Angiodysplasia epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nikita Singh, M.D.[2]

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Overview

Epidemiology and Demographics

Angiodysplasia is the most common vascular malformation of the GI tract and accounts for 20% of major episodes of lower intestinal bleeding.

United States statistics

  • The incidence of colonic diverticular and angiodysplasia bleeding per 100,000 person-years increased over time. which may be attributed to an increased frequency of anticoagulants use.
  • The prevalence of angiodysplasia is less than 1% in healthy patients older than 50 years undergoing screening colonoscopy.
  • Angiodysplasia accounts for up to 50% of episodes of recurrent GI bleeding in patients with end-stage renal disease.
  • The most frequent cause of GI bleeding in patients with von Willebrand disease is angiodysplasia.


International statistics

  • Extensive studies have not been performed to establish the incidence of angiodysplasia worldwide, but the incidence is in all likelihood similar to that in the United States.
  • Predominant location for colonic angiodysplasia in Japanese patients is left colon, whereas it is the right colon for Western patients. Additionally, Japanese patients have a higher incidence of lesions more than 5 mm in size or of elevated type than Western counterparts.


Race-, sex-, and age-related demographics

  • Angiodysplasia affects all races equally.
  • The incidence of angiodysplasia is equal in both men and women.
  • Majority of the affected population is older than 60 years.


Location wise statistics:

Upper GI tract

AD is reportedly the cause in 4–7% of patients presenting with nonvariceal upper GI bleeding. In the largest study, 676 patients underwent endoscopy for suspected UGIB over a 40‐month period. AD was found in 4% of patients, of whom 77% had experienced at least one episode of overt upper GI bleeding (hematemesis or melena) and the rest had features of occult GI bleeding. Multiple lesions were found in 63% of cases and colonic AD was detected in 50% of those who had a colonoscopy performed.

Small bowel

In patients under 50 years of age with obscure GI bleeding (OGIB), small bowel tumors are commonly identified as the cause in 5–7%. However, in patients older than 50 years, the source is likely to be small bowel AD.

Liao et al. performed a systematic review of all original articles relevant to wireless capsule endoscopy (WCE) for the evaluation of patients with small bowel signs and symptoms published between 2000 and 2008. A total of 227 studies involving 22 840 procedures were included. OGIB (overt and occult) was the most common indication (66.0%) and AD was the most common cause (50.0%) of bleeding in those patients. In another study, small bowel AD lesions were the most common cause of severe life‐threatening overt OGIB.

Colon

The colon is the most frequent site of AD in the GI tract. In western patients, lesions are predominantly located in the caecum and ascending colon (54–81.9%), while lesions diagnosed in Japanese patients are more likely to be in the descending colon (41.7%). The prevalence of colonic AD in healthy asymptomatic adults was estimated to be 0.83% and none of these individuals developed bleeding over a mean follow‐up duration of 3 years.

Therefore, treatment of nonbleeding lesions is generally not recommended. The frequency of colonic AD as a cause of lower GI hemorrhage varies between 3% and 40%. Bleeding from colonic AD can be mild, chronic, recurrent, and can stop spontaneously in up to 90% of patients; nonetheless, it can also be life-threatening.

Approximately 40–60% of patients with upper or lower GI AD have more than one lesion and 27% of patients with colonic AD had multiple lesions involving two or more segments of the large bowel.28 Moreover, while AD is usually present in the same part of the GI tract, synchronous lesions elsewhere can occur in approximately 20% of patients.

These findings suggest that local factors may be important in the pathogenesis of nonhereditary AD. It also highlights the importance of evaluating both the upper and lower GI tract in patients with symptomatic AD. AD can only be confidently diagnosed as the cause of blood loss if it was actively bleeding at the time of endoscopy.

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