Angiodysplasia overview

Angiodysplasia Microchapters
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Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Angiodysplasia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nikita Singh, M.D.[2]

Historical Perspective

Angiodysplasia was first reported in 1839 by Phillips as a vascular lesion causing bleeding from large intestine. Heyde discovered the association between aortic stenosis and angiodysplasia in 1958. The term angiodysplasia was coined by Galdabini in 1974.

Classification

There are multiple systems of classification of angiodysplasia. One system of classification is based on location, size, and number of angiodysplastic lesions. Another system uses endoscopic findings to classify angiodysplasia.

Pathophysiology

The exact pathogenesis of angiodysplasia is unknown. It has been proposed that chronic obstruction of submucosal veins coupled with the effect of ageing, ultimately leading to the formation of small arterio-venous collaterals. Angiogenic factors have also been found to play a role in the development of angiodysplasia.

Differentiating Angiodysplasia overview from Other Diseases

Angiodysplasia must be differentiated from other diseases that cause hematochezia, melena, and iron deficiency anemia like, diverticulitis, hemorrhoids, colon cancer, upper GI bleed and inflammatory bowel disease.

Epidemiology and Demographics

Angiodysplasia is the most common vascular malformation of the GI tract and accounts for 20% of major episodes of lower intestinal bleeding. The prevalence of angiodysplasia is less than 1% in healthy patients older than 50 years undergoing screening colonoscopy. The incidence of angiodysplasia is equal in both men and women. Majority of the affected population is older than 60 years. The most common location of angiodysplasia of the gastrointestinal tract is the colon.

Risk Factors

The most important risk factors for active bleeding from angiodysplasia include advanced age, cardiovascular comorbidities, von Willebrand disease, end-stage renal disease, and antiplatelet or anticoagulant use.

Screening

There are no specific indications for screening angiodysplasia.

Natural History, Complications, and Prognosis

Natural History

The natural history of angiodysplasia in asymptomatic people is benign and the risk of bleeding is low.

Complications

Anemia, hemodynamic instability from massive blood loss.

Prognosis

Prognosis is favorable in asymptomatic cases and in cases where bleeding is controlled.

Diagnosis

History and Symptoms

Many patients with angiodysplasia lack symptoms. Others present with GI bleeding or its consequences. Patients may present with rectal bleeding (0-60%), melena (passing black tarry bloody stool) (0-26%), occult blood positive stool (4-47%), or iron deficiency anemia (0-51%). Spontaneous cessation of bleeding (90%) is the rule for lesions located in any part of the GI tract.

Symptoms include hematochezia ( 60%), melena ( 26%), hematemesis observed in angiodysplasia of the upper GI tract.

Physical Examination

Signs and symptoms of iron deficiency anemia like can be found in patients with occult bleeding.

A systolic ejection murmur can be heard if associated with aortic stenosis.

Laboratory Findings

Complete blood count, renal function tests, liver function tests and coagulation studies to diagnose any underlying medical conditions.

Imaging Findings

Endoscopy is the imaging modality of choice for the diagnosis of angiodysplasia. Lesions appear like flat, 5- to 10 mm, cherry-red, fern-like pattern of vessels.

Other Diagnostic Studies

Hdelical CT angiography or magnetic resonance angiography can be used in case the conventional methods fail to show bleeding sources.

Treatment

Medical Therapy

Endoscopic treatment is the therapy of choice in which cautery or argon plasma coagulation (APC) is used. Other options are mechanical hemostasis using clips, sclerotherapy. First-line medications are antifibrinolytics tranexamic acid or aminocaproic acid. Estrogens can be used to stop bleeding from angiodysplasia. In difficult cases, there have been positive reports about octreotide and thalidomide,

Surgery

In severe cases or cases not responsive to either endoscopic or medical treatment, surgical resection may be necessary to arrest the bleeding.

Prevention

Primary or secondary prevention is currently not available.