History and exam

Key diagnostic factors

common

gastrointestinal bleeding

Patients usually display chronic, painless, low-grade, intermittent bleeding, with either fresh rectal bleeding in lower gastrointestinal disease or melena in upper gastrointestinal disease.

There may be long periods of time between bleeding episodes, and episodes are usually self-limiting.

In rare cases, patients may present with massive hemorrhage (hematochezia or hematemesis).

Usually bright red stool, but may be maroon.

Other diagnostic factors

common

age >60 years

Angiodysplasia is thought to result from a degenerative process associated with aging.[23]​[46][47]

Two retrospective studies found that age greater than 80 years was an independent risk factor for symptomatic angiodysplasia of the colon.[25][26]

shortness of breath

Because bleeding may be low grade and chronic, patients may present with symptoms and signs of anemia.

fatigue

Because bleeding may be low grade and chronic, patients may present with symptoms and signs of anemia.

pallor

Because bleeding may be low grade and chronic, patients may present with symptoms and signs of anemia.

uncommon

tachycardia

May occur if bleeding occurs at a faster pace and in larger amounts.

hypotension

May occur if bleeding occurs at a faster pace and in larger amounts.

Risk factors

weak

chronic renal failure/end-stage renal disease

In patients with chronic renal failure, angiodysplasia is responsible for 19% to 32% of lower gastrointestinal bleeding episodes, compared with 5% to 6% episodes in the general population.[4]​ Increased risk of bleeding may be attributed to uremic platelet dysfunction, use of anticoagulants, or reduced production of erythropoietin.[4]​ An increased prevalence of angiodysplasia is observed in patients undergoing dialysis and is a common cause of gastrointestinal bleeding in this patient group.[13][14][15]

von Willebrand disease

The incidence of angiodysplasia is higher in patients with von Willebrand disease.[4][16]​​​​[31][32]

Bleeding from gastrointestinal angiodysplasia is observed only in patients with either hereditary or acquired von Willebrand disease; these patients lack high molecular weight multimers of von Willebrand factor.[4][33]​​​ These multimer abnormalities have been shown to be associated with increased risk of bleeding from angiodysplasia.[4]

aortic stenosis

Heyde syndrome is characterized by gastrointestinal bleeding from angiodysplasia in the presence of aortic stenosis.[19]​ It has predominantly been attributed to acquired von Willebrand disease, but the absence of von Willebrand disease does not rule out the diagnosis of Heyde syndrome.[19]

One large epidemiologic study found a significant association between aortic stenosis and gastrointestinal bleeding presumed due to intestinal angiodysplasia.[20] Prevalence of patients with both aortic stenosis and gastrointestinal bleeding was low, which may have precluded smaller studies finding a significant association.[20]​ Classically, angiodysplasia is located in the ascending colon, while that associated with Heyde syndrome is predominantly located in the small intestine.[19]​ One meta-analysis reported cessation of bleeding after valve replacement.[21]

scleroderma

Gastrointestinal mucosal abnormalities, including gastric and/or small intestinal angiodysplasia and gastric and/or small intestinal telangiectasia, were reported in 52% of patients with systemic sclerosis in one study.[22]

cardiovascular disease

Cardiovascular disease is an important risk factor for the diagnosis of angiodysplasia.[23]

In one small cohort study, a significant association was found between hypertension and small bowel angiodysplasia.[24]

increasing age

One systematic review found that increasing age was a risk factor for the diagnosis of angiodysplasia during endoscopy.[23]

Two retrospective studies found that age greater than 80 years was an independent risk factor for symptomatic angiodysplasia of the colon.[25][26]

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