Angiodysplasia of the gastrointestinal tract

Digestive angiodysplasias are degenerative arteriovenous lesions most commonly located in the right colon and cecum. They account for 5 to 10% of lower gastrointestinal bleeding but represent the primary cause of "occult" gastrointestinal bleeding (30% according to some anatomic-pathological series). The majority of cases involve patients over 50 years old. A possible association with aortic stenosis (up to 25% of cases according to some series) is highly debated.

Clinical Presentation

The manifestations of digestive angiodysplasias are recurrent lower gastrointestinal bleeding (90% spontaneously resolve) of varying severity. Massive bleeding with shock is rare.

The diagnostic suspicion arises from repeated lower gastrointestinal bleeding or, frequently, during an evaluation following the incidental discovery of anemia.

Additional Tests

Biological tests often reveal chronic mild to moderate iron deficiency anemia.

The main useful tests remain endoscopy and arteriography (celiac trunk and mesenteric arteries), although computed tomography (CT) reconstructions seem promising. In cases of negativity and strong clinical-biological suspicion, a Tc-labeled red blood cell SPECT may identify a source of occult bleeding.

Therapeutic Management - Treatments

In addition to purely supportive measures for poorly tolerated anemia, the type of treatment will depend on the symptoms, recurrence, extent of the angiodysplasia, age, and general condition of the patient.

• Asymptomatic angiodysplasia discovered incidentally: Observation. Simple clinical follow-up.
• Symptomatic in a very elderly or fragile patient: Consider medical treatment (octreotide 2 x 0.1 mg SC or vasopressin IV) and avoidance of anticoagulants and antiplatelet agents unless absolutely necessary.
• Other cases: Endoscopic treatments (sclerotherapy, laser, etc.)
• Abundant and recurrent bleeding despite endoscopic treatment: Segmental surgical resection.

Bibliography

Hawkey CJ et al., Textbook of clinical Gastroenterology and Hepatology, 2d edition, Wiley-BlackWell, 2012

Saltzman JR, Angiodysplasia of the gastrointestinal tract, UpToDate, 2022