Refers to a small vascular malformation of the gut.
A common cause of unexplained gastrointestinal bleeding and anemia.
Lesions are often multiple.
Lesions frequently involve the cecum or ascending colon, although they can occur at other places.
The small intestine is estimated to be the source of G.I. bleeding in approximately 5 to 10% of patients, and angiodysplasia is the most common cause of small, intestinal, bleeding.
Treatment may be with endoscopic interventions, medication, or occasionally surgery.
Endoscopic therapy is commonly used to treat small intestinal angiodysplasia although studies have failed to document, long-term efficacy with re-bleeding episodes ranging from 43 to 45%.
Antiangiogenic therapies for small intestinal angiodysplasia bleeding are on the basis of strong vascular endothelial growth factor (VEGF) expression and agents to be considered, include thalidomide, and bevacizumab.
Somatostatin analogs may be a benefit.
Blood loss can be subtle and presenting with anemia.
Tarry stools may occur.
Fecal occult blood testing may be positive with active bleeding.
Diagnosis achieved by endoscopy, either colonoscopy or esophagogastroduodenoscopy.. Although the lesions can be notoriously hard to find, the patient usually is diagnosed by endoscopy.
Camera studies, by pill enteroscopy is useful in diagnosing lesions particularly of the small bowel.
In cases with negative endoscopic findings angiography of the mesenteric arteries may be helpful in making a diagnosis, and allows for interventional therapy.
Increases with age.
Risk of bleeding is increased in disorders of coagulation.
Associated with advanced kidney disease.
Heyde’s syndrome, refers to the coincidence of aortic valve stenosis and bleeding from angiodysplasia.
In the Heyde’s syndrome von Willebrand factor (vWF) is proteolysed due to high shear stress in the turbulent blood flow around the aortic valve.
vWF is most active in vascular beds with high shear stress, including angiodysplasias.
Endoscopic treatment with cautery or argon plasma coagulation (APC) may be therapeutic.
Resection of the affected part of the bowel may be required.
Embolization through angiography is occasionally successful.
Systemic therapy with antifibrinolytics tranexamic acid or aminocaproic acid may be helpful.
Estrogens can be used to stop bleeding.