Angiodysplasia overview: Difference between revisions

Jump to navigation Jump to search
Line 68: Line 68:
The most important risk factors for angiodysplasia include:  
The most important risk factors for angiodysplasia include:  


# Age (>60 years)  
#Age (>60 years)
# Aortic stenosis  
#Aortic stenosis
# von Willebrand disease (VWD)  
#von Willebrand disease (VWD)
# Chronic kidney disease  
#Chronic kidney disease


==Screening==
==Screening==
There are no specific indications for screening angiodysplasia.


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==

Revision as of 21:18, 3 September 2021

Angiodysplasia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Angiodysplasia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Angiodysplasia overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Angiodysplasia overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Angiodysplasia overview

CDC on Angiodysplasia overview

Angiodysplasia overview in the news

Blogs on Angiodysplasia overview

Directions to Hospitals Treating Angiodysplasia

Risk calculators and risk factors for Angiodysplasia overview

Please help WikiDoc by adding more content here. It's easy! Click here to learn about editing.

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

Overview

In medicine (gastroenterology), angiodysplasia is a small, acquired vascular malformation of the gut. It is a common cause of otherwise unexplained gastrointestinal bleeding and anemia, especially after sixth decade of life. Lesions are often multiple, and frequently involve the cecum or ascending colon, although they can occur at other places. Treatment may be with endoscopic interventions, medication, or occasionally surgery.

Historical Perspective

The first case of angiodysplasia was described in a letter to the London Medical Gazette by Phillips as a vascular abnormality causing bleeding from the large bowel in 1839. However, the term "Angiodysplasia" was coined by Galdabini in 1974. Due to the unknown etiology of these lesions, multiple terms have been used, like arteriovenous malformation, telangiectasia, angioma, and hemangioma.[1]

Classification

One system of classification is based on location, size, and number of angiodysplasias. [2]

Classification of gastrointestinal angiodysplasia
Location Size Number of lesions
Gastric Minute (<2 mm in diameter) Unique (n = 1)
Duodenal Intermediate (2 to 5 mm) Multiple (n = 2 to 10)
Jejunal Large (>5 mm) Diffuse (n > 10)
Colonic
For example, "D-S2-N3" signifies multiple angiodysplasias of intermediate size in the duodenum.

Another system of classification uses endoscopic techniques to classify angiodysplasia depending on size, bleeding and surrounding venous dilatation. [3]

Type 1: Angioectasias:

Type 1 a - punctulate erythema (< 1 mm), with or without oozing

Type 1 b - patchy erythema (a few mm), with or without oozing

Type 2: Dieulafoy's lesions:

Type 2 a - punctulate lesions (< 1 mm), with pulsatile bleeding

Type 2b - pulsatile red protrusion, without surrounding venous dilatation

Type 3 - pulsatile red protrusion, with surrounding venous dilatation

Type 4 - other lesions not classified into any of the above categories.

Pathophysiology

Exact etiology of angiodysplasia is unclear. Various theories appear in the literature. According to one theory, ageing and intermittent, low-grade obstruction of submucosal veins in the muscularis propria layer leads to the formation of small arterio-venous collaterals. Another theory states that due to chronic hypoxia angiogenic factors like vascular endothelial growth factor (VEGF) and basic fibroblast growth factor increase which contribute to the development of angiodysplasia. [4] A proposed mechanism that may lead to the development of angiodysplasia in aortic stenosis is the development of acquired von Willebrand disease (VWD) from mechanical disruption of von Willebrand factor multimers during their passage from the stenotic aortic valve.[5]

Differentiating Angiodysplasia overview from Other Diseases

Angiodysplasia must be differentiated from other diseases that cause hematochezia, melena, and iron deficiency anemia like, diverticulitis, hemorrhoids, colon cancer, upper GI bleed and inflammatory bowel disease.

Epidemiology and Demographics

The prevalance of angiodysplasia is 0.8% in adult population but it accounts for 20% of major episodes of lower intestinal bleeding.

Angiodysplasia affects men and women equally regardless of race and is more prevalent after sixth decade of life.

Risk Factors

The most important risk factors for angiodysplasia include:

  1. Age (>60 years)
  2. Aortic stenosis
  3. von Willebrand disease (VWD)
  4. Chronic kidney disease

Screening

There are no specific indications for screening angiodysplasia.

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

  1. Athanasoulis, C. A.; Galdabini, J. J.; Waltman, A. C.; Novelline, R. A.; Greenfield, A. J.; Ezpeleta, M. L. (1978). "Angiodysplasia of the colon: A cause of rectal bleeding". Cardiovascular Radiology. 1 (1): 3–13. doi:10.1007/BF02551967. ISSN 0342-7196.
  2. Schmit A, Van Gossum A (1998). "Proposal for an endoscopic classification of digestive angiodysplasias for therapeutic trials. The European Club of Enteroscopy". Gastrointest Endosc. 48 (6): 659. doi:10.1016/s0016-5107(98)70080-x. PMID 9852467.
  3. Yano T, Yamamoto H, Sunada K, Miyata T, Iwamoto M, Hayashi Y; et al. (2008). "Endoscopic classification of vascular lesions of the small intestine (with videos)". Gastrointest Endosc. 67 (1): 169–72. doi:10.1016/j.gie.2007.08.005. PMID 18155439.
  4. García-Compeán D, Del Cueto-Aguilera ÁN, Jiménez-Rodríguez AR, González-González JA, Maldonado-Garza HJ (2019). "Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points". World J Gastroenterol. 25 (21): 2549–2564. doi:10.3748/wjg.v25.i21.2549. PMC 6558444 Check |pmc= value (help). PMID 31210709.
  5. Vincentelli A, Susen S, Le Tourneau T, Six I, Fabre O, Juthier F; et al. (2003). "Acquired von Willebrand syndrome in aortic stenosis". N Engl J Med. 349 (4): 343–9. doi:10.1056/NEJMoa022831. PMID 12878741.

Template:WS Template:WH