Gastrointestinal angiodysplasias or angioectasias are one of the most common causes of occult gastrointestinal bleeding.
Peak incidence occurs in patients in their 60-70s 3.
Angiodysplasia refers to dilated, thin-walled blood vessels (capillaries, venules, veins) found in the mucosa and submucosa of the gastrointestinal tract. The pathogenesis is unclear 3. They are multiple in ~50% of cases 1,2, and can be found throughout the gastrointestinal tract, but most commonly in the caecum and right colon on the antimesenteric border.
- Heyde syndrome: bleeding angiodysplasia and aortic stenosis (controversial 1)
- chronic renal failure
- von Willebrand disease
- appear as focal areas (< 5 mm) of contrast enhancement in the bowel wall (most prominent in the enteric phase 3)
- early filling of an antimesenteric vein 4
- ectatic vessels but no mass 6
- early venous enhancement indicating arteriovenous shunting
Treatment and prognosis
Approximately 50% of gastrointestinal haemorrhage from angiodysplasia ceases without intervention. Endovascular treatment is generally not effective and first-line treatment is interventional endoscopy. There is a post-treatment bleeding rate of ~25% 2,4.
- 1. Gunjan D, Sharma V, Rana SS et-al. Small bowel bleeding: a comprehensive review. Gastroenterol Rep (Oxf). 2014;2 (4): 262-75. doi:10.1093/gastro/gou025 - Free text at pubmed - Pubmed citation
- 2. Jackson CS, Gerson LB. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am. J. Gastroenterol. 2014;109 (4): 474-83. doi:10.1038/ajg.2014.19 - Pubmed citation
- 3. Huprich JE, Barlow JM, Hansel SL et-al. Multiphase CT enterography evaluation of small-bowel vascular lesions. AJR Am J Roentgenol. 2013;201 (1): 65-72. doi:10.2214/AJR.12.10414 - Pubmed citation
- 4. Mandell J. Core Radiology. Cambridge University Press. (2013) ISBN:1107679680. Read it at Google Books - Find it at Amazon
- 5. Gore RM, Levine MS. Textbook of Gastrointestinal Radiology: Expert Consult. Saunders. ISBN:B00PQHSMAM. Read it at Google Books - Find it at Amazon
- 6. Brant WE, Helms C. Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins. ISBN:1608319121. Read it at Google Books - Find it at Amazon