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angiodysplasia (angioectasia)

Angiodysplasia is a degenerative or congenital vascular anomaly. Etiology: 1) acquired vascular ectasias are associated with aging 2) associations/risk factor(s): a) renal failure b) cardiac disease, especially aortic stenosis Epidemiology: 1) common finding in the elderly 2) equally common in both sexes Pathology: 1) in the gastrointestinal (GI) tract, it may involve the mucosa from the stomach to the colon - small intestine (87%), colon (48%), stomach (27%) [7] 2) lesions are frequently multiple 3) colonic lesions are most frequently found in the cecum & right (ascending) colon 4) ectasias may occur secondary to chronic, partial, intermittent, low-grade obstruction of submucosal veins where they penetrate the colon 5) obstruction is from muscle contraction & distension of the cecum Clinical manifestations: 1) occult, recurrent or gross GI bleeding 2) no associated skin or visceral manifestations Special laboratory: - GI endoscopy - colonoscopy - capsule endoscopy - fern-like pattern, red in color may be seen [5] Radiology: 1) angiography identifies the extent of involvement 2) colon radiography is of no value Management: 1) combined estrogen & progesterone (efficacy not well established [3,4]) 2) thalidomide 100 mg PO QD for 4 months for recurrent small-intestinal angiodysplasia (70% effective) [6] 3) vasopressin 0.15-2.0 units/min in selectively catheterized bleeding artery 4) octreotide 40 mg long-acting release intramuscular every 28 days - highly effective for gastrointestinal angiodysplasia - serious adverse events rare [7] 5) laser therapy or cautery during colonoscopy or during upper GI endoscopy or push enteroscopy [5] 6) surgical resection

General

vascular disease (vasculopathy) intestinal disease

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 352-254
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 308
  3. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  4. 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: 11677198
  5. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018
  6. 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: 37913505 Clinical Trial. https://www.nejm.org/doi/10.1056/NEJMoa2303706
  7. 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: 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