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.
- 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
Angiodysplasia is responsible for non-variceal upper gastrointestinal bleeding in 4–7% of patients.
Small bowel
In patients older than 50 years, the source of obscure gastrointestinal bleeding is most commonly small bowel angiodysplasia.
Colon
The most common location of angiodysplasia of the gastrointestinal tract is the colon. Within the colon, cecum and ascending colon are the most frequent location of angiodysplasia in western patients, whereas, descending colon is the most likely site in Japanese patients.
Angiodysplasia of the colon can be accountable for 3% to 40% of the cases of lower GI hemorrhage which can be classified into mild, chronic, recurrent or 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.