rebleeding rates in patients with angiodysplasias, with a higher percentage of patients receiving octreotide being free of rebleeding at 1 and 2 years compared to placebo 3.
- Thalidomide reduced the number of bleeding episodes in patients with angiodysplasias, but did not reduce mortality 3.
Endoscopic Treatment for Angiodysplasia
- Endoscopic treatments, such as argon plasma coagulation (APC), are also available for angiodysplasia 4, 5, 6.
- APC has been shown to be effective in preventing recurrent bleeding from GI angiodysplasias, with a success rate of 83% at a median follow-up of 18 months 4.
- APC was also found to be effective in treating bleeding angiodysplasia in the upper gastrointestinal tract, with a lower rate of recurrent bleeding and side effects compared to injection therapy 5.
- Long-term outcomes of APC therapy for bleeding in patients with colonic angiodysplasia have also been evaluated, with a success rate of 85% at a median follow-up of 20 months 6.
- Other endoscopic treatments, such as laser photocoagulation, have also been used to control bleeding in patients with angiodysplasia, with a success rate of 84% and a 6% complication rate 7.