Gastrointestinal Angiodysplasia

Gastrointestinal Angiodysplasia

Article
Digestive Health
Men's Health
+2
Contributed byMaulik P. Purohit MD MPHSep 16, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Angiodysplasia of GI Tract
  • Gastrointestinal Vascular Ectasia
  • GI Telangiectasia

What is Gastrointestinal Angiodysplasia? (Definition/Background Information)

  • Gastrointestinal Angiodysplasia (GIAD) is a benign condition caused by vascular malformation, usually in the large, and sometimes, in the small intestine. It causes gastrointestinal tract bleeding resulting in anemia. About three-fourths of such formations are observed in the ascending colon and cecum (of the large intestine)
  • In individuals over 60 years of age, Gastrointestinal Angiodysplasia is the second most common cause of bleeding after diverticulosis, a medical condition resulting in multiple pouch-like formation in the intestines
  • The cause of Gastrointestinal Angiodysplasia is generally unknown, but it is linked to factors such as the use of anticoagulant medications, renal failure necessitating dialysis, bleeding disorders, and Heyde syndrome
  • The diagnosis of Gastrointestinal Angiodysplasia may involve various blood tests including stool test for occult blood, and imaging tools such as colonoscopy and angiographic studies, which may help detect active bleeding within the GI tract
  • Periodic observation may be maintained for asymptomatic cases. Surgical management may be proposed, depending on the signs and symptoms caused by the vascular malformation. Anemia may have to be treated using iron-rich foods and blood transfusions, if required
  • The prognosis of an individual with Gastrointestinal Angiodysplasia is typically excellent with suitable treatment, since in many cases the bleeding is self-limiting. However, the prognosis also depends upon the severity of the condition

Who gets Gastrointestinal Angiodysplasia? (Age and Sex Distribution)

  • Gastrointestinal Angiodysplasia usually affects middle-aged and older adults, over the age of 50 years. A peak period of 60-70 years is noted
  • Both males and females are affected; but, colonic angiodysplasia affects both men and women at an equal incidence rate
  • There is no known predilection towards any ethnic or racial group, and the condition is seen worldwide

What are the Risk Factors for Gastrointestinal Angiodysplasia? (Predisposing Factors)

The risk factors for Gastrointestinal Angiodysplasia include the following:

  • Taking blood thinners or anticoagulants (anti-platelet medications)
  • Bleeding disorders such as von Willebrand factor (vWF) deficiency
  • Prolonged constipation
  • Chronic renal failure patients on dialysis
  • Heyde syndrome; in which there is GI bleeding due to angiodysplasia in individuals with aortic stenosis and acquired von Willebrand factor disease (2A deficiency)
  • GIAD is known to be associated with scleroderma (an autoimmune skin condition); many cases have been reported in individuals with this skin condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Gastrointestinal Angiodysplasia? (Etiology)

The exact cause of Gastrointestinal Angiodysplasia is unknown.

  • Research scientists believe that it is an acquired condition that results from chronic contraction of the small/large intestine resulting in obstruction of the blood vessels
  • The contributory factors for GI Angiodysplasia development may include the use of blood thinning medications, chronic constipation or hard stools, Heyde syndrome, kidney failure necessitating kidney dialysis, bleeding disorders, and scleroderma

What are the Signs and Symptoms of Gastrointestinal Angiodysplasia?

The signs and symptoms of Gastrointestinal Angiodysplasia may include:

  • Gastrointestinal tract bleeding can be mild or profuse; it can also be periodic, meaning that the bleeding occurs on and off
  • Profuse bleeding can cause black tarry stools (melena)
  • Chronic bleeding can result in anemia with symptoms including pale skin, lethargy and/or fatigue, poor appetite, lightheadedness, irritability and headaches
  • GIAD lesions are usually small and less than 5 mm in size
  • These vascular malformations are commonly present in the ascending colon and cecum (part of the large intestine, at the beginning); 75% of the cases are reported at these regions
  • 15% of the cases are observed in the jejunum and ileum (parts of the small intestine)
  • The remainder can be anywhere in the GI tract (in the large and small intestine)
  • The malformations can be single or multiple, but often they are more than one

In some cases, the condition may be asymptomatic (presenting no significant signs and symptoms).

How is Gastrointestinal Angiodysplasia Diagnosed?

Gastrointestinal Angiodysplasia is diagnosed with the help of the following tests and exams:

  • Complete physical exam with comprehensive evaluation of medical history
  • Complete blood count (CBC): This measures the red blood cell count and hemoglobin levels in blood. Low levels of hemoglobin and/or RBC count can indicate iron deficiency
  • Fecal occult blood test (FOBT):
    • This test is used to check if there is bleeding in the gastrointestinal tract
    • The test is usually positive, when there is active bleeding; the test can be negative, when the individual is not bleeding (silent period)
  • Tests such as partial thromboplastin time (PTT) and prothrombin time (PT), to check for blood coagulation
  • Colonoscopy:
    • A colonoscopy is a test that allows the physician to look at the inner lining of the colon and rectum
    • A typical colonoscopy involves using a thin, flexible tube (called a colonoscope), with an attached video camera, to view the colon and rectum
    • During a colonoscopy, it is not always easy to detect the site of the bleeding, since these malformations can be small and difficult to detect
  • Capsule endoscopy (enteroscopy) and colonoscopy: Also, known as pill endoscopy and colonoscopy, it is a diagnostic tool in which a small capsule/pill with an attached camera is swallowed. As the pill goes through the small/large intestines, the camera visualizes the lining of the bowel to detect site of the bleeding
  • Selective GI angiography
  • Multiphase CT angiography: It is another technique, which can help detect an active bleeding
  • Radioactive scintigraphy can also help detect active bleeding in the GI tract

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Gastrointestinal Angiodysplasia?

The complications from Gastrointestinal Angiodysplasia could include:

  • Chronic and recurrent bleeding
  • Emotional trauma due to chronic bleeding episodes
  • Severe and acute bleeding can even be life-threatening
  • Chronic blood loss can lead to iron deficiency anemia
  • Anemia can also cause impairment in intellectual functioning, behavioral problems, etc.
  • Bleeding may occur even after treatment in some cases
  • Damage to vital nerves, blood vessels, and surrounding structures during surgery

How is Gastrointestinal Angiodysplasia Treated?

The treatment measures for Gastrointestinal Angiodysplasia may be considered based on the following:

  • Individuals, with GI Angiodysplasia, diagnosed incidentally during colonoscopy and are asymptomatic, do not need treatment. Such individuals may be monitored by the healthcare provider on a regular basis
  • Currently, it is recommended that GI Angiodysplasia detected during a colonoscopy, should be considered for preventative treatment on a case-by-case basis. Routine ablation treatment on colonoscopy should not be performed

Symptomatic conditions may be treated through the following measures:

  • Endoscopic cautery using techniques such as argon plasma coagulation
  • Selective arterial embolization
  • Medications to help with coagulation, such as antifibrinolytics, and treatment using estrogen hormone
  • If the individual has severe anemia (or iron-deficiency anemia), then the following treatment may be provided:
    • Blood transfusions for severe blood loss
    • Use of iron supplements and iron-rich diet (that include meats, spinach, eggplant, dried fruits, poultry, eggs, and iron-fortified cereals)
  • If conservative measures fail, or if the bleeding is severe, then surgery to resect a portion of the bowel (partial bowel resection) may be undertaken
  • Post-operative care is important: Minimum activity level is to be ensured until the surgical wound heals
  • Follow-up care with regular screening and check-ups are important

Note: Estrogen therapy can have unwanted side effects, and so, a risks v/s benefits analysis must be assessed before commencing therapy.

How can Gastrointestinal Angiodysplasia be Prevented?

  • Current medical research has not established a method of preventing Gastrointestinal Angiodysplasia formation
  • However, if the condition is caused or aggravated by hard stools, then taking steps to avoid chronic constipation may be beneficial
  • Early diagnosis and treatment will help prevent complications due to GIAD, from causing severe bleeding incidences

What is the Prognosis of Gastrointestinal Angiodysplasia? (Outcomes/Resolutions)

  • The prognosis of Gastrointestinal Angiodysplasia is generally excellent with adequate and appropriate treatment. In many individuals (over 50-90% of them), the bleeding is known to stop spontaneously
  • However, the prognosis also depends upon the severity of bleeding episodes, the age and overall health of the individual

Additional and Relevant Useful Information for Gastrointestinal Angiodysplasia:

Gastrointestinal Angiodysplasia (GIAD) is not similar to an arteriovenous malformation (AVM) of the gastrointestinal tract, because unlike GIAD, a GI AVM is usually single and large and can be identified via endoscopy, as a single, bright red spot.

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Maulik P. Purohit MD MPH picture
Approved by

Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

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