Recurrent severe gastrointestinal hemorrhage complicating diffuse angiodysplasia: efficacy of estrogen and progesterone therapy

BACKGROUND: Vascular abnormalities are being reported with increasing frequ ency as a cause of major lower gastrointestinal hemorrhage in the elderly. They are occasionally very difficult to treat by conventional means. CASE REPORT: A 66-year-old white man with a history of type 2 diabetes mell itus, coronary artery disease, congestive heart failure, severe peripheral arterial occlusion disease and chronic renal insufficiency presented for fi ve years recurrent major bleeding due to gastrointestinal angiodysplasia, r equiring repeated transfusions. He was treated with efficacy using ethinyl- estradiol (30 mu g) and norethisterone acetate (1 mg) given orally once dai ly. After six months of treatment transfusion requirements fell to 0 unit a nd the patients hemoglobin was stable at 13 g/dl. Attempts to stop hormone therapy (by the patient himself, without complaint of side effects) led to a fall in hemoglobin. CONCLUSION: Hormonal therapy should be considered when multiple degenerativ e mucosal vascular bleeding lesions are beyond the reach of therapeutic end oscopy leading to high transfusion needs and when surgical risk is unaccept ably high.