The Use of Thalidomide in Severe Refractory Anaemia Due to Gastric Antral Vascular Ectasia (GAVE) in Cirrhosis?

Marcelo Aveiro; Tatiana Rodrigues; Tiago Rabadão; Filipa Ferreira; Mariana Teixeira; Ana Oliveira; Inês Vasconcelos

doi:10.12890/2020_002099

The Use of Thalidomide in Severe Refractory Anaemia Due to Gastric Antral Vascular Ectasia (GAVE) in Cirrhosis?

Eur J Case Rep Intern Med. 2020 Nov 18;7(12):002099. doi: 10.12890/2020_002099. eCollection 2020.

Authors

Marcelo Aveiro¹, Tatiana Rodrigues¹, Tiago Rabadão¹, Filipa Ferreira¹, Mariana Teixeira¹, Ana Oliveira¹, Inês Vasconcelos²

Affiliations

¹ Department of Internal Medicine, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
² Department of Family Medicine, USF Atlântico Norte, Gafanha da Nazaré, Portugal.

Abstract

Gastric antral vascular ectasia (GAVE) is a rare cause of upper gastrointestinal bleeding associated with cirrhosis. The first-line treatment is endoscopic therapy with argon plasma coagulation (APC). There is a high recurrence rate, but some evidence suggests that thalidomide could play an important role in controlling refractory anaemia due to GAVE. The authors present the case of a cirrhotic patient with a recent diagnosis of GAVE, who underwent multiple endoscopic treatments and blood transfusions because of haematemesis. The patient started thalidomide and 6 months later, there was no recurrence of haematemesis and haemoglobin levels were stable, with no reported adverse effects.

Learning points: The chronic bleeding associated with gastric antral vascular ectasia (GAVE) presenting with cirrhosis is more severe than that associated with portal hypertensive gastropathy.Argon plasma coagulation remains the first-line treatment, but GAVE has a high recurrence rate.Thalidomide could be an effective and safe option for recurrent bleeding due to GAVE in patients with cirrhosis.

Keywords: GAVE; cirrhosis; thalidomide.