Gut 2004;53:609-612
© 2004 by BMJ Publishing Group Ltd & British Society of Gastroenterology
Thalidomide for treatment of severe intestinal bleeding
J Bauditz, G Schachschal, S Wedel and H Lochs
Charité University Hospital, IVth Department of Medicine, Berlin, Germany
Correspondence to:
Dr J Bauditz
Universitätsklinikum Charité, IV. Medizinische Klinik und Poliklinik, Schumannstr. 20/21, 10117 Berlin, Germany; juergen.bauditz@charite.de
ABSTRACT
Apart from its anti-inflammatory activity, which has been used
for the treatment of active Crohn’s disease, thalidomide
is also a potent inhibitor of angiogenesis. We therefore studied
the effect of thalidomide in six patients with severe recurrent
intestinal bleeding refractory to standard treatment (three
patients with Crohn’s disease (CD), three patients with
obscure intestinal bleeding; mean of 56 blood transfusions within
the last 24 months). Bleeding stopped within two weeks after
the start of thalidomide in all patients. Haemoglobin normalised
without further transfusions for the whole observation period
(mean follow up 33 months) while patients needed a mean of 2.2
(CD) and 3.1 (obscure bleeding) blood units/month in the 12
months before treatment. After three months of thalidomide therapy,
serum levels of vascular endothelial growth factor were strongly
suppressed compared with pretreatment levels. (CD 818 (82)
v 129 (86) pg/ml; obscure bleeding 264 (68)
v 50 (25) pg/ml).
All six patients reported transient fatigue. Peripheral neuropathy
was observed in one patient with CD after nine months and was
reversible after lowering the dose to 100 mg daily. These results
indicate that thalidomide might be useful for patients with
otherwise refractory intestinal bleeding.
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