Use of Estrogen Therapy in a Patient with Gastrointestinal Bleeding Secondary to arteriovenous malformations

Abstract

OBJECTIVE:

To describe a patient with gastrointestinal (GI) bleeding caused by arteriovenous malformations (AVMs) that was treated with estrogen therapy.

CASE SUMMARY:

A 70-year-old white man was diagnosed with multiple AVMs in the cecum, duodenum, and stomach. Pharmacologic management included the use of ferrous sulfate; however, the patient continued to have recurrent bleeding that required multiple transfusions and endoscopic cauterization. Therapy was initiated with ethinyl estradiol 0.05 mg po qd; no further transfusions have been required for 10 months.

DISCUSSION:

It is estimated that AVMs of the GI tract account for 1–8% of upper GI bleeding episodes and up to 6% of lower GI bleeding episodes. Hormonal agents have been reported to decrease bleeding in patients with both hereditary and acquired AVMs.

CONCLUSIONS:

The role of estrogen therapy in treating AVMs of the GI tract is unclear and supported by only one clinical study.