Angiodysplasia natural history, complications and prognosis: Difference between revisions
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{{Angiodysplasia}} | {{Angiodysplasia}} | ||
{{CMG}} {{AE}} {{ | {{CMG}} {{AE}} {{NKT}} | ||
==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== | ||
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*[[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> | *[[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]]. | *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> | *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. | *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. | *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. | ||
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*[[Iron deficiency anemia|Iron-deficiency anemia]] | *[[Iron deficiency anemia|Iron-deficiency anemia]] | ||
*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== | ||
* The [[prognosis]] of angiodysplasia in asymptomatic patients is good as the bleeding risk is low. | *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> | *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. | *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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[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
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{{WS}} | {{WS}} | ||
{{WH}} | {{WH}} | ||
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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
- Iron-deficiency anemia
- Side effects from treatment e.g., subcutaneous emphysema,[3] perforation of the bowel during argon plasma coagulation[4]
- Re-bleeding post procedure
- Severe loss of blood from the GI tract
- Death from hypovolemic shock
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
- ↑ 1.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.