Saito M, Miyashita K, Ieko M, Yokoyama E, Kanaya M, Izumiyama K, Mori A, Morioka M, Kondo T. Repeated hemorrhagic ulcers of the esophagus associated with acquired hemophilia A: A case report. World J Gastrointest Endosc 2025; 17(12): 114836 [DOI: 10.4253/wjge.v17.i12.114836]
Corresponding Author of This Article
Makoto Saito, Chief Physician, Blood Disorders Center, Aiiku Hospital, Chuo-ku Minami 4 Nishi 25, Sapporo 064-0804, Hokkaido, Japan. ikyoku@aiiku-hp.or.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
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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/
Dec 16, 2025 (publication date) through Dec 19, 2025
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Saito M, Miyashita K, Ieko M, Yokoyama E, Kanaya M, Izumiyama K, Mori A, Morioka M, Kondo T. Repeated hemorrhagic ulcers of the esophagus associated with acquired hemophilia A: A case report. World J Gastrointest Endosc 2025; 17(12): 114836 [DOI: 10.4253/wjge.v17.i12.114836]
Makoto Saito, Emi Yokoyama, Minoru Kanaya, Koh Izumiyama, Akio Mori, Masanobu Morioka, Takeshi Kondo, Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
Kencho Miyashita, Department of Gastroenterology, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
Masahiro Ieko, Department of Nursing, Faculty of Health and Medical Sciences, Sapporo University of Health Sciences, Sapporo 007-0894, Hokkaido, Japan
Author contributions: Saito M designed this study and wrote the manuscript; Saito M, Miyashita K, Ieko M, Yokoyama E, Kanaya M, Izumiyama K, Mori A, Morioka M, and Kondo T contributed to the analysis and interpretation of the data; Saito M, Yokoyama E, and Kondo T primarily decided on the treatment strategy; Miyashita K was involved in the endoscopic procedure in this patient. All authors took part in drafting the article and agree to be accountable for all aspects of the work.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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/
Received: September 29, 2025 Revised: October 18, 2025 Accepted: November 13, 2025 Published online: December 16, 2025 Processing time: 78 Days and 3 Hours
Abstract
BACKGROUND
Acquired hemophilia A (AHA) is a rare blood disorder that can cause life-threatening severe bleeding because of the development of autoantibodies (inhibitors) against factor VIII. AHA is common in elderly patients, and although most cases are characterized by subcutaneous or intramuscular bleeding, rare cases of gastrointestinal bleeding have been reported. Controlling gastrointestinal bleeding in patients with AHA is difficult even after multiple endoscopic hemostasis or transcatheter arterial embolization procedures, and these patients are prone to rebleeding.
CASE SUMMARY
We report the case of a 76-year-old Japanese woman with AHA who presented with repeated bleeding from an esophageal ulcer as the initial symptom. A hemorrhagic ulcer was detected in the lower esophagus, and endoscopic hemostasis using radiofrequency ablation was performed seven times over a month. However, this procedure was unsuccessful, and the patient was transferred to our department. Hypertonic saline - epinephrine injection plus clipping was administered for endoscopic hemostasis, but the treatment response of the patient was poor. After the AHA diagnosis was confirmed, a single dose of a mixture of factors VIIa and X was administered as a bypass hemostatic agent, and the bleeding was successfully controlled. In addition, emicizumab, a bispecific monoclonal antibody that is a substitute for activated factor VIII, was administered, and no further rebleeding was observed.
CONCLUSION
Multidisciplinary interventions between endoscopists and hematologists are essential to manage rare gastrointestinal bleeding caused by coagulation disorders, such as AHA.
Core Tip: Acquired hemophilia A can cause life-threatening, severe bleeding. Most cases are characterized by subcutaneous or intramuscular bleeding, whereas gastrointestinal hemorrhage is rare. We report the case of a 76-year-old woman with AHA who presented with repeated bleeding from an esophageal ulcer. Endoscopic hemostasis using radiofrequency ablation was performed seven times; however, this procedure was unsuccessful. First, a mixture of factors VIIa and X (a bypass hemostatic agent) was administered, successfully controlling the hemorrhage from the esophageal ulcer. In addition, emicizumab (a substitute for activated factor VIII) was administered, after which no further bleeding was observed.
