Angiodysplasia pathophysiology
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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
The exact pathogenesis of angiodysplasia is unknown. It has been proposed that chronic obstruction of submucosal veins coupled with the effect of aging, ultimately lead to the formation of small arterio-venous collaterals. Angiogenic factors have also been found to play a role in the development of angiodysplasia.
Pathophysiology
- The exact pathogenesis of angiodysplasia is still unknown.
- According to a theory, angiodysplasia develops due to chronic obstruction of submucosal veins coupled with the effect of ageing, ultimately leading to the formation of small arterio-venous collaterals.[1]
- Some studies have revealed increased levels of angiogenic factors like vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang1), Ang2 etc. in small bowel and human colonic angiodysplasia.[2][3]
- It has also been proposed that aortic stenosis, von Willebrand disease and chronic renal failure by various mechanisms contribute to development of angiodysplasia.[1]
Associated Conditions
The following conditions have been reported to be associated with angiodysplasia:
- Von Willebrand disease (vWD)[4]
- Aortic stenosis (Heyde syndrome)[4][5]
- End-stage renal disease (ESRD)[6]
- Systemic sclerosis (SSc)[7]
Gross Pathology
- Angiodysplasia is particularly difficult to recognise on gross examination of a resection specimen without the use of specific injection techniques.[8]
- Angiodysplasia can be seen easily on endoscopy. The most common appearance on endoscopy is a flat, red lesion with a fern-like of regular margin.
Histology
- Angiodysplastic lesions on histology appear as ectatic, thin-walled blood vessels in mucosa or submucosa.[9]
- Histopathologic findings on resected specimen are diagnostic.[10]
References
- ↑ 1.0 1.1 Sami SS, Al-Araji SA, Ragunath K (2014). "Review article: gastrointestinal angiodysplasia - pathogenesis, diagnosis and management". Aliment Pharmacol Ther. 39 (1): 15–34. doi:10.1111/apt.12527. PMID 24138285.
- ↑ Holleran G, Hussey M, Smith S, McNamara D (2017). "Assessment of serum angiogenic factors as a diagnostic aid for small bowel angiodysplasia in patients with obscure gastrointestinal bleeding and anaemia". World J Gastrointest Pathophysiol. 8 (3): 127–132. doi:10.4291/wjgp.v8.i3.127. PMC 5561433. PMID 28868182.
- ↑ Holleran G, Hall B, O'Regan M, Smith S, McNamara D (2015). "Expression of Angiogenic Factors in Patients With Sporadic Small Bowel Angiodysplasia". J Clin Gastroenterol. 49 (10): 831–6. doi:10.1097/MCG.0000000000000260. PMID 25319741.
- ↑ 4.0 4.1 Warkentin TE, Moore JC, Anand SS, Lonn EM, Morgan DG (2003). "Gastrointestinal bleeding, angiodysplasia, cardiovascular disease, and acquired von Willebrand syndrome". Transfus Med Rev. 17 (4): 272–86. doi:10.1016/s0887-7963(03)00037-3. PMID 14571395.
- ↑ Pate GE, Chandavimol M, Naiman SC, Webb JG (2004). "Heyde's syndrome: a review". J Heart Valve Dis. 13 (5): 701–12. PMID 15473466.
- ↑ Tariq T, Karabon P, Irfan FB, Goyal S, Mayeda MM, Parsons A; et al. (2019). "Secondary angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease: Results from the nationwide inpatient sample". World J Gastrointest Endosc. 11 (10): 504–514. doi:10.4253/wjge.v11.i10.504. PMC 6885446 Check
|pmc=value (help). PMID 31798771. - ↑ Marie I, Ducrotte P, Antonietti M, Herve S, Levesque H (2008). "Watermelon stomach in systemic sclerosis: its incidence and management". Aliment Pharmacol Ther. 28 (4): 412–21. doi:10.1111/j.1365-2036.2008.03739.x. PMID 18498445.
- ↑ Koga H, Iida M, Nagai E, Aoyagi K, Matsumoto T, Takesue M; et al. (1996). "Jejunal angiodysplasia confirmed by intravascular injection technique in vitro. Report of a case and review of the literature". J Clin Gastroenterol. 23 (2): 139–44. doi:10.1097/00004836-199609000-00017. PMID 8877645.
- ↑ Thelmo WL, Vetrano JA, Wibowo A, DiMaio TM, Cruz-Vetrano WP, Kim DS (1992). "Angiodysplasia of colon revisited: pathologic demonstration without the use of intravascular injection technique". Hum Pathol. 23 (1): 37–40. doi:10.1016/0046-8177(92)90008-q. PMID 1544666.
- ↑ Accordino R, Paties C, Inzani E, Civardi C, Cremonesi V, Lagasi L; et al. (1995). "[Angiodysplasia of the right colon]". Minerva Chir. 50 (7–8): 703–6. PMID 8532207.