Angiodysplasia may be defined as a condition that is characterized by a vascular anomaly of the gut that is characterized by a lesion of the colon, the gastrointestinal tract, the stomach, the intestine and other areas. It usually causes an enlargement of the affected organ and leads to enormous loss of blood through the blood vessels.
According to its places of occurrence, it may be classified as colonic and gastric angiodysplasia, angiodysplasia of stomach and the intestine, cecal angiodysplasia, duodenal and small bowel angiodysplasia. Angiodysplasia of the colon is also known as colonic angiomas or arteriovenous. Since it involves vascular malformation, it may also be known as vascular ectasia of the colon. Severe colonic angiodysplasia may lead to Heyde’s Syndrome, which by combination with bleeding is known as Angiodysplasia aortic stenosis.
In most cases, angiodysplasia is asymptomatic by nature but it may manifest itself in a variety of forms. In most cases, the signs of angiodysplasia include feebleness, lethargy, and breathlessness, defecation of tarred stool which may be bright red, dark or black in color. The lesions that develop in case of angiodysplasia are usually small in size and nonpalpable by nature. Patients suffering from duodenal angiodysplasia and that of the stomach may exhibit overt or occult bleeding. All these signs are actually triggered due to profuse loss of blood through the rectum that is itself a significant symptom of angiodysplasia. Bleeding may either be chronic or recurrent. However, one does not have to bear any sort of pain in case of angiodysplasia unless it is associated with a severe underlying cause.
Although the exact cause of angiodysplasia is ambiguous, yet one may ascribe it to the process and impact of ageing as is common in case of most diseases. With age one’s blood vessels may degenerate and its subsequent rupture may further cause severe loss of blood.
Angiodysplasia may also be caused by a condition characterized by colon spasms that may lead to an enlargement of the blood vessels of the area affected. Moreover, an inflammation of the blood vessels creates a narrow passage between the artery and the vein known as arteriovenous fistula. This is actually the area from where the patient starts to bleed from. Mucosal hypoperfusion occurring as a result of cardiac problem may also be cited as a cause of angiodysplasia.
It may also be caused by other vascular, cardiac or pulmonary disease that involves hypo-oxygenation of the microcirculation.
Besides these, angiodysplasia may also be caused by other underlying diseases affecting the blood vessels such as Osler-Weber-Rendu syndrome, also known as hereditary hemorrhagic telangiectasia (HHT), scleroderma, Heyde’s syndrome and renal failure. Other factors that thrust high shear stress may also be responsible for causing the same.
Angiodysplasia may be diagnosed by conducting a Complete blood count (CBC), stool test, an endoscopy, esphagogastroduodenoscopy (EGD) or colonoscopy, angiography of the arteries, scintigraphy, and a double-balloon or pill enteroscopy. Angiodysplasia angiography may only be performed in case there is active bleeding from the arteries into the colon. The latter tests may prove highly beneficial in case of angiodysplasia of stomach, intestine and colon.
The treatment of angiodysplasia depends on the nature of symptoms, the hemodynamic stability and the severity of bleeding from the rectum.
Hemodynamically unstable patients are treated with the help of intravenous pulse cyclophosphamide treatment and packed RBCs. One may also go for an endoscopic treatment which entails undertaking laser techniques such as heater probe, monopolar electrocautery, sclerotherapy, neodymium: yttrium-aluminum-garnet (Nd:YAG) lasers, Olympus EVIS LUCERA, band ligation and argon plasma coagulation (APC) lasers. In case the lesions are not visible on a colonoscopy, one may have to for an angiodysplasia angiography.
Certain medications such as octreotides, thalidomide, desmopressin, tranexamic acid, aminocaproic acid and estrogens may aid the treatment of angiodysplasia. One may also go for a hormone replacement therapy using estrogen but it may have side-effects which may be a bit difficult to counter.
However, one may resort to surgical procedures in case of severity of the condition. It may include complete or partial gastrectomy, and right hemicolectomy. But such measures are kept as last options for the purpose of severely dealing with hemorrhage. One is also advised to refrain from using nonsteroidal anti-inflammatory drugs in this case to prevent the condition to aggravate.
Taking into account all these factors, it is advisable for undergoing a proper treatment of angiodysplasia well before the situation turns life-threatening.
Written by akshay
on June 23rd, 2011. The article was last updated on August 30th, 2011