What is Angiodysplasia?
is a small lesion caused by a malformed blood vessel in the gastrointestinal tract. After diverticulosis, it is the second leading cause of bleeding in the lower gastrointestinal tract in patients older than 60 years. It accounts for 6% of cases of lower gastrointestinal tract bleeding. The bleeding is usually grave enough to cause anemia. Most frequently more than one lesion generally appear in and around the cecum (the connecting pouch between the small and large intestine) and the colon in the large intestine.
Symptoms of Angiodysplasia
- Black tar like stools medically known as melena. In 20-25% bleeding occurrences, melena is the only perceived symptom.
- Maroon colored stools or hematochezia could also occur.
- Predominant anemia.
- Fecal Occult blood (not visibly apparent ) is tested positive. Even though bleeding persists, infrequent bleeding may cause the test to be negative.
- Iron deficiency causing anemia and a positive fecal occult blood test can be the only symptom of angiodysplasia in 10-15% patients.
Causes of Gastrointestinal Bleeding Lesions
- Due to age and strain on the walls of the blood vessels in the gastrointestinal tract and colon.
- Individuals having a blood clotting disorder are more prone to it than others.
- A narrowing in the aortic valve leading to the heart can increase the pressure and stress in other blood vessels increasing the incidence of the discussed condition. Aortic Valve Stenosis can increase the risk of bleeding from existing lesions.
- Endoscopy (administering a nasogastric tube through the mouth) or a colonoscopy (administering a nasogastric tube through the anus) is usually done to detect the condition.
- It is difficult to reach the small intestine with endoscopy. A relatively new technique known as pill enteroscopy is used. A pill enabled with a video camera and a radio transmitter is ingested. It send the images of the small intestine to the receiver worn by the patient.
- Radiographic Imaging, Computed Tomography(CT) scan or Magnetic Resonance Imaging (MRI) could also be done to diagnose the condition.
Treatment and Management of Angiodysplasia
- In cases of single isolated lesions detected during routine endoscopic screening, no treatment is usually administered.
- In patients having occult and overt bleeding, immediate therapeutic and diagnostic options should be explored to treat them.
- Coagulants can be directly administered at the site of the bleeding lesion with the help of the endoscope. Argon Plasma Coagulation (APC) laser treatment is a well known therapy to that effect.
- Surgical resection of the affected organ is also done to provide relief.
- Medications like estrogens are also administered but a lot of side effects are associated with estrogen usage.