angiodysplasia (angioectasia)

Introduction

Angiodysplasia is a degenerative or congenital vascular anomaly.

Etiology

• acquired vascular ectasias are associated with aging
• associations/risk factor(s):
  • renal failure
  • cardiac disease, especially aortic stenosis

Epidemiology

• common finding in the elderly
• equally common in both sexes

Pathology

• in the gastrointestinal (GI) tract, it may involve the mucosa from the stomach to the colon
  • small intestine (87%), colon (48%), stomach (27%)
• lesions are frequently multiple
• colonic lesions are most frequently found in the cecum & right (ascending) colon
• ectasias may occur secondary to chronic, partial, intermittent, low-grade obstruction of submucosal veins where they penetrate the colon
• obstruction is from muscle contraction & distention of the cecum

Clinical manifestations

• occult, recurrent or gross GI bleeding
• no associated skin or visceral manifestations

Diagnostic procedures

• GI endoscopy
  • colonoscopy
  • capsule endoscopy
    • fern-like pattern, red in color may be seen

Radiology

• angiography identifies the extent of involvement
• colon radiography is of no value

Management

• combined estrogen & progesterone (efficacy not well established)
• thalidomide 100 mg PO QD for 4 months for recurrent small-intestinal angiodysplasia (70% effective)
• vasopressin 0.15-2.0 units/min in selectively catheterized bleeding artery
• octreotide 40 mg long-acting release intramuscular every 28 days
  • highly effective for gastrointestinal angiodysplasia
  • serious adverse events rare
• laser therapy or cautery during colonoscopy or during upper GI endoscopy or push enteroscopy
• surgical resection

More general terms

• vascular disease (vasculopathy)
• intestinal disease