Angiodysplasia

Question 1

Angiodysplasia

Answer 1

Angiodysplasia

Angiodysplasia is a vascular deformity of the gastrointestinal tract which predisposes to bleeding and iron deficiency anaemia. There is thought to be an association with aortic stenosis, although this is debated. Angiodysplasia is generally seen in elderly patients

Diagnosis
colonoscopy
mesenteric angiography if acutely bleeding

Management
endoscopic cautery or argon plasma coagulation
antifibrinolytics e.g. Tranexamic acid
oestrogens may also be used

Question 2

Angiodysplasia - Example Question

Answer 2

A 65-year-old woman comes to the gastroenterology clinic with persistent iron deficiency anaemia. she has had two colonoscopies and one upper GI endoscopy without finding a significant lesion, and haemoglobin continues to drop despite iron replacement. On examination she has a blood pressure of 142/105 mmHg, her pulse is 75 and regular. She looks pale. You note an ejection systolic murmur. Which of the following is the most appropriate way to investigate her?

	> Capsule endoscopy
	CT colonoscopy
	Labelled white cell scan
	Repeat upper GI endoscopy
	Repeat colonoscopy

The suspicion here is a diagnosis of Heyde’s syndrome, with aortic stenosis and small bowel angiodysplasia. The pathogenesis of the angiodysplasia is unknown but may be related to local circulatory changes because of the valve stenosis. Further conventional endoscopy is not likely to be useful, capsule endoscopy that can adequately visualise the small bowel. Angiodysplasia usually resolves once the valve is repaired.

Further conventional endoscopy investigations have potentially a less than 5% chance of picking up a previously undetected lesion. Labelled white cell scan is most useful for large volume bleeding, and CT colonoscopy is less sensitive than conventional endoscopy.

Question 3

Heyde’s Syndrome

Answer 3

= Chronic Gastrointestinal blood loss in the presence of AORTIC STENOSIS + ANGIODYSPLASIA

Can be either small or large bowel angiodysplasia

Pathophysiology of angiodysplasia is unknown - may be due to changes in the pressure within the mesenteric venous plexus as the condition often resolves once the valve is treated

Ix:
- Endoscopy
- Capsule Endoscopy
- Colonoscopy 
> If all of above are negative > labelled white cell scanning + Intra-operative enteroscopy - however this carries greater risk until the valve is repaired