Angiodysplasia

Overview

Angiodysplasia is a condition in which small, abnormal, and fragile blood vessels develop in the lining of the gastrointestinal (digestive) tract. These malformed vessels are prone to bleeding because their walls are thin and easily damaged. Angiodysplasia is one of the more common causes of bleeding from the digestive tract, particularly in people over 60.

The abnormal vessels can appear anywhere in the gut but are most often found in the colon (large intestine), the stomach, and the small intestine. Bleeding can range from slow and hidden, leading to gradual anemia, to sudden and obvious. Many people with angiodysplasia never have problems and the lesions are found incidentally during a scope test. When bleeding does occur, it is usually painless, which can make the condition easy to overlook until anemia or visible blood prompts investigation.

Symptoms

Angiodysplasia often causes no symptoms at all. When it does, the main problem is bleeding, which may be obvious or hidden.

• Painless bleeding from the digestive tract
• Bright red blood in the stool or maroon-colored stools (lower gut bleeding)
• Black, tarry stools (bleeding higher in the digestive tract)
• Vomiting blood, in some cases of upper-tract bleeding
• Fatigue, weakness, paleness, or shortness of breath from anemia caused by slow, ongoing blood loss

Bleeding from angiodysplasia is usually intermittent, stopping and starting on its own, which is why it can be difficult to pin down. Slow chronic bleeding may cause iron-deficiency anemia before any blood is visible.

Causes

The exact cause of angiodysplasia is not fully known, but it is thought to develop over time as part of aging and wear on the blood vessels of the gut.

• Age-related vessel changes: repeated stretching and pressure on the bowel wall over many years may cause small veins to become dilated and fragile.
• Reduced blood flow: conditions that affect circulation may contribute.

Angiodysplasia is more common in people with certain medical conditions, such as kidney disease, heart valve disease, and some bleeding or blood-vessel disorders, which may make the abnormal vessels more likely to form or to bleed.

Risk Factors

Several factors raise the likelihood of developing angiodysplasia or of bleeding from it.

• Older age, especially over 60
• Chronic kidney disease, particularly in people on dialysis
• Aortic valve disease and other heart conditions
• Use of blood thinners or antiplatelet medicines, which increase bleeding
• Certain inherited blood-vessel disorders, such as hereditary hemorrhagic telangiectasia
• Disorders affecting blood clotting

Diagnosis

Diagnosing angiodysplasia can be challenging because the bleeding is often intermittent. A clinician uses tests both to find the source of bleeding and to confirm the abnormal vessels.

• Colonoscopy: a camera examines the colon and can both find and treat bleeding lesions.
• Upper endoscopy: a scope examines the stomach and upper small intestine.
• Capsule endoscopy: a swallowable camera images the small intestine, which is hard to reach otherwise.
• Angiography or specialized imaging: used to locate active bleeding, especially when it is brisk.
• Blood tests: to detect anemia and check for ongoing blood loss.

Sometimes several tests are needed before the source is identified.

Treatment

Treatment depends on whether the angiodysplasia is bleeding and how severe the bleeding is. Lesions found by chance without bleeding usually need no treatment.

• Endoscopic treatment: during a scope, the abnormal vessels can be sealed using heat (cautery), argon plasma coagulation, clips, or banding to stop or prevent bleeding.
• Iron replacement and transfusion: iron supplements treat anemia, and blood transfusions are given for significant blood loss.
• Angiographic treatment: in active, hard-to-reach bleeding, an interventional radiologist may block the bleeding vessel.
• Medication adjustment: reviewing or pausing blood thinners when appropriate.
• Surgery: rarely, removing a section of bowel is needed for severe or repeated bleeding that other measures cannot control.

Because lesions can recur, ongoing monitoring is sometimes necessary.

Prevention and Self-Care

• Use blood thinners and NSAIDs only as needed and under medical guidance, since they increase bleeding
• Treat and monitor underlying conditions such as kidney or heart valve disease
• Take iron as prescribed to correct and prevent anemia
• Report any black stools, blood in the stool, or unexplained fatigue promptly
• Keep follow-up appointments so recurrent bleeding can be caught early

When to See a Doctor

See a clinician if you notice signs of digestive bleeding or develop unexplained fatigue and paleness, which can signal slow blood loss. Seek emergency care immediately for:

• Vomiting blood or material that looks like coffee grounds
• Black, tarry stools or a large amount of bright red blood in the stool
• Feeling faint, dizzy, or short of breath
• A fast heartbeat or signs of significant blood loss

Heavy gastrointestinal bleeding is an emergency that requires immediate medical attention.

Related Topics

Frequently Asked Questions

References

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gastrointestinal bleeding.
2. Mayo Clinic. Gastrointestinal bleeding.
3. MedlinePlus, U.S. National Library of Medicine. Angiodysplasia of the colon.
4. American Society for Gastrointestinal Endoscopy (ASGE). Understanding GI bleeding.