From the Guidelines
Angiodysplasia is commonly associated with systemic diseases such as hereditary hemorrhagic telangiectasia (HHT), chronic kidney disease, and aortic stenosis, and medical treatments including tranexamic acid, systemic bevacizumab, and hormonal therapy have shown efficacy in managing bleeding episodes. Three systemic diseases that cause angiodysplasia include:
- Hereditary hemorrhagic telangiectasia (HHT) 1
- Chronic kidney disease (particularly end-stage renal disease)
- Aortic stenosis (known as Heyde's syndrome) For medical management of angiodysplasia bleeding, three treatments supported by observational trials include:
- Tranexamic acid, which is recommended for patients with mild GI bleeding due to its low potential for harm 1
- Systemic bevacizumab, which is recommended for patients with moderate or severe GI bleeding, resulting in substantial improvements in mean hemoglobin and reduced red cell transfusion 1
- Hormonal therapy with estrogen-progesterone combinations, which enhances vascular integrity and improves coagulation factors, although its use has declined due to thromboembolic risks 1 The use of systemic bevacizumab is particularly notable, as it has shown substantial improvements in mean hemoglobin and reduced red cell transfusion in patients with moderate or severe GI bleeding 1. These treatments are typically reserved for patients with recurrent bleeding episodes not manageable by endoscopic intervention, which remains the first-line approach for acute bleeding from angiodysplasia.
From the Research
Systemic Diseases that Cause Angiodysplasia
- Hereditary hemorrhagic telangiectasia (HHT) 2, 3, 4, 5
- Aortic valve stenosis, which is associated with Heyde's syndrome 6
- Acquired von Willebrand disease, which is linked to aortic stenosis and angiodysplasia 6