The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Analysis of risk factor and clinical characteristics of angiodysplasia presenting as upper gastrointestinal bleeding

  • Kim, Dae Bum (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Chung, Woo Chul (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Lee, Seok Jong (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Sung, Hea Jung (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Woo, Seokyung (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyo Suk (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Jeong, Yeon Oh (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Lee, Hyewon (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Yeon-Ji (Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
  • Received : 2015.03.31
  • Accepted : 2015.06.25
  • Published : 2016.07.01
⟨ Previous Next ⟩

Abstract

Background/Aims: Angiodysplasia is important in the differential diagnosis of upper gastrointestinal bleeding (UGIB), but the clinical features and outcomes associated with UGIB from angiodysplasia have not been characterized. We aimed to analyze the clinical characteristics and outcomes of angiodysplasia presented as UGIB. Methods: Between January 2004 and December 2013, a consecutive series of patients admitted with UGIB were retrospectively analyzed. Thirty-five patients with bleeding from angiodysplasia were enrolled. We compared them with an asymptomatic control group (incidental finding of angiodysplasia in health screening, n = 58) and bleeding control group (simultaneous finding of angiodysplasia and peptic ulcer bleeding, n = 28). Results: When patients with UGIB from angiodysplasia were compared with the asymptomatic control group, more frequent rates of nonantral location and large sized lesion (${\geq}1cm$) were evident in multivariate analysis. When these patients were compared with the bleeding control group, they were older (mean age: $67.94{\pm}9.16years$ vs.$55.07{\pm}13.29years$, p = 0.03) and received less transfusions (p = 0.03). They also had more frequent rate of recurrence (40.0% vs. 20.7%, p = 0.02). Conclusions: Non-antral location and large lesions (${\geq}1cm$) could be risk factors of UGIB of angiodysplasia. UGIB due to angiodysplasia was more common in older patients. Transfusion requirement would be less and a tendency of clinical recurrence might be apparent.

Keywords

References

  1. Gunnlaugsson O. Angiodysplasia of the stomach and duodenum. Gastrointest Endosc 1985;31:251-254. https://doi.org/10.1016/S0016-5107(85)72174-8
  2. Moreto M, Figa M, Ojembarrena E, Zaballa M. Vascular malformations of the stomach and duodenum: an endoscopic classification. Endoscopy 1986;18:227-229. https://doi.org/10.1055/s-2007-1018385
  3. Clouse RE, Costigan DJ, Mills BA, Zuckerman GR. Angiodysplasia as a cause of upper gastrointestinal bleeding. Arch Intern Med 1985;145:458-461. https://doi.org/10.1001/archinte.1985.00360030098019
  4. Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol 1993;88:807-818.
  5. Fan GW, Chen TH, Lin WP, et al. Angiodysplasia and bleeding in the small intestine treated by balloon-assisted enteroscopy. J Dig Dis 2013;14:113-116. https://doi.org/10.1111/1751-2980.12021
  6. Athanasoulis CA, Galdabini JJ, Waltman AC, Novelline RA, Greenfield AJ, Ezpeleta ML. Angiodysplasia of the colon: a cause of rectal bleeding. Cardiovasc Radiol 1977-1978;1:3-13. https://doi.org/10.1007/BF02551967
  7. Hoog CM, Brostrom O, Lindahl TL, Hillarp A, Larfars G, Sjoqvist U. Bleeding from gastrointestinal angioectasias is not related to bleeding disorders: a case control study. BMC Gastroenterol 2010;10:113. https://doi.org/10.1186/1471-230X-10-113
  8. Navab F, Masters P, Subramani R, Ortego TJ, Thompson CH. Angiodysplasia in patients with renal insufficiency. Am J Gastroenterol 1989;84:1297-1301.
  9. Chalasani N, Cotsonis G, Wilcox CM. Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. Am J Gastroenterol 1996;91:2329-2332.
  10. Sami SS, Al-Araji SA, Ragunath K. Review article: gastrointestinal angiodysplasia: pathogenesis, diagnosis and management. Aliment Pharmacol Ther 2014;39:15-34. https://doi.org/10.1111/apt.12527
  11. Weaver GA, Alpern HD, Davis JS, Ramsey WH, Reichelderfer M. Gastrointestinal angiodysplasia associated with aortic valve disease: part of a spectrum of angiodysplasia of the gut. Gastroenterology 1979;77:1-11.
  12. Cunningham JT. Gastric telangiectasias in chronic hemodialysis patients: a report of six cases. Gastroenterology 1981;81:1131-1133.
  13. Chalasani N, Cotsonis G, Wilcox CM. Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. Am J Gastroenterol 1996;91:2329-2332.
  14. Gilmore PR. Angiodysplasia of the upper gastrointestinal tract. J Clin Gastroenterol 1988;10:386-394. https://doi.org/10.1097/00004836-198808000-00009
  15. Dodda G, Trotman BW. Gastrointestinal angiodysplasia. J Assoc Acad Minor Phys 1997;8:16-19.
  16. Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon: degenerative lesions of aging. Gastroenterology 1977;72(4 Pt 1):650-660.
  17. Saperas E, Videla S, Dot J, et al. Risk factors for recurrence of acute gastrointestinal bleeding from angiodysplasia. Eur J Gastroenterol Hepatol 2009;21:1333-1339. https://doi.org/10.1097/MEG.0b013e32830e491c
  18. Moake JL, Turner NA, Stathopoulos NA, Nolasco LH, Hellums JD. Involvement of large plasma von Willebrand factor (vWF) multimers and unusually large vWF forms derived from endothelial cells in shear stress-induced platelet aggregation. J Clin Invest 1986;78:1456-1461. https://doi.org/10.1172/JCI112736
  19. White CM, Poxon V, Alexander-Williams J. A study of motility of normal human gastroduodenal region. Dig Dis Sci 1981;26:609-617. https://doi.org/10.1007/BF01367673
  20. Junquera F, Saperas E, de Torres I, Vidal MT, Malagelada JR. Increased expression of angiogenic factors in human colonic angiodysplasia. Am J Gastroenterol 1999;94:1070-1076. https://doi.org/10.1111/j.1572-0241.1999.01017.x
  21. Klagsbrun M, D'Amore PA. Vascular endothelial growth factor and its receptors. Cytokine Growth Factor Rev 1996;7:259-270. https://doi.org/10.1016/S1359-6101(96)00027-5
  22. Huang YF, Yang CH, Huang CC, Tai MH, Hsu KS. Pharmacological and genetic accumulation of hypoxia-inducible factor-1alpha enhances excitatory synaptic transmission in hippocampal neurons through the production of vascular endothelial growth factor. J Neurosci 2010;30:6080-6093. https://doi.org/10.1523/JNEUROSCI.5493-09.2010
  23. Seghezzi G, Patel S, Ren CJ, et al. Fibroblast growth factor-2 (FGF-2) induces vascular endothelial growth factor (VEGF) expression in the endothelial cells of forming capillaries: an autocrine mechanism contributing to angiogenesis. J Cell Biol 1998;141:1659-1673. https://doi.org/10.1083/jcb.141.7.1659
  24. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001;414:813-820. https://doi.org/10.1038/414813a
  25. Suh SW, Gum ET, Hamby AM, Chan PH, Swanson RA. Hypoglycemic neuronal death is triggered by glucose reperfusion and activation of neuronal NADPH oxidase. J Clin Invest 2007;117:910-918. https://doi.org/10.1172/JCI30077
  26. Gupte SA, Levine RJ, Gupte RS, et al. Glucose-6-phosphate dehydrogenase-derived NADPH fuels superoxide production in the failing heart. J Mol Cell Cardiol 2006;41:340-349. https://doi.org/10.1016/j.yjmcc.2006.05.003
  27. Decoursey TE, Ligeti E. Regulation and termination of NADPH oxidase activity. Cell Mol Life Sci 2005;62:2173-2193. https://doi.org/10.1007/s00018-005-5177-1
  28. Jackson CS, Gerson LB. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am J Gastroenterol 2014;109:474-483. https://doi.org/10.1038/ajg.2014.19

Cited by

  1. An overview of angiodysplasia: management and patient prospects vol.12, pp.9, 2018, https://doi.org/10.1080/17474124.2018.1503532
  2. Non-variceal upper gastrointestinal bleeding vol.4, pp.1, 2018, https://doi.org/10.1038/nrdp.2018.20
  3. Recurrence of Multiple Gastrointestinal Angioectasias Despite Treatment with Argon Plasma Coagulation Requiring Thalidomide Treatment in a Patient with Cirrhosis: A Rare Case Report vol.11, pp.3, 2016, https://doi.org/10.7759/cureus.4196
  4. A Risk Assessment of Factors for the Presence of Angiodysplasias During Endoscopy and Factors Contributing to Symptomatic Bleeding and Rebleeds vol.64, pp.10, 2016, https://doi.org/10.1007/s10620-019-05683-7
  5. Secondary angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease: Results from the nationwide inpatient sample vol.11, pp.10, 2019, https://doi.org/10.4253/wjge.v11.i10.504
  6. Thalidomide for the treatment of angiodysplasia‐related recurrent gastrointestinal hemorrhage: Is low dose a safe and viable option? vol.7, pp.12, 2016, https://doi.org/10.1002/ccr3.2501
  7. Benefit of Capsule Endoscopy in the Setting of Iron Deficiency Anemia in Patients Above Age 65 vol.3, pp.1, 2020, https://doi.org/10.1093/jcag/gwy058