Makindo Medical Notes

Angiodysplasias are fragile vascular malformations of the bowel wall, often found incidentally.
👉 Treatment is not usually required if the patient is asymptomatic. Symptomatic cases present with bleeding and anaemia.

📖 About

• Acquired vascular anomaly of the gastrointestinal tract, increasing in prevalence with age.
• Most commonly affects the caecum and right colon (antimesenteric border).
• Important cause of lower GI bleeding in elderly patients 👵👴.

🔗 Associations

• Osler-Weber-Rendu syndrome (hereditary haemorrhagic telangiectasia).
• Heyde syndrome: Severe calcific aortic stenosis → shear stress damages von Willebrand factor → acquired vWF disease → predisposes to bleeding. ❤️🩸

🧬 Aetiology & Pathology

• Age-related degeneration of submucosal veins and venules → thin-walled, dilated, ectatic vessels prone to rupture.
• Histology: Endothelial-lined channels ± smooth muscle.
• Bleeding usually occurs intermittently and can be occult or overt.

👩‍⚕️ Clinical Features

• Iron-deficiency anaemia → fatigue, pallor, dyspnoea on exertion.
• Intermittent GI bleeding (may be occult or frank PR bleeding).
• Typically seen in frail elderly patients; bleeding may be chronic, recurrent, and difficult to localise.

🔎 Investigations

• Bloods: FBC (microcytic anaemia), U&E, clotting, ferritin, B12, folate.
• OGD + Colonoscopy: First-line to rule out malignancy/diverticulitis and identify angiodysplasias.
• Capsule endoscopy: Useful for small bowel lesions.
• Angiography: Detects active bleeding (>1.5 ml/min); may show early venous filling.
• Differentials: Colorectal cancer, diverticulitis, haemorrhoids.

💊 Management

• Asymptomatic: No treatment required.
• Endoscopic therapy: Argon plasma coagulation (APC) or cautery at colonoscopy for bleeding lesions.
• Optimise medications: Review and balance anticoagulation/antiplatelet therapy.
• Supportive: Iron supplementation, IV iron, or blood transfusion for anaemia.
• Radiological: Angiographic embolisation for refractory bleeding.
• Medical therapy: Tranexamic acid, thalidomide, or oestrogen-progesterone therapy in select cases.
• Surgery: Segmental colectomy for localised, severe, or recurrent bleeding not controlled by other means.

📚 References

• Gastroenterology – Angiodysplasia and GI bleeding
• NEJM – Heyde Syndrome and Angiodysplasia