Angiodysplasia is a vascular deformity of the gastrointestinal tract which predisposes to bleeding and iron deficiency anaemia.

There is thought to be an association with aortic stenosis, although this is debated. Angiodysplasia is generally seen in elderly patients

Features

• anaemia
• gastrointestinal (GI) bleeding
  • if upper GI then may be melena
  • if lower GI then may present as brisk, fresh red PR bleeding

Diagnosis

• colonoscopy
• mesenteric angiography if acutely bleeding

Management

• for active bleeding lesions:
  • endoscopic therapy is first-line: argon plasma coagulation (APC) or bipolar cautery can be used to coagulate visible vessels. Adrenaline injection may provide temporary haemostasis
  • in unstable patients or where endoscopy fails, mesenteric angiography with embolisation can be considered
  • surgery (e.g. segmental bowel resection) is a last resort for refractory or massive bleeding
• for recurrent or less severe bleeding:
  • antifibrinolytics (e.g. tranexamic acid) may reduce bleeding episodes
  • hormonal therapy with oestrogens and progesterone may be trialled in refractory cases (evidence is limited)
• supportive care:
  • iron supplementation for anaemia
  • blood transfusion as required