Longhyphen;term effect of hormonal therapy for bleeding gastrointestinal vascular malformations

摘要

ObjectiveTo investigate the acute, long-term and persisting effect of oestrogenmdash;progesterone therapy on bleeding frequency and on transfusion requirements in patients with bleeding gastrointestinal vascular malformations.DesignA double-blind randomized placebo-controlled, cross-over trial was performed using 0.050 mg ethinyloestradiol and 1 mg norethisterone.ResultsOestrogenmdash;progesterone therapy was very effective in reducing transfusion requirements: 2.8 compared with 11.2 units of packed cells over a 6-month treatment period (P= 0.002). Only three out of 13 patients treated with ethinyloestradiol and norethisterone required transfusion for persistent bleeding, while 12 out of 13 patients in the placebo group required transfusion (P= 0.001). After finishing hormonal therapy, patients who responded to this therapy did not need transfusion for a mean of 9.6 months. The post-treatment transfusion requirements were significantly lower than those prior to hormonal treatment: 0.31 units packed cells per patient per month compared with 1.39 (P= 0.006). A second course of hormonal therapy was effective in preventing haemorrhage and transfusion.ConclusionsOestrogen-progesterone therapy stops bleeding in patients with severely bleeding gastrointestinal vascular malformations. This effect persists for a mean period of about 10 months.