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They cause chronic anaemia or gastrointestinal bleeding in 10% of patients. This disease affects the elderly in particular, with a 50% likelihood of recurrence following the first bleeding episode. The large number and location of the lesions often makes it difficult to access and treat them.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Endoscopic argon plasma coagulation (APC) is considered the treatment of choice, with arteriography and/or surgery reserved for cases of severe haemorrhaging.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Several pharmacological alternatives have been tried, both with, or when, endoscopic APC fails. These include combined oestrogen–progesterone therapy, thalidomide and somatostatin analogues.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Hormone treatment has not demonstrated any long-term benefits.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> As for the somatostatin analogues, octreotide is the most widely used active substance.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,5,6</span></a> Another of the analogues used is lanreotide.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The first study on the use of octreotide concluded that it was safe and effective in controlling recurrent gastrointestinal bleeding due to angiodysplasia in elderly patients unsuitable for endoscopic or surgical treatment. However, recurrent bleeding occurs in up to 20% of patients treated with octreotide, with an adverse event occurring in up to 53% of cases.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Lanreotide is a synthetic analogue of somatostatin, which, among other actions, inhibits meal-induced increases in superior mesenteric artery and portal venous blood flow. Lanreotide autogel has an aqueous base that facilitates subcutaneous administration. Its safety profile is very similar to that of subcutaneous octreotide; adverse reactions, which occur in approximately 30% of patients, are basically mild and transient and mainly gastrointestinal in nature.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Four patients in our department diagnosed with gastrointestinal angiodysplasia are currently on treatment with lanreotide autogel.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We describe two cases that have been followed up for the longest time after initiation of lanreotide treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case 1</span><p id="par0035" class="elsevierStylePara elsevierViewall">A 94-year-old woman with gastric and jejunal angiodysplasias was started on treatment with octreotide LAR and underwent argon fulguration of the gastric lesions. She was admitted to hospital twice for severe gastrointestinal bleeding (haemoglobin 5<span class="elsevierStyleHsp" style=""></span>g/dL). Between the admissions and outpatient follow-up, she required intravenous iron therapy on one occasion and transfusion of 12 units of packed red blood cells. Since the treatment was not effective, she was switched to lanreotide autogel. In the subsequent 10 months, she presented no further episodes of melaena, nor did she require blood transfusions or endoscopic fulguration. Her haemoglobin values are currently normal.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 2</span><p id="par0040" class="elsevierStylePara elsevierViewall">An 84-year-old woman diagnosed with jejunoileal angiodysplasias (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) was prescribed treatment with octreotide LAR. She was admitted on 2 occasions for melaena and received transfusion of 3 units of packed red blood cells and intravenous iron infusion on several occasions. However, in the 10 months after being switched to lanreotide, the patient has shown no further signs of gastrointestinal bleeding, nor has she required blood transfusion or iron therapy. Her haemoglobin levels are now normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The drug doses used were 20<span class="elsevierStyleHsp" style=""></span>mg of octreotide monthly and 120<span class="elsevierStyleHsp" style=""></span>mg of lanreotide autogel every 6 weeks.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The other two patients with gastrointestinal angiodysplasia have been on lanreotide for 5 and 6 months and maintain normal haemoglobin levels.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Scientific evidence on the usefulness of treating angiodysplasias with somatostatin analogues is based on studies consisting of few patients. Octreotide was mainly administered, and when octreotide or lanreotide were used indiscriminately, there was no indication of any difference in response, nor were dose and administration regimen clearly defined. No studies exist that assess the usefulness of switching from one analogue to another.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The cases reported above support the efficacy of switching from octreotide to lanreotide in patients for whom the former is not effective or has lost its efficacy. These findings need to be demonstrated in studies with a larger number of cases and supported by greater scientific evidence. It should also be stressed that in patients on anticoagulant treatment, the risk of haematomas is higher for intramuscular octreotide than for subcutaneous lanreotide.</p><p id="par0065" class="elsevierStylePara elsevierViewall">This series—like most of those published—has limitations, namely the absence of a control group and the small sample size. Moreover, since it is likely that drug efficacy depends on bleeding severity and on concurrent treatments that predispose the patient to bleeding (especially anticoagulants), equivalent studies on the efficacy of different doses are therefore warranted.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ramos-Rosario HA, Badia Aranda E, Martín Lorente JL, Arias García L, Sicilia Aladrén B, Sáez-Royuela F. Eficacia de lanreótido en pacientes con angiodisplasias gastrointestinales refractarias al tratamiento con octreótido. Gastroenterol Hepatol. 2016;39:213–214.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 902 "Ancho" => 900 "Tamanyo" => 83057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Intestinal angiodysplasia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Avances en el tratamiento farmacológico de la hemorragia digestiva de origen oscuro" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Molina Infante" 1 => "B. 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Year/Month | Html | Total | |
---|---|---|---|
2024 October | 21 | 5 | 26 |
2024 September | 52 | 10 | 62 |
2024 August | 48 | 8 | 56 |
2024 July | 59 | 7 | 66 |
2024 June | 40 | 5 | 45 |
2024 May | 33 | 7 | 40 |
2024 April | 41 | 7 | 48 |
2024 March | 59 | 7 | 66 |
2024 February | 81 | 10 | 91 |
2024 January | 81 | 4 | 85 |
2023 December | 63 | 8 | 71 |
2023 November | 70 | 9 | 79 |
2023 October | 66 | 6 | 72 |
2023 September | 41 | 6 | 47 |
2023 August | 53 | 2 | 55 |
2023 July | 73 | 9 | 82 |
2023 June | 78 | 2 | 80 |
2023 May | 101 | 3 | 104 |
2023 April | 69 | 3 | 72 |
2023 March | 109 | 13 | 122 |
2023 February | 73 | 2 | 75 |
2023 January | 75 | 8 | 83 |
2022 December | 57 | 17 | 74 |
2022 November | 55 | 12 | 67 |
2022 October | 69 | 10 | 79 |
2022 September | 54 | 16 | 70 |
2022 August | 31 | 14 | 45 |
2022 July | 28 | 7 | 35 |
2022 June | 30 | 6 | 36 |
2022 May | 25 | 6 | 31 |
2022 April | 38 | 9 | 47 |
2022 March | 44 | 12 | 56 |
2022 February | 42 | 9 | 51 |
2022 January | 60 | 12 | 72 |
2021 December | 37 | 8 | 45 |
2021 November | 73 | 9 | 82 |
2021 October | 66 | 17 | 83 |
2021 September | 50 | 13 | 63 |
2021 August | 59 | 9 | 68 |
2021 July | 56 | 12 | 68 |
2021 June | 31 | 8 | 39 |
2021 May | 45 | 19 | 64 |
2021 April | 114 | 24 | 138 |
2021 March | 70 | 6 | 76 |
2021 February | 44 | 14 | 58 |
2021 January | 51 | 16 | 67 |
2020 December | 37 | 11 | 48 |
2020 November | 57 | 14 | 71 |
2020 October | 38 | 16 | 54 |
2020 September | 37 | 18 | 55 |
2020 August | 40 | 7 | 47 |
2020 July | 47 | 9 | 56 |
2020 June | 33 | 14 | 47 |
2020 May | 47 | 24 | 71 |
2020 April | 27 | 14 | 41 |
2020 March | 52 | 10 | 62 |
2020 February | 40 | 16 | 56 |
2020 January | 38 | 25 | 63 |
2019 December | 49 | 13 | 62 |
2019 November | 32 | 15 | 47 |
2019 October | 35 | 7 | 42 |
2019 September | 85 | 10 | 95 |
2019 August | 27 | 7 | 34 |
2019 July | 23 | 20 | 43 |
2019 June | 38 | 44 | 82 |
2019 May | 86 | 102 | 188 |
2019 April | 23 | 43 | 66 |
2019 March | 15 | 13 | 28 |
2019 February | 20 | 13 | 33 |
2019 January | 24 | 12 | 36 |
2018 December | 16 | 12 | 28 |
2018 November | 29 | 11 | 40 |
2018 October | 18 | 10 | 28 |
2018 September | 6 | 4 | 10 |
2018 August | 9 | 3 | 12 |
2018 July | 14 | 1 | 15 |
2018 June | 13 | 3 | 16 |
2018 May | 15 | 1 | 16 |
2018 April | 22 | 12 | 34 |
2018 March | 5 | 6 | 11 |
2017 July | 1 | 0 | 1 |
2017 April | 0 | 1 | 1 |