Angiodysplasia

Angiodysplasia refers to vascular lesions in the gastrointestinal tract characterized by dilated, tortuous, thin-walled vessels in the mucosa and submucosa. The condition is most common in the colon, particularly the cecum and ascending colon, and is a frequent source of lower GI bleeding in older adults. Many individuals with angiodysplasia are asymptomatic, but the lesions can cause occult or overt bleeding leading to iron deficiency anemia.

The exact cause is not fully understood. Age-related degenerative changes, intermittent venous obstruction, and mucosal ischemia may contribute to the development of these fragile vessels. Angiodysplasia is sometimes associated with other conditions, notably aortic stenosis (Heyde syndrome) due to high shear forces causing acquired von Willebrand factor deficiency and increased bleeding risk.

Clinical features range from none to chronic or intermittent GI bleeding, which may present as melena or hematochezia and can result in iron deficiency anemia. Diagnosis typically begins with endoscopy; colonoscopy is the most common test for colonic lesions. If small-bowel involvement is suspected, capsule endoscopy or deep enteroscopy can help. Imaging such as CT angiography or MR angiography may be used to localize active bleeding, and conventional angiography can enable therapeutic embolization in ongoing hemorrhage.

Management depends on bleeding severity. Mild cases may require observation and iron supplementation. Endoscopic therapy with argon plasma coagulation or clipping is commonly used for accessible lesions. Recurrent or inaccessible bleeding may be treated with transarterial embolization or, rarely, surgical resection. Pharmacologic options, including somatostatin analogues like octreotide, have shown benefit in some cases. Regular follow-up is important due to potential recurrences.