Angiodysplasia of the colon and small intestine

Rebleeding

The natural history of angiodysplasia is poorly understood.[40]Raju GS, Gerson L, Das A, et al. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology. 2007 Nov;133(5):1697-717. http://www.gastrojournal.org/article/S0016-5085%2807%2901148-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/17983812?tool=bestpractice.com It is estimated that <10% of all patients with angiectasia will eventually bleed. Rebleeding is reported to be between 30% and 40% per annum.[76]Samaha E, Rahmi G, Landi B, et al. Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol. 2012 Feb;107(2):240-6. http://www.ncbi.nlm.nih.gov/pubmed/21946281?tool=bestpractice.com ​ This risk is propagated by patients’ comorbidity.

Presence of multiple lesions, frequent previous bleeding episodes, heart failure, smoking status, and transfusion requirements predict recurrent bleeding.[23]Grooteman KV, Holleran G, Matheeuwsen M, et al. A risk assessment of factors for the presence of angiodysplasias during endoscopy and factors contributing to symptomatic bleeding and rebleeds. Dig Dis Sci. 2019 Oct;64(10):2923-32. https://www.doi.org/10.1007/s10620-019-05683-7 http://www.ncbi.nlm.nih.gov/pubmed/31190204?tool=bestpractice.com [77]Arieira C, Magalhães R, Dias de Castro F, et al. Small bowel angioectasias rebleeding and the identification of higher risk patients. Dig Dis Sci. 2021 Jan;66(1):175-80. https://www.doi.org/10.1007/s10620-020-06137-1 http://www.ncbi.nlm.nih.gov/pubmed/32072436?tool=bestpractice.com  Bleeding stops spontaneously in >90% of presentations.[6]Annamalai G, Robertson I. Acute gastrointestinal haemorrhage: investigation and treatment. Imaging. 2004;16:264-70.

Mortality

Mortality due to the complications of bleeding is around 10%.[40]Raju GS, Gerson L, Das A, et al. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology. 2007 Nov;133(5):1697-717. http://www.gastrojournal.org/article/S0016-5085%2807%2901148-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/17983812?tool=bestpractice.com A poor prognosis is associated with emergency surgery, hemorrhagic shock at presentation, and the presence of comorbidities.