Angiodysplasia of the colon and small intestine

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 24 Jul 2025

Last updated: 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.

Definition

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]

History and exam

Key diagnostic factors

gastrointestinal bleeding

Full details

Other diagnostic factors

age >60 years
shortness of breath
fatigue
pallor
tachycardia
hypotension

Full details

Risk factors

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

Full details

Diagnostic tests

1st tests to order

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

Full details

Tests to consider

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

Full details

Emerging tests

magnetic resonance angiography

Treatment algorithm

ACUTE

hemodynamically unstable (severe hemorrhage)

hemodynamically stable

ONGOING

recurrent bleed

Contributors

Authors

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

Disclosures

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

Disclosures

NN declares that she has no competing interests.

Acknowledgements

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.

Disclosures

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

Peer reviewers

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

Disclosures

BDC declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text Abstract

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. Abstract

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.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Diverticular disease
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Guidelines
- The role of imaging for GI bleeding: ACG and SAR consensus recommendations
- Management of patients with acute lower gastrointestinal bleeding
More Guidelines
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Angiodysplasia of the colon and small intestine

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Emerging tests

Treatment algorithm

hemodynamically unstable (severe hemorrhage)

hemodynamically stable

recurrent bleed

Contributors

Authors

Reena Sidhu, MD, FRCP

Disclosures

Nicoletta Nandi, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

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

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice