eMedicine Specialties > Gastroenterology > Colon

Angiodysplasia of the Colon: Follow-up

Author: Alan BR Thomson, MD, MSc, PhD, Professor, Department of Medicine, Division of Gastroenterology, University of Alberta Faculty of Medicine
Coauthor(s): Andrea Duchini, MD, Assistant Professor of Medicine, Associate Medical Director of Liver Transplantation, Division of Transplantation, Department of Surgery, The Methodist Hospital-Cornell University, Houston; John Godino, MD, Staff Physician, Department of Internal Medicine, Brooke Army Medical Center; Peter Wong, MD, Director of Gastroenterology Clinical Service/Manometry and Physiology, Brooke Army Medical Center; Assistant Professor, Department of Medicine, Division of Gastroenterology, University of Texas Health Science Center at San Antonio
Contributor Information and Disclosures

Updated: May 27, 2009

Follow-up

Further Inpatient Care

  • Admit the patient with colonic angiodysplasia to the intensive care unit (ICU) if the patient is hemodynamically unstable. Monitor for recurrent bleeding and stabilization of the hematocrit. Transfuse as needed.

Further Outpatient Care

  • The exact time frame for follow-up colonoscopy in patients with angiodysplasia is controversial. If the patient is asymptomatic, a repeat colonoscopy is not recommended. Outpatient monitoring of hemoglobin and repeated tests for occult blood can be performed. Patients with chronic GI bleeding may need repeated colonoscopies.

Deterrence/Prevention

  • No preventive methods for angiodysplasia have been definitely identified at this time. Avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended in patients with chronic bleeding.

Complications

  • Hemodynamic instability may result from massive bleeding.

Prognosis

  • The prognosis in patients with angiodysplasia is favorable because most angiodysplasias spontaneously cease bleeding (90% of cases).
  • Richter et al reviewed the clinical course of 101 patients with colonic angiodysplasia.38
    • The cases of 15 asymptomatic individuals who had never bled were followed for as long as 68 months (mean, 23 mo), and no patient experienced bleeding during this observation period.38 Therefore, conservatively manage nonbleeding angiodysplasia that is discovered as an incidental finding.
    • Thirty-one patients with overt bleeding or anemia managed with blood transfusions alone had rebleeding rates at 1 year of 26% and 3 years of 46%. The high rate of rebleeding justifies treatment for angiodysplasia in symptomatic individuals.
  • Rebleeding after hemicolectomies occurs in 5-30% of patients, which is much less than that of endoscopic techniques.

Patient Education

  • If angiodysplasia is identified incidentally, most patients can be reassured because most remain asymptomatic.
  • Preventive treatment with endoscopic obliteration should be decided on a patient-to-patient basis and should not be done routinely.

Miscellaneous

Medicolegal Pitfalls

  • No intervention is needed for nonbleeding angiodysplasia found incidentally, unless the patients will need to be anticoagulated.
  • The presence of left-sided diverticular disease does not alter the extent of colonic resection if the angiogram demonstrates right-sided angiodysplasia with or without extravasation, because as many as 80% of bleeding diverticula are known to occur on the right side of the colon. The risk of the left colon becoming a source of future bleeding if left behind is relatively low compared with the increased morbidity and mortality of subtotal colectomy.

Special Concerns

  • Obliteration of angiodysplasia in the cecum should be done with extreme care due to a higher risk of perforation when compared with lesions in the left colon.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of Anca Tapardel, MD, and Narmin Kassam, MD, to the development and writing of this article.



More on Angiodysplasia of the Colon

Overview: Angiodysplasia of the Colon
Differential Diagnoses & Workup: Angiodysplasia of the Colon
Treatment & Medication: Angiodysplasia of the Colon
Follow-up: Angiodysplasia of the Colon
Multimedia: Angiodysplasia of the Colon
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Regula J, Wronska E, Pachlewski J. Vascular lesions of the gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2008;22(2):313-28. [Medline].

  2. Heyde EC. Gastrointestinal bleeding in aortic stenosis. N Engl J Med. 1958;259:196.

  3. Margulis AR, Heinbecker P, Bernard HR. Operative mesenteric arteriography in the search for the site of bleeding in unexplained gastrointestinal hemorrhage: a preliminary report. Surgery. Sep 1960;48:534-9. [Medline].

  4. Akhtar AJ, Shaheen MA, Zha J. Organic colonic lesions in patients with irritable bowel syndrome (IBS). Med Sci Monit. Sep 2006;12(9):CR363-7. [Medline].

  5. Clouse RE. Vascular lesions: ectasias, tumors, and malformations. In: Yamada T, Alpers DH, Laine L, Owyang C, Powell DW, eds. Textbook of Gastroenterology. Vol 2. 3rd ed. Philadelphia, Pa: JB Lippincott; 1999:2564-78.

  6. Ming SC, Goldman H. Vascular abnormalities of the gastrointestinal tract. In: Ming SC, Goldman H, eds. Pathology of the Gastrointestinal Tract. 2nd ed. Baltimore, Md: Williams & Wilkins Company; 1998:272-4.

  7. Mudhar HS, Balsitis M. Colonic angiodysplasia and true diverticula: is there an association?. Histopathology. Jan 2005;46(1):81-8. [Medline].

  8. Biss T, Hamilton P. Myelofibrosis and angiodysplasia of the colon: another manifestation of portal hypertension and massive splenomegaly?. J Clin Pathol. Sep 2004;57(9):999-1000. [Medline]. [Full Text].

  9. Schmidmaier R, Bittmann I, Gotzberger M, et al. Vascular ectasia of the whole intestine as a cause of recurrent gastrointestinal bleeding after high-dose chemotherapy. Endoscopy. Sep 2006;38(9):940-2. [Medline].

  10. Foutch PG, Rex DK, Lieberman DA. Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol. Apr 1995;90(4):564-7. [Medline].

  11. Rosborough TK, Swaim WR. Acquired von Willebrand's disease, platelet-release defect and angiodysplasia. Am J Med. Jul 1978;65(1):96-100. [Medline].

  12. Cass AJ, Bliss BP, Bolton RP, Cooper BT. Gastrointestinal bleeding, angiodysplasia of the colon and acquired von Willebrand's disease. Br J Surg. Sep 1980;67(9):639-41. [Medline].

  13. Duray PH, Marcal JM Jr, LiVolsi VA, et al. Gastrointestinal angiodysplasia: a possible component of von Willebrand's disease. Hum Pathol. Jun 1984;15(6):539-44. [Medline].

  14. Gostout CJ, Bowie EJW, Balm R, Fischer PK. Is angiodysplasia associated with von Willebrand's disease?. Gastroenterology. 1990;98:A172.

  15. Fressinaud E, Meyer D. International survey of patients with von Willebrand disease and angiodysplasia. Thromb Haemost. Sep 1 1993;70(3):546. [Medline].

  16. Makris M. Gastrointestinal bleeding in von Willebrand disease. Thromb Res. 2006;118 suppl 1:S13-7. [Medline].

  17. Hirri HM, Green PJ, Lindsay J. Von Willebrand's disease and angiodysplasia treated with thalidomide. Haemophilia. May 2006;12(3):285-6. [Medline].

  18. Emanuel RB, Weiser MM, Shenoy SS, Satchidanand SK, Asirwatham J. Arteriovenous malformations as a cause of gastrointestinal bleeding: the importance of triple-vessel angiographic studies in diagnosis and prevention of rebleeding. J Clin Gastroenterol. Jun 1985;7(3):237-46. [Medline].

  19. Schwartz J, Rozenfeld V, Habot B. Cessation of recurrent bleeding from gastrointestinal angiodysplasia, after beta blocker treatment in a patient with hypertrophic subaortic stenosis--a case history. Angiology. Mar 1992;43(3 pt 1):244-8. [Medline].

  20. Pate GE, Chandavimol M, Naiman SC, Webb JG. Heyde's syndrome: a review. J Heart Valve Dis. Sep 2004;13(5):701-12. [Medline].

  21. Ueno S, Nakase H, Kasahara K, et al. Clinical features of Japanese patients with colonic angiodysplasia. J Gastroenterol Hepatol. Aug 2008;23(8 pt 2):e363-6. [Medline].

  22. Imperiale TF, Ransohoff DF. Aortic stenosis, idiopathic gastrointestinal bleeding, and angiodysplasia: is there an association? A methodologic critique of the literature. Gastroenterology. Dec 1988;95(6):1670-6. [Medline].

  23. Kaaroud H, Fatma LB, Beji S, et al. Gastrointestinal angiodysplasia in chronic renal failure. Saudi J Kidney Dis Transpl. Sep 2008;19(5):809-12. [Medline]. [Full Text].

  24. Roskell DE, Biddolph SC, Warren BF. Apparent deficiency of mucosal vascular collagen type IV associated with angiodysplasia of the colon. J Clin Pathol. Jan 1998;51(1):18-20. [Medline]. [Full Text].

  25. Junquera F, Saperas E, de Torres I, Vidal MT, Malagelada JR. Increased expression of angiogenic factors in human colonic angiodysplasia. Am J Gastroenterol. Apr 1999;94(4):1070-6. [Medline].

  26. Kovacs M, Pak P, Pak G, Feheer J, Huttl K. [Multiple angiodysplasias diagnosed by capsule endoscopy] [Hungarian]. Orv Hetil. Dec 23 2007;148(51):2435-40. [Medline].

  27. Jarbandhan S, van der Veer WM, Mulder CJ. Double-balloon endoscopy in the diagnosis and treatment of hemorrhage from retrovalvular angiodysplasias. J Gastrointestin Liver Dis. Sep 2008;17(3):333-4. [Medline]. [Full Text].

  28. Monkemuller K, Fry LC, Neumann H, Rickes S, Malfertheiner P. [Diagnostic and therapeutic utility of double balloon endoscopy: experience with 225 procedures] [Spanish]. Acta Gastroenterol Latinoam. Dec 2007;37(4):216-23. [Medline].

  29. Skibba RM, Hartong WA, Mantz FA, Hinthorn DR, Rhodes JB. Angiodysplasia of the cecum: colonoscopic diagnosis. Gastrointest Endosc. Feb 1976;22(3):177-9. [Medline].

  30. Richardson JD, Max MH, Flint LM Jr, et al. Bleeding vascular malformations of the intestine. Surgery. Sep 1978;84(3):430-6. [Medline].

  31. Suzuki N, Arebi N, Saunders BP. A novel method of treating colonic angiodysplasia. Gastrointest Endosc. Sep 2006;64(3):424-7. [Medline].

  32. Hurlstone DP, Karageh M, Sanders DS. The Olympus EVIS LUCERA variable indices of haemoglobin chart function: a novel technique for establishing the completeness of vascular mucosal ablation in colonic angiodysplasia. Endoscopy. Jan 2006;38(1):102. [Medline]. [Full Text].

  33. Vakil N, Huilgol V, Khan I. Effect of push enteroscopy on transfusion requirements and quality of life in patients with unexplained gastrointestinal bleeding. Am J Gastroenterol. Mar 1997;92(3):425-8. [Medline].

  34. Pishvaian AC, Lewis JH. Use of endoclips to obliterate a colonic arteriovenous malformation before cauterization. Gastrointest Endosc. May 2006;63(6):865-6. [Medline].

  35. Polese L, Angriman I, Pagano D, et al. Laser therapy and surgical treatment in transfusion-dependent patients with upper-gastrointestinal vascular ectasia. Lasers Med Sci. Sep 2006;21(3):140-6. [Medline].

  36. Meyer CT, Troncale FJ, Galloway S, Sheahan DG. Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature. Medicine (Baltimore). Jan 1981;60(1):36-48. [Medline].

  37. Lewis BS, Salomon P, Rivera-MacMurray S, et al. Does hormonal therapy have any benefit for bleeding angiodysplasia?. J Clin Gastroenterol. Sep 1992;15(2):99-103. [Medline].

  38. Richter JM, Hedberg SE, Athanasoulis CA, Schapiro RH. Angiodysplasia. Clinical presentation and colonoscopic diagnosis. Dig Dis Sci. Jun 1984;29(6):481-5. [Medline].

  39. Alavi A, Ring EJ. Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography. AJR Am J Roentgenol. Oct 1981;137(4):741-8. [Medline]. [Full Text].

  40. Alvarez L, Puleo J, Balint JA. Investigation of gastrointestinal bleeding in patients with end stage renal disease. Am J Gastroenterol. Jan 1993;88(1):30-3. [Medline].

  41. Apostolakis E, Doering C, Kantartzis M, Winter J, Schulte HD. Calcific aortic-valve stenosis and angiodysplasia of the colon: Heyde's syndrome--report of two cases. Thorac Cardiovasc Surg. Dec 1990;38(6):374-6. [Medline].

  42. Bhutani MS, Gupta SC, Markert RJ, et al. A prospective controlled evaluation of endoscopic detection of angiodysplasia and its association with aortic valve disease. Gastrointest Endosc. Nov 1995;42(5):398-402. [Medline].

  43. Boley SJ, Sammartano R, Adams A, et al. On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology. Apr 1977;72(4 pt 1):650-60. [Medline].

  44. Boley SJ, Sprayregen S, Sammartano RJ, Adams A, Kleinhaus S. The pathophysiologic basis for the angiographic signs of vascular ectasias of the colon. Radiology. Dec 1977;125(3):615-21. [Medline].

  45. Brandt LJ, Mukhopadhyay D. Masking of colon vascular ectasias by cold water lavage. Gastrointest Endosc. Jan 1999;49(1):141-2. [Medline].

  46. Britt LG, Warren L, Moore OF 3rd. Selective management of lower gastrointestinal bleeding. Am Surg. Mar 1983;49(3):121-5. [Medline].

  47. Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg. Nov 1986;204(5):530-6. [Medline]. [Full Text].

  48. Chalasani N, Cotsonis G, Wilcox CM. Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. Am J Gastroenterol. Nov 1996;91(11):2329-32. [Medline].

  49. Chou CC, Dabney JM. Interrelation of ileal wall compliance and vascular resistance. Am J Dig Dis. Dec 1967;12(12):1198-208. [Medline].

  50. Cottone C, Disclafani G, Genova G, et al. Use of BICAP in a case of colon angiodysplasia. Surg Endosc. 1991;5(2):99-100. [Medline].

  51. Duchini A, Sessoms SL. Gastrointestinal hemorrhage in patients with systemic sclerosis and CREST syndrome. Am J Gastroenterol. Sep 1998;93(9):1453-6. [Medline].

  52. Ettorre GC, Francioso G, Garribba AP, et al. Helical CT angiography in gastrointestinal bleeding of obscure origin. AJR Am J Roentgenol. Mar 1997;168(3):727-31. [Medline]. [Full Text].

  53. Flynn CT, Chandran PK. Renal failure and angiodysplasia of the colon. Ann Intern Med. Jul 1985;103(1):154. [Medline].

  54. Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol. Jun 1993;88(6):807-18. [Medline].

  55. Foutch PG. Colonic angiodysplasia. Gastroenterologist. Jun 1997;5(2):148-56. [Medline].

  56. Ghosh J, Speake D, Benbow EW, Watson AJ. Co-existence of true colonic diverticula with angiodysplasia. Colorectal Dis. Sep 2005;7(5):530-2. [Medline].

  57. Greason KL, Acosta JA, Magrino TJ, Choe M. Angiodysplasia as the cause of massive lower gastrointestinal hemorrhage in a young adult. Report of a case. Dis Colon Rectum. Jun 1996;39(6):702-4. [Medline].

  58. Gupta N, Longo WE, Vernava AM 3rd. Angiodysplasia of the lower gastrointestinal tract: an entity readily diagnosed by colonoscopy and primarily managed nonoperatively. Dis Colon Rectum. Sep 1995;38(9):979-82. [Medline].

  59. Hemingway AP. Angiodysplasia as a cause of iron deficiency anaemia. Blood Rev. Sep 1989;3(3):147-51. [Medline].

  60. Ho S, Jackson J. The angiographic diagnosis of colonic carcinoma. Clin Radiol. May 1998;53(5):345-9. [Medline].

  61. Hochter W, Weingart J, Kuhner W, Frimberger E, Ottenjann R. Angiodysplasia in the colon and rectum. Endoscopic morphology, localisation and frequency. Endoscopy. Sep 1985;17(5):182-5. [Medline].

  62. Howard OM, Buchanan JD, Hunt RH. Angiodysplasia of the colon. Experience of 26 cases. Lancet. Jul 3 1982;2(8288):16-9. [Medline].

  63. Katsinelos P, Paroutoglou G, Beltsis A, et al. Recurrent colonic Dieulafoy's lesion associated with bizarre vascular malformations and abnormal von Willebrand factor. Acta Gastroenterol Belg. Oct-Dec 2005;68(4):443-5. [Medline].

  64. Kheterpal S. Angiodysplasia: a review. J R Soc Med. Oct 1991;84(10):615-8. [Medline]. [Full Text].

  65. Kitiyakara T, Selby W. Non-small-bowel lesions detected by capsule endoscopy in patients with obscure GI bleeding. Gastrointest Endosc. Aug 2005;62(2):234-8. [Medline].

  66. Krevsky B. Detection and treatment of angiodysplasia. Gastrointest Endosc Clin N Am. Jul 1997;7(3):509-24. [Medline].

  67. Moparty B, Raju GS. Role of hemoclips in a patient with cecal angiodysplasia at high risk of recurrent bleeding from antithrombotic therapy to maintain coronary stent patency: a case report. Gastrointest Endosc. Sep 2005;62(3):468-9. [Medline].

  68. Noer RJ, Derr JW. Effect of distention on intestinal revascularization. Arch Surg. Sep 1949;59(3):542-9. [Medline].

  69. Orsi P, Guatti-Zuliani C, Okolicsanyi L. Long-acting octreotide is effective in controlling rebleeding angiodysplasia of the gastrointestinal tract. Dig Liver Dis. May 2001;33(4):330-4. [Medline].

  70. Potter GD, Sellin JH. Lower gastrointestinal bleeding. Gastroenterol Clin North Am. Jun 1988;17(2):341-56. [Medline].

  71. Reinus JF, Brandt LJ. Vascular ectasias and diverticulosis. Common causes of lower intestinal bleeding. Gastroenterol Clin North Am. Mar 1994;23(1):1-20. [Medline].

  72. Roberts PL, Schoetz DJ Jr, Coller JA. Vascular ectasia. Diagnosis and treatment by colonoscopy. Am Surg. Jan 1988;54(1):56-9. [Medline].

  73. Sabanathan S, Nag SB. Angiodysplasia of the colon: a post-mortem study. J R Coll Surg Edinb. Sep 1982;27(5):285-91. [Medline].

  74. Scheffer SM, Leatherman LL. Resolution of Heyde's syndrome of aortic stenosis and gastrointestinal bleeding after aortic valve replacement. Ann Thorac Surg. Oct 1986;42(4):477-80. [Medline].

  75. Semba T, Fujii Y. Relationship between venous flow and colonic peristalsis. Jpn J Physiol. Aug 1970;20(4):408-16. [Medline].

  76. Serin E, Paydas S, Yildizer K, Seyrek N, Sagliker Y. von Recklinghausen's disease associated with angiodysplasia of colon and end-stage renal disease. Nephron. 1995;71(2):243. [Medline].

  77. Sharma R, Gorbien MJ. Angiodysplasia and lower gastrointestinal tract bleeding in elderly patients. Arch Intern Med. Apr 24 1995;155(8):807-12. [Medline].

  78. Szilagyi A, Ghali MP. Pharmacological therapy of vascular malformations of the gastrointestinal tract. Can J Gastroenterol. Mar 2006;20(3):171-8. [Medline]. [Full Text].

  79. Tedesco FJ, Waye JD, Raskin JB, Morris SJ, Greenwald RA. Colonoscopic evaluation of rectal bleeding: a study of 304 patients. Ann Intern Med. Dec 1978;89(6):907-9. [Medline].

  80. Thelmo WL, Vetrano JA, Wibowo A, et al. Angiodysplasia of colon revisited: pathologic demonstration without the use of intravascular injection technique. Hum Pathol. Jan 1992;23(1):37-40. [Medline].

  81. Welch CE, Athanasoulis CA, Galdabini JJ. Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease. World J Surg. Jan 1978;2(1):73-83. [Medline].

  82. Wright HK, Pelliccia O, Higgins EF Jr, Sreenivas V, Gupta A. Controlled, semielective, segmental resection for massive colonic hemorrhage. Am J Surg. Apr 1980;139(4):535-8. [Medline].

  83. Zuckerman G, Benitez J. A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding. Am J Gastroenterol. Jan 1992;87(1):62-6. [Medline].

  84. Zuckerman GR, Cornette GL, Clouse RE, Harter HR. Upper gastrointestinal bleeding in patients with chronic renal failure. Ann Intern Med. May 1985;102(5):588-92. [Medline].

[ CLOSE WINDOW ]

Further Reading

Related eMedicine Topics

Clinical Trials
 National Guideline Clearinghouse

[ CLOSE WINDOW ]

Keywords

angiodysplasia of the colon, colonic angiodysplasia, angiodysplasia, arteriovenous malformation, AVM, angiomatosis, vascular ectasia, hemangioma, telangiectasia, vascular lesion of the gastrointestinal tract, gastrointestinal bleeding, GI bleeding, GI hemorrhage, gastrointestinal hemorrhage, rectal bleeding, blood in stool, colonoscopy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Alan BR Thomson, MD, MSc, PhD, Professor, Department of Medicine, Division of Gastroenterology, University of Alberta Faculty of Medicine
Alan BR Thomson, MD, MSc, PhD is a member of the following medical societies: American Federation for Aging Research, American Federation for Clinical Research, American Gastroenterological Association, American Geriatrics Society, American Physiological Society, Canadian Association of Gastroenterology, Gastroenterology Research Group, New York Academy of Sciences, and Royal Society of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Andrea Duchini, MD, Assistant Professor of Medicine, Associate Medical Director of Liver Transplantation, Division of Transplantation, Department of Surgery, The Methodist Hospital-Cornell University, Houston
Andrea Duchini, MD is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and International Liver Transplantation Society
Disclosure: Nothing to disclose.

John Godino, MD, Staff Physician, Department of Internal Medicine, Brooke Army Medical Center
John Godino, MD is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Peter Wong, MD, Director of Gastroenterology Clinical Service/Manometry and Physiology, Brooke Army Medical Center; Assistant Professor, Department of Medicine, Division of Gastroenterology, University of Texas Health Science Center at San Antonio
Peter Wong, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Medical Editor

Marco G Patti, MD, Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine
Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.