Review article: gastrointestinal angiodysplasia - pathogenesis, diagnosis and management

Abstract

Summary Background Angiodysplasia (AD) of the gastrointestinal (GI) tract is an important condition that can cause significant morbidity and –rarely – mortality. Aim To provide an up‐to‐date comprehensive summary of the literature evaluating this disease entity with a particular focus on pathogenesis as well as current and emerging diagnostic and therapeutic modalities. Recommendations for treatment will be made on the basis of the current available evidence and consensus opinion of the authors. Methods A systematic literature search was performed. The search strategy used the keywords ‘angiodysplasia’ or ‘arteriovenous malformation’ or ‘angioectasia’ or ‘vascular ectasia’ or ‘vascular lesions’ or ‘vascular abnormalities’ or ‘vascular malformations’ in the title or abstract. Results Most AD lesions (54–81.9%) are detected in the caecum and ascending colon. They may develop secondary to chronic low‐grade intermittent obstruction of submucosal veins coupled with increased vascular endothelial growth factor‐dependent proliferation. Endotherapy with argon plasma coagulation resolves bleeding in 85% of patients with colonic AD. In patients who fail (or are not suitable for) other interventions, treatment with thalidomide or octreotide can lead to a clinically meaningful response in 71.4% and 77% of patients respectively. Conclusions Angiodysplasia is a rare, but important, cause of both overt and occult GI bleeding especially in the older patients. Advances in endoscopic imaging and therapeutic techniques have led to improved outcomes in these patients. The choice of treatment should be decided on a patient‐by‐patient basis. Further research is required to better understand the pathogenesis and identify potential therapeutic targets.

Absence of Complications after Endoscopic Mucosal Biopsy

“…Angiodysplasias was found in 25.6% of the patients in our study who were admitted for observation or management of upper GI bleeding. In contrast, published literature generally attributes only 4–7% of upper GI bleeding to angiodysplasia [25]. These lesions are increasingly being diagnosed with improved endoscopy.…”

Recurrent Gastrointestinal Bleeding from Dieulafoy’s Lesions in a Patient with Type 1 von Willebrand Disease: A Rare Association

“…Indeed, there is some evidence supporting a link between vWD and angiodysplasia [3,6,17], a different kind of vascular abnormality. These conditions were proposed to form a triad along with aortic stenosis in the pathophysiology of Heyde's syndrome, with the initial event being selective destruction of the largest vWF multimers by the stenosed aortic valve, resulting in acquired vWD [18,19]. The loss of these multimers would then promote bleeding in the particular setting of a local high-shear condition found in angiodysplasias [18].…”

Laparoscopic ileocecal resection for cecalangiodysplasia

“…У пациентов зрелого и пожилого возраста эти поражения представлены, как правило, приобретен-ной артериовенозной мальформацией -ангиодисплазией (АД). По причине относительной редкости АД кишечника рандомизи-рованных проспективных контролируемых исследований прове-дено очень мало [9]. В связи с развитием и улучшением методов инструментальной диагностики в последнее время отмечается рост частоты выявления АД кишечника, в том числе и бессим-птомных.…”

“…Проведено лишь небольшое количество проспективных рандо-мизированных исследований с малыми размерами выборок, в которых получены противоречивые результаты [9]. В связи с этим рекомендовать фармакотерапию в рутинной практике в на-стоящее время нельзя.…”