Angiodysplasia of the Colon Medication

  • Author: Hussein Al-Hamid, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Jul 27, 2016
 

Medication Summary

Medical treatment has been used in active and recurrent bleeding from colonic angiodysplasia with controversial results. Hormonal treatment with estrogen and progesterone has been evaluated by randomized trials but remains controversial and is probably not effective. Octreotide, both short and long acting, has been described as effective in a few case reports and case series only. Other agents, such as thalidomide, remain experimental. Desmopressin (DDAVP) has also been used in specific subsets of patients. At the moment, no medical therapy has been proven to effectively treat bleeding from angiodysplasia. A recent meta-analysis suggested that hormonal therapy was not effective in bleeding cessation; however, somatostatn analogs could be effective therapy for gastrointestinal angiodysplasias.[97]

Next

Oral Contraceptives

Class Summary

Only use hormonal therapy for the small subset of patients who are transfusion-dependent from bleeding angiodysplasia refractory to conservative and endoscopic therapy and who are poor surgical candidates. This therapy is not for routine management of bleeding angiodysplasia. No large-scale, randomized, double-blinded studies have demonstrated its effectiveness.

Estrogen-progesterone therapy, previously used to treat bleeding associated with hereditary hemorrhagic telangiectasia (HHT), also has been tried in patients with GI bleeding from angiodysplasia.

Proposed mechanisms by which hormonal therapy might affect bleeding include improvement in coagulation, alterations in microvascular circulation, and improvements in endothelial integrity.

Data from a double-blinded, crossover trial using 0.05 mg ethinyl estradiol and 1 mg norethisterone administered daily to 10 elderly patients with GI ectasia (6 of the patients had HHT) have indicated that the combination significantly reduced bleeding and transfusion requirements. Several other small series with anecdotal success have been described, but one must be skeptical.

A retrospective cohort study of 64 patients by Lewis et al refutes the benefits of hormonal therapy in angiodysplasia.[98] Thirty patients were administered 5-10 mg of norethynodrel with mestranol (0.075-0.15 mg) or with conjugated estrogens (0.625 mg); the bleeding rates did not differ before and after therapy, and they did not differ from bleeding rates of historical controls or from patients who refused therapy.[98] Treatment adverse effects in this study included vaginal bleeding, fluid retention, and stroke (23% of the treated patients).

Overall, the current data do not support the use of hormonal therapy in patients with colonic angiodysplasia.

Ethinyl estradiol and norethindrone (Ovcon 50)

 

Suggested mechanisms by which hormonal therapy might affect bleeding include improvement in coagulation, alterations in the microvascular circulation, and improvements in endothelial integrity. One tab contains ethinyl estradiol 0.05 mg and norethindrone 1 mg.

Previous
Next

Somatostatin Analogues

Class Summary

Somatostatin analogues have been reported to decrease the rate of bleeding from intestinal angiodysplasia. In our experience, these agents are usually well tolerated and may decrease the rate of chronic bleeding. Octreotide should be the first choice in patients with portal hypertension.

Octreotide (Sandostatin)

 

Mechanism of action in this setting is not fully understood. Used in acute variceal bleeding and for recurrent bleeding after endoscopic therapy.

May reduce the transfusion requirement.

Previous
 
Contributor Information and Disclosures
Author

Hussein Al-Hamid, MD Fellow, Department of Gastroenterology, Providence Hospital

Hussein Al-Hamid, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Roberto M Gamarra, MD Consulting Gastroenterologist, Digestive Health Associates, PLC

Roberto M Gamarra, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Crohn's and Colitis Foundation of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Marc D Basson, MD, PhD, MBA, FACS Associate Dean for Medicine, Professor of Surgery and Basic Science, University of North Dakota School of Medicine and Health Sciences

Marc D Basson, MD, PhD, MBA, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Gastroenterological Association, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

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 Surgical Association, American College of Surgeons, American Gastroenterological Association, American Medical 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, Western Surgical Association

Disclosure: Nothing to disclose.

John Godino, MD Staff Physician, Department of Medicine, Brooke Army Medical Center

John Godino, MD is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Andrea Duchini, MD Associate Professor of Medicine and Surgery, Director of Hepatology, University of Texas Medical Branch School of Medicine; Medical Director of Liver Transplantation, Department of Surgery, University of Texas Medical Branch School of Medicine

Andrea Duchini, MD is a member of the following medical societies: American College of Physicians, International Liver Transplantation Society, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Alan BR Thomson, MD Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

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

Disclosure: Nothing to disclose.

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. 1960 Sep. 48:534-9. [Medline].

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

  5. Kim BK, Han HS, Lee SY, Kim CH, Jin CJ. Cecal polypoid arteriovenous malformations removed by endoscopic biopsy. J Korean Med Sci. 2009 Apr. 24(2):342-5. [Medline]. [Full Text].

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

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

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

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

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

  11. 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. 2006 Sep. 38(9):940-2. [Medline].

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

  13. 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. 1992 Mar. 43(3 pt 1):244-8. [Medline].

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

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

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

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

  18. Gola W, Lelonek M. Clinical implication of gastrointestinal bleeding in degenerative aortic stenosis: an update. Cardiol J. 2010. 17(4):330-4. [Medline].

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

  20. Slaughter MS. Hematologic effects of continuous flow left ventricular assist devices. J Cardiovasc Transl Res. 2010 Dec. 3(6):618-24. [Medline].

  21. Harvey L, Holley CT, John R. Gastrointestinal bleed after left ventricular assist device implantation: incidence, management, and prevention. Ann Cardiothorac Surg. 2014 Sep. 3(5):475-9. [Medline].

  22. Mishra PK, Kovac J, de Caestecker J, et al. Intestinal angiodysplasia and aortic valve stenosis: let's not close the book on this association. Eur J Cardiothorac Surg. 2009 Apr. 35(4):628-34. [Medline].

  23. Vaz A, Correia A, Martins B, et al. Heyde syndrome--the link between aortic stenosis and gastrointestinal bleeding. Rev Port Cardiol. 2010 Feb. 29(2):309-14. [Medline].

  24. Massyn MW, Khan SA. Heyde syndrome: a common diagnosis in older patients with severe aortic stenosis. Age Ageing. 2009 May. 38(3):267-70; discussion 251. [Medline].

  25. Lee HE, Sagong C, Yeo KY, et al. A case of hereditary hemorrhagic telangiectasia. Ann Dermatol. 2009 May. 21(2):206-8. [Medline].

  26. Boubaker K, Boubaker S, Ounissi M, et al. [Colic angiodysplasia and chronic haemodialysis. Argon plasma treatment. A case report]. Nephrol Ther. 2010 Jul. 6(4):248-50. [Medline].

  27. Ingraham KM, O'Brien MS, Shenin M, Derk CT, Steen VD. Gastric antral vascular ectasia in systemic sclerosis: demographics and disease predictors. J Rheumatol. 2010 Mar. 37(3):603-7. [Medline].

  28. Rosenfeld G, Enns R. Argon photocoagulation in the treatment of gastric antral vascular ectasia and radiation proctitis. Can J Gastroenterol. 2009 Dec. 23(12):801-4. [Medline]. [Full Text].

  29. Selinger CP, Ang YS. Gastric antral vascular ectasia (GAVE): an update on clinical presentation, pathophysiology and treatment. Digestion. 2008. 77(2):131-7. [Medline].

  30. Lanas A, Garcia-Rodriguez LA, Polo-Tomas M, Ponce M, Quintero E, Perez-Aisa MA. The changing face of hospitalisation due to gastrointestinal bleeding and perforation. Aliment Pharmacol Ther. 2011 Mar. 33(5):585-91. [Medline].

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

  32. Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc. 2010 Feb. 71(2):280-6. [Medline].

  33. Porush JG, Faubert PF. Chronic renal failure. Porush JG, Faubert PF, eds. Renal Disease in the Aged. Boston, MA: Little Brown; 1991.

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

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

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

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

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

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

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

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

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

  43. Olokoba AB, Obateru OA, Olatoke SA. Angiodysplasia of the colon: a report of two cases and review of literature. Niger J Clin Pract. 2012 Jan-Mar. 15(1):101-3. [Medline].

  44. Yannam GR, Yu DC, Kelly DR, Chen MK, Beierle EA. Angiodysplasia (vascular malformations) of the colon presenting as an acute abdomen. J Pediatr Surg. 2012 Oct. 47(10):e37-40. [Medline].

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

  46. Redondo-Cerezo E, Gomez-Ruiz CJ, Sanchez-Manjavacas N, et al. Long-term follow-up of patients with small-bowel angiodysplasia on capsule endoscopy. Determinants of a higher clinical impact and rebleeding rate. Rev Esp Enferm Dig. 2008 Apr. 100(4):202-7. [Medline].

  47. 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. 1985 Jun. 7(3):237-46. [Medline].

  48. Macdonald J, Porter V, Scott NW, McNamara D. Small bowel lymphangiectasia and angiodysplasia: a positive association; novel clinical marker or shared pathophysiology?. J Clin Gastroenterol. 2010 Oct. 44(9):610-4. [Medline].

  49. Uhm MS, Kim N, Nah JC, et al. Congenital angiodysplasia in a woman presenting with idiopathic jejunal varicosis on angiography. Gut Liver. 2009 Jun. 3(2):122-6. [Medline]. [Full Text].

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

  51. 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. 2008 Sep. 17(3):333-4. [Medline]. [Full Text].

  52. 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. 2007 Dec. 37(4):216-23. [Medline].

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

  54. Scaglione G, Russo F, Franco MR, et al. Age and video capsule endoscopy in obscure gastrointestinal bleeding: a prospective study on hospitalized patients. Dig Dis Sci. 2011 Apr. 56(4):1188-93. [Medline].

  55. Tan KK, Wong D, Sim R. Superselective embolization for lower gastrointestinal hemorrhage: an institutional review over 7 years. World J Surg. 2008 Dec. 32(12):2707-15. [Medline].

  56. Fry LC, Bellutti M, Neumann H, Malfertheiner P, Monkemuller K. Incidence of bleeding lesions within reach of conventional upper and lower endoscopes in patients undergoing double-balloon enteroscopy for obscure gastrointestinal bleeding. Aliment Pharmacol Ther. 2009 Feb 1. 29(3):342-9. [Medline].

  57. Muhammad A, Pitchumoni CS. Evaluation of iron deficiency anemia in older adults: the role of wireless capsule endoscopy. J Clin Gastroenterol. 2009 Aug. 43(7):627-31. [Medline].

  58. Riccioni ME, Urgesi R, Spada C, et al. Unexplained iron deficiency anaemia: Is it worthwhile to perform capsule endoscopy?. Dig Liver Dis. 2010 Aug. 42(8):560-6. [Medline].

  59. Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc. 2010 Feb. 71(2):280-6. [Medline].

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

  61. ASGE Technology Committee, Wang A, Banerjee S, Barth BA, et al. Wireless capsule endoscopy. Gastrointest Endosc. 2013 Dec. 78(6):805-15. [Medline].

  62. May A, Farber M, Aschmoneit I, et al. Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders. Am J Gastroenterol. 2010 Mar. 105(3):575-81. [Medline].

  63. ASGE Standards of Practice Committee, Khashab MA, Pasha SF, Muthusamy VR, et al. The role of deep enteroscopy in the management of small-bowel disorders. Gastrointest Endosc. 2015 Oct. 82(4):600-7. [Medline].

  64. Rahmi G, Samaha E, Vahedi K, et al. Multicenter comparison of double-balloon enteroscopy and spiral enteroscopy. J Gastroenterol Hepatol. 2013 Jun. 28(6):992-8. [Medline].

  65. Khashab MA, Lennon AM, Dunbar KB, et al. A comparative evaluation of single-balloon enteroscopy and spiral enteroscopy for patients with mid-gut disorders. Gastrointest Endosc. 2010 Oct. 72(4):766-72. [Medline].

  66. Godeschalk MF, Mensink PB, van Buuren HR, Kuipers EJ. Primary balloon-assisted enteroscopy in patients with obscure gastrointestinal bleeding: findings and outcome of therapy. J Clin Gastroenterol. 2010 Oct. 44(9):e195-200. [Medline].

  67. Chen LH, Chen WG, Cao HJ, et al. Double-balloon enteroscopy for obscure gastrointestinal bleeding: a single center experience in China. World J Gastroenterol. 2010 Apr 7. 16(13):1655-9. [Medline].

  68. Hegde SR, Iffrig K, Li T, Downey S, Heller SJ, Tokar JL. Double-balloon enteroscopy in the elderly: safety, findings, and diagnostic and therapeutic success. Gastrointest Endosc. 2010 May. 71(6):983-9. [Medline].

  69. Madisch A, Schmolders J, Bruckner S, Aust D, Miehlke S. Less favorable clinical outcome after diagnostic and interventional double balloon enteroscopy in patients with suspected small-bowel bleeding?. Endoscopy. 2008 Sep. 40(9):731-4. [Medline].

  70. Yeh TS, Liu KH, Su MY, et al. Laparoscopically assisted bowel surgery in an era of double-balloon enteroscopy: from inside to outside. Surg Endosc. 2009 Apr. 23(4):739-44. [Medline].

  71. Kamalaporn P, Cho S, Basset N, et al. Double-balloon enteroscopy following capsule endoscopy in the management of obscure gastrointestinal bleeding: outcome of a combined approach. Can J Gastroenterol. 2008 May. 22(5):491-5. [Medline].

  72. Arakawa D, Ohmiya N, Nakamura M, et al. Outcome after enteroscopy for patients with obscure GI bleeding: diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy. Gastrointest Endosc. 2009 Apr. 69(4):866-74. [Medline].

  73. Crook DW, Knuesel PR, Froehlich JM, et al. Comparison of magnetic resonance enterography and video capsule endoscopy in evaluating small bowel disease. Eur J Gastroenterol Hepatol. 2009 Jan. 21(1):54-65. [Medline].

  74. Westerhoff M, Tretiakova M, Hovan L, Miller J, Noffsinger A, Hart J. CD61, CD31, and CD34 improve diagnostic accuracy in gastric antral vascular ectasia and portal hypertensive gastropathy: An immunohistochemical and digital morphometric study. Am J Surg Pathol. 2010 Apr. 34(4):494-501. [Medline].

  75. Pavlov KA, Chekmaryova IA, Shchyogolev AI, Mishnyov OD. Ultrastructural characteristics of peripheral arteriovenous and venous angiodysplasias. Bull Exp Biol Med. 2009 Apr. 147(4):480-4. [Medline].

  76. Dray X, Camus M, Coelho J, et al. Treatment of gastrointestinal angiodysplasia and unmet needs. Dig Liver Dis. 2011 Jul. 43(7):515-22. [Medline].

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

  78. 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. 2006 Jan. 38(1):102. [Medline]. [Full Text].

  79. 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. 1997 Mar. 92(3):425-8. [Medline].

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

  81. Rossetti A, Buchs NC, Breguet R, Bucher P, Terraz S, Morel P. Transarterial embolization in acute colonic bleeding: review of 11 years of experience and long-term results. Int J Colorectal Dis. 2013 Jun. 28(6):777-82. [Medline].

  82. 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. 2006 Sep. 21(3):140-6. [Medline].

  83. Schulz SW, O'Brien M, Maqsood M, et al. Improvement of severe systemic sclerosis-associated gastric antral vascular ectasia following immunosuppressive treatment with intravenous cyclophosphamide. J Rheumatol. 2009 Aug. 36(8):1653-6. [Medline].

  84. Fuccio L, Zagari RM, Serrani M, et al. Endoscopic argon plasma coagulation for the treatment of gastric antral vascular ectasia-related bleeding in patients with liver cirrhosis. Digestion. 2009. 79(3):143-50. [Medline].

  85. Brown C, Subramanian V, Wilcox CM, Peter S. Somatostatin analogues in the treatment of recurrent bleeding from gastrointestinal vascular malformations: an overview and systematic review of prospective observational studies. Dig Dis Sci. 2010 Aug. 55(8):2129-34. [Medline].

  86. Saperas E, Videla S, Dot J, et al. Risk factors for recurrence of acute gastrointestinal bleeding from angiodysplasia. Eur J Gastroenterol Hepatol. 2009 Dec. 21(12):1333-9. [Medline].

  87. Herrera S, Bordas JM, Llach J, et al. The beneficial effects of argon plasma coagulation in the management of different types of gastric vascular ectasia lesions in patients admitted for GI hemorrhage. Gastrointest Endosc. 2008 Sep. 68(3):440-6. [Medline].

  88. Lecleire S, Ben-Soussan E, Antonietti M, et al. Bleeding gastric vascular ectasia treated by argon plasma coagulation: a comparison between patients with and without cirrhosis. Gastrointest Endosc. 2008 Feb. 67(2):219-25. [Medline].

  89. Wells CD, Harrison ME, Gurudu SR, et al. Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation. Gastrointest Endosc. 2008 Aug. 68(2):231-6. [Medline].

  90. Molina Infante J, Perez Gallardo B, Hernandez Alonso M, et al. [Octreotide long acting release for severe obscure gastrointestinal haemorrhage in elderly patients with serious comorbidities]. Med Clin (Barc). 2009 Nov 7. 133(17):667-70. [Medline].

  91. Molina-Infante J, Perez-Gallardo B. Somatostatin analogues for bleeding gastrointestinal angiodysplasias: when should thalidomide be prescribed?. Dig Dis Sci. 2011 Jan. 56(1):266-7. [Medline].

  92. Hutchinson JM, Jennings JS, Jones RL. Long-acting somatostatin analogue therapy in obscure-overt gastrointestinal bleeding in noncirrhotic portal hypertension: a case report and literature review. Eur J Gastroenterol Hepatol. 2010 Jun. 22(6):754-8. [Medline].

  93. Belard E, Foss CH, Christensen LA, Schmidt P, Nojgaard C. [Thalidomide therapy for gastrointestinal angiodysplasia]. Ugeskr Laeger. 2009 Nov 16. 171(47):3454-5. [Medline].

  94. Kamalaporn P, Saravanan R, Cirocco M, et al. Thalidomide for the treatment of chronic gastrointestinal bleeding from angiodysplasias: a case series. Eur J Gastroenterol Hepatol. 2009 Dec. 21(12):1347-50. [Medline].

  95. Dabak V, Kuriakose P, Kamboj G, Shurafa M. A pilot study of thalidomide in recurrent GI bleeding due to angiodysplasias. Dig Dis Sci. 2008 Jun. 53(6):1632-5. [Medline].

  96. 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). 1981 Jan. 60(1):36-48. [Medline].

  97. Jackson CS, Gerson LB. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am J Gastroenterol. 2014 Apr. 109(4):474-83; quiz 484. [Medline].

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

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

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

  101. 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. 1990 Dec. 38(6):374-6. [Medline].

  102. 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. 1995 Nov. 42(5):398-402. [Medline].

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

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

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

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

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

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

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

  110. 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].

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

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

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

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

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

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

  117. 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. 1996 Jun. 39(6):702-4. [Medline].

  118. 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. 1995 Sep. 38(9):979-82. [Medline].

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

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

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

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

  123. 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. 2005 Oct-Dec. 68(4):443-5. [Medline].

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

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

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

  127. 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. 2005 Sep. 62(3):468-9. [Medline].

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

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

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

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

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

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

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

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

  136. 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].

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

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

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

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

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

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

  143. 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. 1992 Jan. 87(1):62-6. [Medline].

 
Previous
Next
 
Algorithm for acute gastrointestinal (GI) bleeding. CBC = complete blood cell count; CXR = chest x-ray; EKG = electrocardiography; IVF = intravenous fluid; NG = nasogastric.
Angiodysplasia identified on the cecum wall during colonoscopy.
Double-contrast barium enema studies in a 44-year-old man known to have a long history of ulcerative colitis. These images show total colitis and extensive pseudopolyposis.
Double-contrast barium enema examination in a patient with Crohn colitis demonstrates numerous aphthous ulcers.
 
Medscape Consult
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.