angiodysplasia (angioectasia)
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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%)[7]
- 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 & distension 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[5]
Radiology
- angiography identifies the extent of involvement
- colon radiography is of no value
Management
- combined estrogen & progesterone (efficacy not well established[3][4])
- thalidomide 100 mg PO QD for 4 months for recurrent small-intestinal angiodysplasia (70% effective)[6]
- 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[7]
- laser therapy or cautery during colonoscopy or during upper GI endoscopy or push enteroscopy[5]
- surgical resection
More general terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 352-254
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 308
- ↑ 3.0 3.1 UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 4.0 4.1 Journal Watch 21(24):196, 2001 Junquera F, Feu F, Papo M et al A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. Gastroenterology 121:1073, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11677198
- ↑ 5.0 5.1 5.2 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018
- ↑ 6.0 6.1 Chen H, Wu S, Tang M et al. Thalidomide for recurrent bleeding due to small-intestinal angiodysplasia. N Engl J Med 2023 Nov 2; 389:1649. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37913505 Clinical Trial. https://www.nejm.org/doi/10.1056/NEJMoa2303706
- ↑ 7.0 7.1 7.2 Goltstein LCMJ, Grooteman KV, Bernts LHP et al. Standard of care versus octreotide in angiodysplasia-related bleeding (the OCEAN study): A multicenter randomized controlled trial. Gastroenterology 2024 Apr; 166:690-703. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38158089 Free article https://www.gastrojournal.org/article/S0016-5085(23)05685-8/fulltext?referrer=https%3A%2F%2Fwww.jwatch.org%2Fhttps://www.gastrojournal.org/article/S0016-5085(23)05685-8/fulltext?referrer=https%3A%2F%2Fwww.jwatch.org%2F