II. Definitions
- Gastrointestinal Angiodysplasia or Arteriovenous Malformation
- Abnormal vascular structures (arteries, veins, capillaries) in the Gastrointestinal Tract
- Dieulafoy Vascular Malformation
- Tortuous arteriole in the submucosa of the Stomach which may result in upper gastrointestinal Hemorrhage
III. Epidemiology
- Relatively rare cause of Gastrointestinal Bleeding
- Most common in age over 60 years
- Chronic Kidney Disease may predispose to earlier onset
IV. Pathophysiology
- Abnormal vascular structures form in response to chronic low grade intermittent submucosal vein obstruction
- Increased Vascular Endothelial Growth Factor dependent proliferation also contrubutes
V. Types
-
Upper Gastrointestinal Bleeding
- Responsible for 4 to 7% of non-variceal Upper Gastrointestinal Bleeding
-
Lower Gastrointestinal Bleeding (most common)
- Cecum and ascending colon (>54% of lesions)
VI. Causes
- Aortic Stenosis (Heyde's Syndrome)
- Von Willebrand Disease
- Chronic Renal Failure
VII. Symptoms
- Recurrent painless Gastrointestinal Bleeding
- May present as acute Gastrointestinal Bleeding or chronic Gastrointestinal Bleeding
- May present as Upper Gastrointestinal Bleeding or lower Gastrintestinal bleeding
VIII. Diagnosis: Colonoscopy
- Abnormal ectatic, dilated or tortuous blood vessels lined by endothelium (but no Smooth Muscle)
- Vessels are small (typically <10 mm)
- Abnormal vessels lie within the intestinal mucosa and submucosa
- More than one lesion is seen in 40-60% of patients
IX. Management
- See Gastrointestinal Bleeding
- See Lower Gastrointestinal Bleeding
- Treatment of nonbleading lesions is not typically recommended
- Persistent bleeding
- Endoscopic argon plasma coagulation (first-line)
- Associated with 7-15% recurrence rate
- Endoscopic direct contact thermal electrocautery and possible endoclip placement
- Endoscopic argon plasma coagulation (first-line)
- Longterm bleeding prevention
- Lanreotide (Somatuline)
- Improves Hemoglobin, and decreases hospitalizations, transfusions and endoscopies
- Frago (2018) Scand J Gastroenterol 53(12):1496-502 [PubMed]
- Chetcuti (2017) Scand J Gastroenterol 52(9): 962-8 [PubMed]
- Hormonal management (e.g. Ethinyl Estradiol and norethisterone)
- Does not appear to decrease bleeding episodes or transfusions
- Junquera (2001) Gastroenterology 121(5): 1073-9 [PubMed]
- Lanreotide (Somatuline)
X. Course
- Self-resolves in 40-45% of cases
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Related Studies
Concepts | Disease or Syndrome (T047) |
ICD9 | 569.84 |
SnomedCT | 32868004, 235853006 |
English | Angiodysplasia of intestine (without mention of hemorrhage), Angio intes w/o hmrhg, angiodysplasia intestine, angiodysplasia of intestine, angiodysplasia intestines, Angiodysplasia of intestinal tract (disorder), Localized arteriovenous malformations of intestinal tract, Localised arteriovenous malformations of intestinal tract, Angiodysplasia of intestine (without mention of haemorrhage), Angiodysplasia of intestinal tract, Angiodysplasia of intestine, Intestinal vascular dysplasia, Angiodysplasia of intestine (disorder), Angiodysplasia of intestinal tract, NOS, Localized arteriovenous malformations of intestinal tract, NOS, Angiodysplasia of intestine without mention of hemorrhage |
Dutch | angiodysplasie van darmen (zonder vermelding van bloeding), angiodysplasie van ingewanden (zonder vermelding van bloeding) |
French | Angiodysplasie de l'intestin sans mention d'hémorragie, Angiodysplasie de l'intestin (sans mention d'hémorragie) |
German | Angiodysplasie des Darms (ohne Erwaehnung einer Blutung) |
Italian | Angiodisplasia intestinale (senza menzione di emorragia), Angiodisplasia dell'intestino, senza menzione di emorragia |
Portuguese | Angiodisplasia do intestino (sem referência a hemorragia) |
Spanish | Angiodisplasia de intestino (sin mención de hemorragia), angiodisplasia del tracto intestinal, malformaciones arteriovenosas localizadas en el intestino, angiodisplasia del tracto intestinal (trastorno), angiodisplasia del intestino (trastorno), angiodisplasia del intestino, displasia vascular intestinal |
Japanese | 腸管血管異形成(出血の記載のないもの), チョウカンケッカンイケイセイシュッケツノキサイノナイモノ |
Czech | Angiodysplazie střeva (bez zmínky o krvácení) |
Hungarian | Bél angiodysplasia (vérzés említése nélkül), Bél angiodysplasiája (vérzés említése nélkül) |
Ontology: Angiodysplasia of colon (C0267370)
Concepts | Disease or Syndrome (T047) |
ICD10 | K55.2 |
SnomedCT | 90858003, 197244008 |
English | AV - Angiodysplasia of colon, Angiodysplasia of large int, colonic angiodysplasia (diagnosis), colonic angiodysplasia, colon angiodysplasia, angiodysplasia colon, Large intestine angiodysplasia, Angiodysplasia, Vascular ectasia of colon, AV - Angiodysplasia malformation of colon, Angiodysplasia of large intestine, Telangiectasia of colon, Angiodysplasia of colon (disorder), Vascular ectasia of colon (disorder), Angiodysplasia of colon, angiodysplasia |
German | Angiodysplasie des Kolons, Angiodysplasie des Dickdarms |
Korean | 결장의 혈관형성이상 |
Czech | Angiodysplazie tlustého střeva |
Dutch | angiodysplasie van dikke darm, Angiodysplasie van colon |
French | Angiodysplasie du gros intestin |
Hungarian | Vastagbél angiodysplasia |
Italian | Angiodisplasia dell'intestino crasso |
Japanese | 大腸血管異形成, ダイチョウケッカンイケイセイ |
Portuguese | Angiodisplasia do intestino grosso |
Spanish | Angiodisplasia del intestino grueso, angiodisplasia del colon (trastorno), angiodisplasia del colon, ectasia vascular del colon (trastorno), ectasia vascular del colon |
Ontology: Dieulafoy's vascular malformation (C0341217)
Concepts | Disease or Syndrome (T047) |
SnomedCT | 109558001 |
Spanish | Malformación vascular de Dieulafoy, enfermedad de Dieulafoy, malformación vascular de Dieulafoy (trastorno), malformación vascular de Dieulafoy |
French | Malformation vasculaire de Dieulafoy |
Dutch | Dieulafoy-vaatmisvorming, Dieulafoy; ulcus, ulcus; Dieulafoy |
Portuguese | Malformação vascular de Dieulafoy |
German | Dieulafoy-Gefaessmissbildung |
Italian | Malformazione vascolare di Dieulafoy |
Japanese | デュラフォア血管奇形, デュラフォアケッカンキケイ |
English | Dieulafoy lesion of stomach, Dieulafoy lesion of stomach (diagnosis), Dieulafoy vascular malformation, dieulafoy lesions, dieulafoy disease, dieulafoy lesion, dieulafoy diseases, dieulafoy's ulcer, Calibre persistent artery, Caliber persistent artery, Dieulafoy disease, Dieulafoy's vascular malformation (disorder), Dieulafoy's vascular malformation, ulcer; Dieulafoy, Dieulafoy; ulcer |
Czech | Dieulafoyova vaskulární malformace |
Hungarian | Dieulafoy vascularis malformatio |
Ontology: Gastrointestinal arteriovenous malformation (C0744321)
Concepts | Anatomical Abnormality (T190) |
Italian | Malformazione arterovenosa gastrointestinale |
Japanese | 胃腸管動静脈奇形, イチョウカンドウジョウミャクキケイ |
Czech | Gastrointestinální arteriovenózní malformace |
Hungarian | Gastrointestinalis arteriovenosus malformatio |
English | Gastrointestinal arteriovenous malformation, Gastrointestinal Arteriovenous Malformation |
Portuguese | Malformação arteriovenosa gastrointestinal |
Spanish | Malformación arteriovenosa gastrointestinal |
Dutch | maagdarmstelsel arterioveneuze misvorming |
French | Malformation artérioveineuse gastro-intestinale |
German | arteriovenoese Missbildung im Intestinaltrakt |
Ontology: Gastrointestinal vascular malformation (C0851971)
Concepts | Disease or Syndrome (T047) |
Italian | Malformazioni vascolari gastrointestinali, Malformazione vascolare gastrointestinale |
Japanese | 消化管血管奇形, ショウカカンケッカンキケイ, 胃腸血管奇形, イチョウケッカンキケイ |
Czech | Gastrointestinální cévní malformace, Vaskulární malformace v gastrointestinálním traktu |
English | Gastrointestinal vascular malformations, Gastrointestinal vascular malformation |
Spanish | Malformación vascular gastrointestinal, Malformaciones vasculares gastrointestinales |
Portuguese | Malformação gastrointestinal vascular, Malformações vasculares gastrointestinais |
French | Malformation vasculaire gastro-intestinale, Malformations vasculaires gastro-intestinales |
Dutch | gastro-intestinale vaatmisvorming, maagdarmstelselvaatmisvormingen |
German | Fehlbildung der gastrointestinalen Gefaesse, Gastrointestinale Gefaessmissbildungen |
Hungarian | Gastrointestinalis vascularis malformatiók, Gastrointestinalis vascularis malformatio |
Ontology: Gastrointestinal angiodysplasia (C0854242)
Concepts | Disease or Syndrome (T047) |
Italian | Angiodisplasia gastrointestinale |
Japanese | 胃腸管血管異形成, イチョウカンケッカンイケイセイ |
Czech | Gastrointestinální angiodysplazie |
English | Gastrointestinal angiodysplasia |
Hungarian | Gastrointestinalis angiodysplasia |
Portuguese | Angiodisplasia gastrointestinal |
Spanish | Angiodisplasia gastrointestinal |
Dutch | maagdarmstelsel angiodysplasie |
French | Angiodysplasie gastro-intestinale |
German | gastrointestinale Angiodysplasie |
Ontology: Gastrointestinal angiodysplasia haemorrhagic (C0854243)
Concepts | Disease or Syndrome (T047) |
Italian | Angiodisplasia gastrointestinale emorragica |
Dutch | angiodysplasie van maagdarmstelsel hemorragisch, maagdarmstelsel hemorragische angiodysplasie |
French | Angiodysplasie gastrointestinale hémorragique, Angiodysplasie gastro-intestinale hémorragique |
German | gastrointestinale Angiodysplasie, blutend, gastrointestinale Angiodysplasie haemorrhagisch |
Portuguese | Angiodisplasia gastrintestinal hemorrágica, Angiodisplasia gastrointestinal hemorrágica |
Japanese | 出血性胃腸管血管異形成, シュッケツセイイチョウカンケッカンイケイセイ |
English | Gastrointestinal angiodysplasia haemorrhagic, Gastrointestinal angiodysplasia hemorrhagic |
Czech | Gastrointestinální hemoragická angiodysplazie |
Hungarian | Gastrointestinalis angiodysplasia vérzéses, Gastrointestinalis angiodysplasia, haemorrhagiás |
Spanish | Angiodisplasia gastrointestinal hemorrágica |
Ontology: Gastrointestinal telangiectasia (C1619711)
Concepts | Disease or Syndrome (T047) |
Dutch | gastro-intestinale teleangiëctasie |
French | Télangiectasie gastrointestinale |
German | gastrointestinale Teleangiektasie |
Italian | Telangiectasia gastrointestinale |
Portuguese | Telangiectasia gastrointestinal |
Spanish | Telangiectasia gastrointestinal |
Japanese | 胃腸毛細血管拡張症, イチョウモウサイケッカンカクチョウショウ |
Czech | Gastrointestinální telangiektáze |
Hungarian | Gastrointestinalis telangiectasia |
English | Gastrointestinal telangiectasia |