Sirolimus and gastrointestinal angiodysplasia: Can an established agent change the way gastrointestinal bleeding is managed?

Gastrointestinal angiodysplasia (GIAD) is a common, acquired, vascular abnormality in the gastrointestinal tract that is commonly implicated in bleeding. Sirolimus, also known as rapamycin, is a mammalian target of rapamycin pathway inhibitor that has shown significant potential in inhibiting abnormal angiogenesis that has demonstrated efficacy in inhibiting abnormal blood vessel formation in the skin, cornea, and tumors. Sun et al in their single centre prospective study aimed to evaluate the efficacy and safety of sirolimus in treating GIAD-associated bleeding. While their study does provide a sound platform for future studies to investigate the effects of sirolimus in the treatment of GIAD-associated bleeding in an evidence free zone, there are limitations to the study which are not addressed. In this commentary, we summarise the significant highlights from the study performed by Sun et al along with its limitations. In addition to this, we provide an update on the current therapies utilised in the treatment of GIAD-associated bleeding.