Angiodysplasia natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
In asymptomatic people, the course of angiodysplasia is benign, and the bleeding risk is low. Consequently, treatment is not required for incidentally found lesions. [[Complications]] of angiodysplasia include [[Iron deficiency anemia|iron-deficiency anemia]], side effects from treatment e.g., [[subcutaneous emphysema]], [[perforation]] of the bowel during argon plasma coagulation, re-bleeding post procedure, severe loss of blood from the GI tract, death from [[hypovolemic shock]]. Nevertheless, the [[prognosis]] of angiodysplasia in asymptomatic patients is good as the bleeding risk is low. Moreover, in 90% of cases, angiodysplasias stop bleeding spontaneously which might be the result of the venous nature of angiodysplasias.


==Natural History==
==Natural History==
The natural history of angiodysplasia in asymptomatic people is benign and the risk of bleeding is low. Therefore, incidentally found lesions should not be treated.


Bleeding stops spontaneously in around 90% of bleeding angiodysplasias. However, bleeding can be life threatening in some cases leading to death from hemodynamic instability.
*[[Small bowel]] angiodysplasia (SBA) contributes to 50% of obscure GI bleeding cases.<ref name="pmid26540240">{{cite journal| author=Holleran G, Hall B, Zgaga L, Breslin N, McNamara D| title=The natural history of small bowel angiodysplasia. | journal=Scand J Gastroenterol | year= 2016 | volume= 51 | issue= 4 | pages= 393-9 | pmid=26540240 | doi=10.3109/00365521.2015.1102317 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26540240  }} </ref>
*SBA tends to re-bleed more than angiodysplasia of the [[colon]] and [[stomach]].
*In a [[retrospective study]], re-bleeding occurred after about 11 months of diagnosis in 80% of patients, and 3.5% died as a direct result of bleeding.<ref name="pmid26540240">{{cite journal| author=Holleran G, Hall B, Zgaga L, Breslin N, McNamara D| title=The natural history of small bowel angiodysplasia. | journal=Scand J Gastroenterol | year= 2016 | volume= 51 | issue= 4 | pages= 393-9 | pmid=26540240 | doi=10.3109/00365521.2015.1102317 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26540240  }} </ref>
*Multiple lesions and [[valvular heart diseases]] have been found to increase the risk of re-bleeding.
*Apart from recurrence of bleeding, some other concerns in the natural history of angiodysplasia are [[Blood transfusion|transfusion]] requirements, hospital readmissions, and requirement [[endoscopic]], [[pharmacological]], or surgical therapy.
*In [[asymptomatic]] people, the course of angiodysplasia is [[benign]], and the bleeding risk is low. Consequently, treatment is not required for incidentally found lesions.<ref name="pmid7717311">{{cite journal| author=Foutch PG, Rex DK, Lieberman DA| title=Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. | journal=Am J Gastroenterol | year= 1995 | volume= 90 | issue= 4 | pages= 564-7 | pmid=7717311 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7717311  }} </ref>


==Complications==
==Complications==


*Anemia
*[[Iron deficiency anemia|Iron-deficiency anemia]]
*Death from excessive blood loss
*Side effects from treatment e.g., [[subcutaneous emphysema]],<ref name="pmid18423466">{{cite journal| author=Herrera S, Bordas JM, Llach J, Ginès A, Pellisé M, Fernández-Esparrach G | display-authors=etal| title=The beneficial effects of argon plasma coagulation in the management of different types of gastric vascular ectasia lesions in patients admitted for GI hemorrhage. | journal=Gastrointest Endosc | year= 2008 | volume= 68 | issue= 3 | pages= 440-6 | pmid=18423466 | doi=10.1016/j.gie.2008.02.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18423466  }} </ref> [[perforation]] of the bowel during argon plasma coagulation<ref name="pmid12612532">{{cite journal| author=Ben Soussan E, Mathieu N, Roque I, Antonietti M| title=Bowel explosion with colonic perforation during argon plasma coagulation for hemorrhagic radiation-induced proctitis. | journal=Gastrointest Endosc | year= 2003 | volume= 57 | issue= 3 | pages= 412-3 | pmid=12612532 | doi=10.1067/mge.2003.131 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12612532  }} </ref>
*Side effects from treatment
*Re-bleeding post procedure
*Severe loss of blood from the GI tract
*Severe loss of blood from the GI tract
*Death from [[hypovolemic shock]]


==Prognosis==
==Prognosis==
Patients who have bleeding related to this condition despite having had colonoscopy, angiography, or surgery are likely to have more bleeding in the future. The outlook remains good if the bleeding is controlled.
 
*The [[prognosis]] of angiodysplasia in asymptomatic patients is good as the bleeding risk is low.
*In 90% of cases, angiodysplasias stop bleeding spontaneously which might be the result of the venous nature of angiodysplasias.<ref name="pmid19448365">{{cite journal| author=Al-Mehaidib A, Alnassar S, Alshamrani AS| title=Gastrointestinal angiodysplasia in three Saudi children. | journal=Ann Saudi Med | year= 2009 | volume= 29 | issue= 3 | pages= 223-6 | pmid=19448365 | doi=10.4103/0256-4947.51786 | pmc=2813652 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19448365  }} </ref>
*Advanced age, severe bleeding and [[hemodynamic instability]], and the presence of co-morbid medical conditions like [[coronary artery disease]], [[type 2 diabetes mellitus]] may contribute to mortality in these cases.


==References==
==References==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nikita Singh, M.B.B.S.[2]

Overview

In asymptomatic people, the course of angiodysplasia is benign, and the bleeding risk is low. Consequently, treatment is not required for incidentally found lesions. Complications of angiodysplasia include iron-deficiency anemia, side effects from treatment e.g., subcutaneous emphysema, perforation of the bowel during argon plasma coagulation, re-bleeding post procedure, severe loss of blood from the GI tract, death from hypovolemic shock. Nevertheless, the prognosis of angiodysplasia in asymptomatic patients is good as the bleeding risk is low. Moreover, in 90% of cases, angiodysplasias stop bleeding spontaneously which might be the result of the venous nature of angiodysplasias.

Natural History

  • Small bowel angiodysplasia (SBA) contributes to 50% of obscure GI bleeding cases.[1]
  • SBA tends to re-bleed more than angiodysplasia of the colon and stomach.
  • In a retrospective study, re-bleeding occurred after about 11 months of diagnosis in 80% of patients, and 3.5% died as a direct result of bleeding.[1]
  • Multiple lesions and valvular heart diseases have been found to increase the risk of re-bleeding.
  • Apart from recurrence of bleeding, some other concerns in the natural history of angiodysplasia are transfusion requirements, hospital readmissions, and requirement endoscopic, pharmacological, or surgical therapy.
  • In asymptomatic people, the course of angiodysplasia is benign, and the bleeding risk is low. Consequently, treatment is not required for incidentally found lesions.[2]

Complications

Prognosis

  • The prognosis of angiodysplasia in asymptomatic patients is good as the bleeding risk is low.
  • In 90% of cases, angiodysplasias stop bleeding spontaneously which might be the result of the venous nature of angiodysplasias.[5]
  • Advanced age, severe bleeding and hemodynamic instability, and the presence of co-morbid medical conditions like coronary artery disease, type 2 diabetes mellitus may contribute to mortality in these cases.

References

  1. ↑ 1.0 1.1 Holleran G, Hall B, Zgaga L, Breslin N, McNamara D (2016). "The natural history of small bowel angiodysplasia". Scand J Gastroenterol. 51 (4): 393–9. doi:10.3109/00365521.2015.1102317. PMID 26540240.
  2. ↑ Foutch PG, Rex DK, Lieberman DA (1995). "Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people". Am J Gastroenterol. 90 (4): 564–7. PMID 7717311.
  3. ↑ Herrera S, Bordas JM, Llach J, Ginès A, Pellisé M, Fernández-Esparrach G; et al. (2008). "The beneficial effects of argon plasma coagulation in the management of different types of gastric vascular ectasia lesions in patients admitted for GI hemorrhage". Gastrointest Endosc. 68 (3): 440–6. doi:10.1016/j.gie.2008.02.009. PMID 18423466.
  4. ↑ Ben Soussan E, Mathieu N, Roque I, Antonietti M (2003). "Bowel explosion with colonic perforation during argon plasma coagulation for hemorrhagic radiation-induced proctitis". Gastrointest Endosc. 57 (3): 412–3. doi:10.1067/mge.2003.131. PMID 12612532.
  5. ↑ Al-Mehaidib A, Alnassar S, Alshamrani AS (2009). "Gastrointestinal angiodysplasia in three Saudi children". Ann Saudi Med. 29 (3): 223–6. doi:10.4103/0256-4947.51786. PMC 2813652. PMID 19448365.

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