Goal of angioectasia treatment is to control the bleeding

DEAR DR. ROACH: I am 40 years old and have been diagnosed with angioectasia of the gastrointestinal tract.

From my readings, it seems this is a problem in the elderly. What can I expect with this disease, and what is my prognosis? — E.C.

ANSWER: The word “angioectasia” is from Greek roots, meaning “dilated blood vessel.” This condition is more commonly called angiodysplasia (meaning abnormal growth of blood vessels). It is unclear why these occur more often in the elderly; however, they occur most frequently in the gastrointestinal tract — especially the colon, but also the small intestine and, less frequently, the stomach.

They cause problems most often by bleeding, which is a problem in itself, but it also may lead to many prolonged searches for other causes of bleeding, especially colon cancer.

Angiodysplasia can occur by itself or in association with other medical conditions. One I always look for is aortic stenosis, which can be found by physical exam. Another is von Willebrand’s disease, a common but often-undiagnosed bleeding problem. These would be worth considering, especially in a younger person.

The most common location for angiodysplasia to be found in the GI tract is the colon, usually during a colonoscopy.

They can be treated immediately upon discovery, by using electricity or other means (laser, injection, ionized gas) to damage the blood vessels to stop bleeding (called cautery).

The goal of treatment in angiodysplasia is to slow down or eliminate the bleeding. Iron may be necessary to treat anemia. People with prolonged bleeding may need additional therapies, including medications (estrogens and octreotide in particular), and surgery in a few cases.

Prognosis is highly variable, but only very seldom have I seen people with angiodysplasia of the GI tract that hasn’t been wellcontrolled.

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