Case ReportsRefractory bleeding from portal hypertensive gastropathy: a further novel role for thalidomide therapy?Karajeh, Mohammed A.a; Hurlstone, David P.a; Stephenson, Tim J.b; Ray-Chaudhuri, Dominica; Gleeson, Dermot C.aAuthor Information aGastroenterology and Liver Unit bHistopathology Department, Royal Hallamshire Hospital, Sheffield, UK Correspondence to Dr Mohammed A. Karajeh, Gastroenterology and Liver Unit, P14 – P Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK Tel: +44 114 271 3880; fax: +44 114 271 2692; e-mail: [email protected] Received 4 July 2005 Accepted 14 December 2005 European Journal of Gastroenterology & Hepatology: May 2006 - Volume 18 - Issue 5 - p 545-548 Buy Abstract Bleeding from portal hypertensive gastropathy (PHG) can pose a therapeutic challenge. Thalidomide, which selectively inhibits tumour necrosis factor-alpha production by enhancing messenger RNA degradation, has been shown to reduce portal venous pressure in cirrhotic and non-cirrhotic portal hypertension. Thalidomide is also a potent inhibitor of angiogenesis. We describe a case of intractable bleeding from PHG secondary to extrahepatic portal vein obstruction due to malignancy, which was managed successfully by thalidomide, thus obviating the need for major surgery. Although the use of thalidomide for treatment of severe intestinal bleeding has been described previously, this is the first case report, to our knowledge, describing its efficacy in bleeding secondary to PHG. We discuss the possible therapeutic mechanisms for thalidomide in PHG © 2006 Lippincott Williams & Wilkins, Inc.