Angiodysplasia

What is Angiodysplasia?

The term Angiodysplasia refers to degenerative dilated mucosal and submucosal vessels in the gastrointestinal tract that bleed intermittently. It accounts for up to 40% of lower gastrointestinal bleeding in individuals older than 60 and often involves the cecum and ascending colon.

Angiodysplasias are described as acquired vascular ectasias rather than true hemangiomas. These lesions often occur in the right colon and typically cause painless bleeding in older adults.

What causes Angiodysplasia?

Degeneration of submucosal smooth muscle weakens vascular walls and permits venous dilation beneath the mucosa. Repeated contraction compresses venules, leading to dilated, tortuous mucosal and submucosal vessels that can bleed intermittently.

Coexisting aortic stenosis, chronic kidney disease, and von Willebrand factor disease increase wall tension and bleeding risk. These fragile, thin-walled angiodysplastic channels can rupture easily when perfusion surges occur. Older individuals with longstanding cardiovascular disease also display these lesions.

What are the signs and symptoms of Angiodysplasia?

Recurrent, painless lower gastrointestinal bleeding is the hallmark, with presentations ranging from occult iron deficiency to overt hematochezia. Chronic blood loss leads to fatigue, dyspnea on exertion, and diminished exercise tolerance, often prompting evaluation for anemia.

Intermittent brisk bleeding may require transfusion and reveals red blood in stool without abdominal pain, especially when angiodysplasia bowel lesions reside in the right colon. Occult bleeding should prompt evaluation with a complete blood count and iron studies (including ferritin) to detect chronic loss.

How is Angiodysplasia diagnosed?

Colonoscopy is first-line for diagnosis because it enables direct visualization and treatment. Lesions appear as flat, cherry-red, dilated vessels on tortuous mucosa. An abdominal CT angiogram or tagged red blood cell scan complements endoscopy when bleeding is brisk or lesions are beyond the reach of the colonoscope. Capsule endoscopy and deep enteroscopy may be required for jejunal or ileal involvement suspected by persistent anemia despite negative colonoscopy.

How is Angiodysplasia treated?

Initial management focuses on resuscitation with intravenous fluids and blood component therapy to correct hemodynamic compromise. Iron replacement helps replenish stores between bleeding episodes and reduces transfusion dependence.

Endoscopic therapy, typically argon plasma coagulation, seals the dilated vessels and targets recurrent bleeding sites. Somatostatin analogs and thalidomide have roles when endoscopic therapy fails or when lesions are diffuse. Cardiac valve replacement should be considered for individuals with concomitant aortic stenosis, which can increase shear stress. Surgical resection or angiographic embolization is reserved for persistent bleeding unresponsive to minimally invasive measures.

What are the most important facts to know about Angiodysplasia?

• Angiodysplasia is an acquired vascular ectasia causing intermittent lower gastrointestinal bleeding in older individuals.
• Angiodysplasias result from submucosal smooth muscle degeneration and venous dilation, with risk increased by aortic stenosis and renal disease.
• Presentation spans occult iron deficiency anemia to painless hematochezia, often without abdominal discomfort.
• Diagnosis relies on colonoscopy, with CT angiography, tagged red blood cell scans, or capsule endoscopy when necessary.
• Treatment includes resuscitation, iron repletion, endoscopic coagulation, and management of comorbid conditions to prevent recurrent bleeding.