Angiodysplasia

Question 1

What is angiodysplasia?

Answer 1

gastrointestinal mucosal vascular ectasia, a vascular malformation of the GI tract, formed by fragile leaky vessels

not associated with cutaneous lesions, systeimc vascular disease or a familial syndrome

Question 2

In which age group is angiodysplasia most common?

Answer 2

patients typically >60 years

Question 3

In what proportion of patients undergoing GI endoscopy is aniogiodysplasia found?

Answer 3

1-2% for any indication, 4% if scoped for bleeding

Question 4

In what proportion of patients undergoing colonoscopy is aniogiodysplasia found?

Answer 4

3-6%

Question 5

What is thought to be the aetiology of angiodysplasia?

Answer 5

may be degenerative, relating to chronic low-grade obstruction of mucosal veins, or alternatively result from mucosal ischaemia

Question 6

What is a much-debated potential condition that angiodysplasia may be linked to?

Answer 6

aortic stenosis - Heyde syndrome, may be linked to acquired form of von Willebrand disease

Question 7

What are the clinical features of angiodysplasia?

Answer 7

always bleeding: haematemesis, PR bleeding or occult anaemia

Question 8

In what proportion of patients is bleeding from angiodysplasia severe?

Answer 8

in majority it is not life-threatening, but 15% of patients with colonic angiodysplasia have acute massive haemorrhage

Question 9

How is a diagnosis of angiodysplasia made?

Answer 9

endoscopy

Question 10

What are 3 conditions that lesions of angiodysplasia may be indistinguishable from on endoscopy?

Answer 10

1. Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
2. Turner’s syndrome
3. CREST syndrome

Question 11

How can angiodysplasia be distinguished from those conditions which appear the same on endoscopy?

Answer 11

angiodysplasia does not have the extra-intestinal signs of the other disorders

Question 12

What type of investigation may be indicated in suspected angiodysplasia for acute bleeding?

Answer 12

mesenteric angiography

Question 13

What are 5 treatment options for angiodysplasia?

Answer 13

1. Endoscopic obliteration: cautery or agon plasma coagulation
2. Anti-fibrinoytics e.g. tranexamic acid
3. Oestrogen-progestogen therapy
4. Transcatheter embolisation
5. Surgery

Question 14

What are 2 types of endoscopic obliteration procedures to treat angiodysplasia?

Answer 14

1. Endoscopic cautery
2. Argon plasma coagulation

Question 15

When may surgery be the definitive treatment for angiodysplasia?

Answer 15

if the bleeding surce has been clearly defined

Question 16

What is a treatment options for angiodysplasia in patients unfit for surgery?

Answer 16

transcatheter embolisation using coils or Gelfoam

Question 17

What type of medical therapy for angiodysplasia can be used and at what doses? 2 options

Answer 17

1. Oesotrgen-progestogen therapy (0.05mg ethyinylestradiol and 1mg norethisterone daily)
2. Antifibrinolytics e.g. tranexamic acid

Question 18

What are 3 possible effects of hormone therapy to treat angiodysplasia?

Answer 18

1. optimising coagulation,
2. microvascular circulation, or
3. endothelial integrity