Angiodysplasia of the colon and small intestine

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Última revisão: 22 Jul 2025

Última atualização: 10 Jun 2025

Angiodysplasia is a vascular malformation of the gastrointestinal tract characterized by fragile blood vessels which have a propensity to bleed.

It is the second most common cause of lower gastrointestinal bleeding in patients ages >60 years.

Patients often complain of intermittent gastrointestinal bleeding without pain.

Lesions may be single or multiple and most commonly in the stomach, small bowel, or right colon.

Diagnosis is primarily by endoscopy.

Treatment is initially endoscopic coagulation; for severe cases, angiographic embolization and surgical resection may be required.

Rebleeding may occur in about 40% to 50% of patients with small bowel angiodysplasias.

Definição

Angiodysplasia is a vascular malformation of the gastrointestinal tract characterized by fragile blood vessels, which subsequently leads to gastrointestinal bleeding and anemia.

While some studies suggest the cecum and ascending colon as the most frequent locations of angiodysplasias, the advent of capsule endoscopy has revealed that the small bowel is also a common location.[1][2][3][4]

História e exame físico

Principais fatores diagnósticos

gastrointestinal bleeding

Detalhes completos

Outros fatores diagnósticos

age >60 years
shortness of breath
fatigue
pallor
tachycardia
hypotension

Detalhes completos

Fatores de risco

chronic renal failure/end-stage renal disease
von Willebrand disease
aortic stenosis
scleroderma
cardiovascular disease
increasing age

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

CBC
blood type and crossmatch
blood chemistry
coagulation status
esophagogastroduodenoscopy
push enteroscopy
colonoscopy

Detalhes completos

Investigações a serem consideradas

wireless capsule enteroscopy
CT angiography
selective mesenteric angiography
technetium Tc-99m radionuclide scan
CT enterography
device-assisted enteroscopy

Detalhes completos

Novos exames

magnetic resonance angiography

Algoritmo de tratamento

AGUDA

hemodynamically unstable (severe hemorrhage)

hemodynamically stable

CONTÍNUA

recurrent bleed

Colaboradores

Autores

Reena Sidhu, MD, FRCP

Consultant Gastroenterologist

Royal Hallamshire Hospital

Sheffield Teaching Hospitals NHS Foundation Trust

Hon Professor

Division of Clinical Medicine

School of Medicine and Population Health

University of Sheffield

Sheffield

Declarações

RS has received speaker fees and congress travel grants (Dr Falk 2021 & 2023). RS has attended ANx Robotica symposium 2023. RS is an author of a reference cited in this topic.

Nicoletta Nandi, MD

Clinical Fellow

Academic Unit of Gastroenterology

Sheffield Teaching Hospitals NHS Foundation Trust

Sheffield

Declarações

NN declares that she has no competing interests.

Agradecimentos

Prof Reena Sidhu and Dr Nicoletta Nandi would like to gratefully acknowledge Dr Aidan Shaw, Dr Heather Lee, and Dr William Speake, previous contributors to this topic.

Declarações

AS, HL, and WS declare that they have no competing interests.

Revisores

Brooks D. Cash, MD, AGAF, FACG, FACP, FASGE

BMJ Best Practice Gastroenterology expert panel member

Professor of Medicine

University of Texas Health Science Center at Houston

Houston

Declarações

BDC declares that he has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Gerson LB, Fidler JL, Cave DR, et al. ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol. 2015 Sep;110(9):1265-87; quiz 1288.Texto completo Resumo

Sengupta N, Kastenberg DM, Bruining DH, et al. The role of imaging for GI bleeding: ACG and SAR consensus recommendations. Radiology. 2024 Mar;310(3):e232298. Resumo

Triantafyllou K, Gkolfakis P, Gralnek IM, et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2021 Aug;53(8):850-68.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Diverticular disease
- Colorectal cancer
- Gastrointestinal stromal tumors and leiomyomas
Mais Diagnósticos diferenciais
Diretrizes
- The role of imaging for GI bleeding: ACG and SAR consensus recommendations
- Management of patients with acute lower gastrointestinal bleeding
Mais Diretrizes
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Angiodysplasia of the colon and small intestine

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

hemodynamically unstable (severe hemorrhage)

hemodynamically stable

recurrent bleed

Colaboradores

Autores

Reena Sidhu, MD, FRCP

Declarações

Nicoletta Nandi, MD

Declarações

Agradecimentos

Declarações

Revisores

Brooks D. Cash, MD, AGAF, FACG, FACP, FASGE

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

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