Angiodysplasia of the Colon 

  • Author: Alan BR Thomson, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jun 15, 2011
 

Background

Angiodysplasia is the most common vascular lesion of the gastrointestinal tract, and this condition may be asymptomatic, or it may cause gastrointestinal (GI) bleeding.[1] The vessel walls are thin, with little or no smooth muscle, and the vessels are ectatic and thin (see image below).

Angiodysplasia identified on cecum wall during colAngiodysplasia identified on cecum wall during colonoscopy.

Phillips first described a vascular abnormality that caused bleeding from the large bowel in a letter to the London Medical Gazette in 1839. During the 1920s, neoplasms were considered the major source of GI hemorrhage. However, in the 1940s and 1950s, diverticular disease was recognized as an important source of bleeding. In 1951, Smith described active bleeding from a diverticulum visualized through a sigmoidoscope. An association between colonic angiodysplasia and aortic stenosis was described by Heyde in 1958.[2]

Vascular abnormalities as a source of active bleeding were controversial. In 1960, Margulis and colleagues identified a vascular malformation in the cecum of a 69-year-old woman who presented with massive bleeding.[3] This diagnosis was accomplished with operative mesenteric arteriography.

Galdabini first used the name angiodysplasia in 1974; however, confusion about the exact nature of these lesions resulted in a multitude of terms that included arteriovenous malformation, hemangioma, telangiectasia, and vascular ectasia. These terms have varying pathophysiologies, with a common presentation of GI bleeding.

Angiodysplasia is a degenerative lesion of previously healthy blood vessels found most commonly in the cecum and proximal ascending colon. Seventy-seven percent of angiodysplasias are located in the cecum and ascending colon, 15% are located in the jejunum and ileum, and the remainder is distributed throughout the alimentary tract. These lesions typically are nonpalpable and small (< 5 mm).

Angiodysplasia is the most common vascular abnormality of the GI tract. After diverticulosis, it is the second leading cause of lower GI bleeding in patients older than 60 years. Angiodysplasia may account for approximately 6% of cases of lower GI bleeding. It may be observed incidentally at colonoscopy in as many as 0.8% of patients older than 50 years. The prevalence for upper GI lesions is approximately 1-2%.

Small bowel angiodysplasia may account for 30-40% of cases of GI bleeding of obscure origin. Retrospective colonoscopic analyses have shown that 12.1% of 642 persons without symptoms of irritable bowel syndrome (IBS), and 11.9% of those with IBS had colonic angiodysplasia.[4]

Colonic arteriovenous malformation (AVM) is one of the causes of lower GI bleeding. Unlike small vascular ectasia or angiodysplasia, colonic AVM tends to be solitary, large in size, and identified endoscopically as flat or as an elevated bright red lesion.[5]

Angiodysplasia may present as an isolated lesion or as multiple vascular lesions. Unlike congenital or neoplastic vascular lesions of the GI tract, this lesion is not associated with angiomatous lesions of the skin or other viscera.

Clinical presentation in patients with angiodysplasia is usually characterized by maroon-colored stool, melena, or hematochezia. Bleeding is usually low grade, but it can be massive in approximately 15% of patients. In 20-25% of bleeding episodes, only tarry stools are passed. Iron deficiency anemia and stools that are intermittently positive for occult blood can be the only manifestations of angiodysplasia in 10-15% of patients. Bleeding stops spontaneously in greater than 90% of cases but is often recurrent.

For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education articles Gastrointestinal Bleeding, Rectal Bleeding, Diverticulosis and Diverticulitis, and Irritable Bowel Syndrome.

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Pathophysiology

The exact mechanism of development of angiodysplasia is not known, but chronic venous obstruction may play a role.[6, 7] This hypothesis accounts for the high prevalence of these lesions in the right colon and is based on the Laplace law. The Laplace law relates wall tension to luminal size and transmural pressure difference in a cylinder, whereby the wall tension is equal to the pressure difference multiplied by the radius of the cylinder. In the case of the colon, wall tension refers to intramural tension, the pressure difference is that between the bowel lumen and the peritoneal cavity, and cylinder radius is the radius of the right colon. Wall tension is highest in bowel segments with the greatest diameter, such as the right colon.

This theory involving chronic venous obstruction suggests that repeated episodes of colonic distention are associated with transient increases in lumen pressure and size., which results in multiple episodes of increasing wall tension with obstruction of submucosal venous outflow, especially where these vessels pierce the smooth muscle layers of the colon. Over many years, this process causes gradual dilation of the submucosal veins and, eventually, dilation of the venules and arteriolar capillary units feeding them. Ultimately, the capillary rings dilate, the precapillary sphincters lose their competency, and a small arteriovenous communication forms. This accounts for the characteristic early-filling vein observed during mesenteric angiography.

The developmental theory of angiodysplasia accounts for several clinical and pathologic features, including occurrence in older individuals, location in the cecum and proximal right colon, and prominent submucosal veins that dilate after traversing the muscularis propria. In addition, it also accounts for the lack of pathologic changes in arterioles supplying vascular ectasias and the absence of any mucosal lesion associated with them. Previous studies demonstrating that colonic motility, increased tension in the bowel wall, and increased intraluminal pressure can diminish venous flow lend further support to this theory. Dilated submucosal veins have been one of the most consistent histologic findings and may represent the earliest abnormality in colonic angiodysplasia. This histologic feature supports the theory of chronic venous obstruction in the genesis of angiodysplasia.

Of note, the aforementioned pathophysiologic mechanisms responsible for the development of cecal lesions are unlikely to apply to lesions in the upper GI tract, despite being morphologically identical.

A link between a deficiency of high molecular-weight multimers of von Willebrand factor, aortic stenosis, and colonic angiodysplasia has been proposed.

Colonic angiodysplasia and true diverticula may be associated.[8]Portal hypertension colopathy, a form of colonic angiodysplasia, has been described.[9] Vascular ectasia of the entire GI tract has been reported in a patient receiving high-dose chemotherapy and autologous stem cell transplantation for relapsing Hodgkin disease.[10]

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Epidemiology

Frequency

United States

The incidence per 100,000 person-years of hospitalizations due to upper GI ulcer bleeding and perforation has decreased over time, from 54.6 and 3.9 in 1996 (R² = 0.944) to 25.8 and 2.9 in 2005 (R² = 0.410), respectively. In contrast, the incidence of colonic diverticular and angiodysplasia bleeding per 100 000 person-years increased over time from 3.3 and 0.9 in 1996 (R² = 0.443) to 8 and 2.6 in 2005 (R² = 0.715), respectively. Recent recorded drug intake showed an increased frequency of anticoagulants with colonic diverticular and angiodysplasia bleeding, whereas NSAID and low-dose aspirin use were more prevalent in peptic ulcer bleeding and colonic diverticular bleeding, respectively.[11]

The prevalence of angiodysplasia is 0.8% in healthy patients older than 50 years who are undergoing screening colonoscopy.

Foutch et al noted the prevalence of angiodysplasia to be 0.83% from 3 prospective studies in which screening colonoscopies were performed in 964 asymptomatic individuals (mean age, 62 y).[12]

Angiodysplasia is the most common reason (50%) for occult GI bleeding. The pooled completion rate was 84%. The pooled retention rates were approximately 2%.[13]

Patients with von Willebrand disease may have an increased incidence of GI bleeding from colonic angiodysplasia.[14, 15, 16, 17, 18, 19, 20]

International

No widespread studies to determine the international incidence of angiodysplasia have been conducted, but the incidence probably is similar to that in the United States.

Colonic angiodysplasia in Japanese patients is predominantly located in the left colon, whereas in Western patients it is mainly located in the right colon. The percentage of colonic lesions with a size of more than 5 mm or elevated type detected in Japanese patients was significantly higher than in Western patients .[21]

Mortality/Morbidity

  • Bleeding from angiodysplasia is usually self-limited, but it can be chronic, recurrent, or even acute and life threatening.
  • Approximately 90% of bleeding angiodysplasias spontaneously cease bleeding, presumably because of its venous nature.
  • Mortality is related to the severity of bleeding, hemodynamic instability, age, and the presence of comorbid medical conditions.

Race

No racial predilection exists in cases of angiodysplasia of the colon.

Sex

Angiodysplasia of the colon occurs with equal frequency in men and women.

Age

Most patients found to have angiodysplasia are older than 60 years; of these patients, most are older than 70 years. However, case reports exist of occurrence in young people.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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, The Methodist Hospital

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 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.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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.

Alex J Mechaber, MD, FACP  Senior 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

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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Anca Tapardel, MD, Narmin Kassam, MD, and Peter Wong, MD, to the development and writing of this article.

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

  6. 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.

  7. 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.

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

  9. 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].

  10. 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].

  11. 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. Mar 2011;33(5):585-91. [Medline].

  12. 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].

  13. 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. Feb 2010;71(2):280-6. [Medline].

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

  15. 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].

  16. 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].

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

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

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

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

  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].

  24. 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].

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

  26. 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].

  27. 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].

  28. 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].

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

  30. 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].

  31. 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].

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

  33. 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. Apr 2009;35(4):628-34. [Medline].

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

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

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

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

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

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

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

  41. 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. Oct 2010;44(9):610-4. [Medline].

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

  43. 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].

  44. 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].

  45. 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].

  46. 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].

  47. 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. Apr 2011;56(4):1188-93. [Medline].

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

  49. 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. Feb 1 2009;29(3):342-9. [Medline].

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

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

  52. 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. Feb 2010;71(2):280-6. [Medline].

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

  54. 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. Oct 2010;44(9):e195-200. [Medline].

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

  56. 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. May 2010;71(6):983-9. [Medline].

  57. 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. Sep 2008;40(9):731-4. [Medline].

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

  59. 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. May 2008;22(5):491-5. [Medline].

  60. 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. Jan 2009;21(1):54-65. [Medline].

  61. 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. Apr 2010;34(4):494-501. [Medline].

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

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

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

  65. 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].

  66. 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].

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

  68. 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].

  69. 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. Aug 2009;36(8):1653-6. [Medline].

  70. 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].

  71. 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. Aug 2010;55(8):2129-34. [Medline].

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

  73. 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. Sep 2008;68(3):440-6. [Medline].

  74. 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. Feb 2008;67(2):219-25. [Medline].

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

  76. 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). Nov 7 2009;133(17):667-70. [Medline].

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

  78. 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. Jun 2010;22(6):754-8. [Medline].

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

  80. 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. Dec 2009;21(12):1347-50. [Medline].

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

  82. 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].

  83. 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].

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

  85. 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. Apr 2008;100(4):202-7. [Medline].

  86. 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].

  87. 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].

  88. 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].

  89. 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].

  90. 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].

  91. 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].

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

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

  94. 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].

  95. 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].

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

  97. 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].

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

  99. 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].

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

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

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

  103. 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].

  104. 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].

  105. 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].

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

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

  108. 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].

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

  110. 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].

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

  112. 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].

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

  114. 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].

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

  116. 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].

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

  118. 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].

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

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

  121. 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].

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

  123. 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].

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

  125. 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].

  126. 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].

  127. 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].

  128. 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].

  129. 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].

  130. 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].

  131. 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].

 
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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 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.
 
 
 
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