O'Neill RS, Nandakumaran J, Feller R. Sirolimus and gastrointestinal angiodysplasia: Can an established agent change the way gastrointestinal bleeding is managed? World J Gastroenterol 2025; 31(41): 113736 [DOI: 10.3748/wjg.v31.i41.113736]
Corresponding Author of This Article
Robert Sean O'Neill, MBBS, Department of Gastroenterology and Hepatology, Campbelltown Hospital, Therry Road, Campbelltown 2560, New South Wales, Australia. rone1111@outlook.com
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Gastroenterology & Hepatology
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 7, 2025 (publication date) through Nov 9, 2025
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World Journal of Gastroenterology
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1007-9327
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O'Neill RS, Nandakumaran J, Feller R. Sirolimus and gastrointestinal angiodysplasia: Can an established agent change the way gastrointestinal bleeding is managed? World J Gastroenterol 2025; 31(41): 113736 [DOI: 10.3748/wjg.v31.i41.113736]
World J Gastroenterol. Nov 7, 2025; 31(41): 113736 Published online Nov 7, 2025. doi: 10.3748/wjg.v31.i41.113736
Sirolimus and gastrointestinal angiodysplasia: Can an established agent change the way gastrointestinal bleeding is managed?
Robert Sean O'Neill, Jeyvin Nandakumaran, Robert Feller
Robert Sean O'Neill, Jeyvin Nandakumaran, Department of Gastroenterology and Hepatology, Campbelltown Hospital, Campbelltown 2560, New South Wales, Australia
Robert Sean O'Neill, South West Clinical School, The University of New South Wales, Sydney 2052, New South Wales, Australia
Robert Feller, Department of Gastroenterology and Hepatology, St Vincent's Hospital, Sydney 2010, New South Wales, Australia
Robert Feller, School of Medicine, The University of New South Wales, Sydney 2010, New South Wales, Australia
Author contributions: O’Neill RS and Nandakumaran J were responsible for the conception, writing, reviewing and submission of the manuscript; Feller R was responsible for supervision of manuscript preparation, conceptualization, reviewing and submission of the manuscript.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Robert Sean O'Neill, MBBS, Department of Gastroenterology and Hepatology, Campbelltown Hospital, Therry Road, Campbelltown 2560, New South Wales, Australia. rone1111@outlook.com
Received: September 2, 2025 Revised: September 23, 2025 Accepted: October 9, 2025 Published online: November 7, 2025 Processing time: 65 Days and 21.1 Hours
Abstract
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.
Core Tip: This article discussed the current treatment landscape of gastrointestinal angiodysplasia (GIAD) with a focus on pharmacological management rather than endoscopic management. It also examines the study by Sun et al, who demonstrated in their small single-centre study that sirolimus, a mammalian target of rapamycin inhibitor, reduced bleeding and transfusion needs while improving haemoglobin levels in GIAD patients.
