Gastrointestinal angiodysplasia

Gastrointestinal angiodysplasias or angioectasias are one of the most common causes of occult gastrointestinal bleeding.

Epidemiology

Peak incidence occurs in patients in their 60-70s .

Clinical presentation

Patients can present with symptoms and signs upper or lower gastrointestinal bleeding although they can commonly be an incidental finding.

Pathology

Angiodysplasia refers to dilated, thin-walled blood vessels (capillaries, venules, veins) found in the mucosa and submucosa of the gastrointestinal tract. The pathogenesis is unclear . They are multiple in ~50% of cases , and can be found throughout the gastrointestinal tract, but most commonly in the cecum and right colon on the antimesenteric border.

Associations

Radiographic features

CT
  • appear as focal areas (< 5 mm) of contrast enhancement in the bowel wall (most prominent in the enteric phase )
  • early filling of an antimesenteric vein
Angiography
  • ectatic vessels but no mass
  • early venous enhancement indicating arteriovenous shunting

Treatment and prognosis

Approximately 50% of gastrointestinal hemorrhage from angiodysplasia ceases without intervention. Endovascular treatment is generally not effective and first-line treatment is interventional endoscopy. There is a post-treatment bleeding rate of ~25% .