NATURAL HISTORY OF GASTRIC ULCER IN A 25 YEARS FOLLOW-UP: ROLE OF HELICOBACTER PYLORI INFECTION AND NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

inhibitor, which is used systemically in various cancer diseases and as local treatment in age-related macular degeneration have been suggested.Positive effect of systemic treatment with bevacizumab in HHT patient has been reported in case reports and in a phase 2 trial in liver arterio-venous malformations.Methods: From 2013 patients with HHT attached to the Danish National HHT centre with treatment refractory bleeding (epistaxis and gastrointestinal bleeding) were offered out-patient treatment with bevacizumab.Bevacizumab was administered as an induction treatment regimen 5mg/kg bodyweight every third week for a total of 3 infusions.Data on patients were retrospectively reviewed from patient files and from the National HHT database (database permission 3-3013-974/L Danish Health Health and Medicine Autorities).Transfusion need and haemoglobin levels prior to treatment and 12 weeks after completion of induction treatment were evaluated.Results: Twelve patients (8 females) with either HHT1 or HHT2 with a median age of 67 years received treatment from 2013 to 2017.Eight patients had primarily epistaxis, four patients primarily gastrointestinal bleeding.Median haemoglobin level was 5.9 mmol/l prior to treatment with bevacizumab and 7.9 mmol/l twelve weeks after completion of therapy.Median transfusion need 6 months up to treatment with bevacizumab was 8 units and 0 units 6 months after completion of treatment.In 7 out of 12 a substantial reduction in transfusion need was registered.One patient with severe manifestations of HHT with large hepatic malformation, ascites and severe right-sided heart failure did not survive for follow-up.The following side-effects were registered: two patients described hair-loss, one patient experienced tiredness after infusion, and one patient stopped treatment due to facial pain.Conclusion: In HHT patients with severe bleeding refractory to other treatment, bevacizumab may offer a systemic treatment option.In up to 60% of patients a significant reduction in blood transfusion and an increase in haemoglobin levels were documented in this retrospective study at a single university centre.Minor side-effects were reported in 4 of 12 twelve patients. Mo1192