Risk factors for bleeding from gastrointestinal angiodysplasia: a case-control study in patients with bleeding and non-bleeding angiodysplasia

Abstract

Objectives Angiodysplasia (AD) is a common source of gastrointestinal bleeding. Yet, little is known about factors forwarding bleeding in these vascular malformations. The presented study aims to determine risk factors for bleeding that occurs only in patients with symptomatic, but not with asymptomatic, AD.

Methods Case-control study in patients with AD and either a positive or a negative history of gastrointestinal bleeding in Munich, Germany. Groups were compared by clinical, laboratory, and endoscopic features.

Results 80 patients with (58, f 31, med. age 72) or without bleeding AD (22, f 12, med. age 61) were included. Bleeding from AD was significantly associated with the total number of AD (OR 1.4 (95 % CI 1.1–1.7) p = 0.01) and closure time in PFA/collagen-epinephrine test (OR 1.0 (95 % CI 1.0–1.0) p < 0.01). The total number of AD correlated significantly with age (r = 0.36; p = 0.01). AD were mainly detected in the upper small intestine (> 30 %). Although patients with aortic stenosis suffered not significantly more frequently from bleeding from AD, they demonstrated a loss of high molecular multimers of VWF.

Conclusions The amount of AD is clearly correlated to the age of the patient. A higher number of ADs and inhibition of primary hemostasis increase the risk of bleeding.

Zusammenfasung

Hintergrund Angiodysplasien (AD) sind häufig Ursache von gastrointestinalen Blutungen. Wir wissen wenig über Risikofaktoren, die Blutungen aus diesen Gefäßmissbildungen begünstigen können. Die gegenwärtige Studie hatte zum Ziel, Faktoren zu bestimmen, die nur bei Patienten mit symptomatischen, nicht aber bei Patienten mit asymptomatischen AD eine Rolle spielen.

Methoden Fallkontrollstudie mit AD-Patienten entweder mit oder ohne Nachweis einer gastrointestinalen Blutung. Die beiden Gruppen wurden hinsichtlich klinischer, laborchemischer und endoskopischer Parameter verglichen.

Ergebnisse 80 Patienten mit blutenden (58, f 31, mitt. Alter 72) oder nicht blutenden AD (22, f 12, mitt. Alter 61) aus vier Krankenhäusern in München wurden eingeschlossen. Eine Blutung aus AD war signifikant mit der absoluten Zahl der AD (OR 1,4 (95 %-KI 1,1–1,7) P = 0,01) und der Verschlusszeit im PFA/Adrenalin-Test (OR 6,6 (95 %-KI 1,8–23,4) P = 0,004) assoziiert. Die absolute Zahl von AD korrelierte signifikant mit dem Alter (r = 0,369, P = 0,001). Die Mehrzahl der AD wurde im oberen Dünndarm (> 30 %) diagnostiziert. Obwohl Patienten mit Aortenstenose nicht signifikant häufiger aus AD bluteten, wiesen sie einen Verlust der hochmolekularen Multimere des Von-Willebrand-Faktors auf.

Schlussfolgerung Die Zahl der AD korreliert signifikant mit dem Alter der Patienten. Eine höhere Zahl von AD und eine Hemmung der primären Hämostase sind Hauptrisikofaktoren für eine mit AD assoziierte Blutung.

Key words

angiodysplasia - gastrointestinal bleeding - von Willebrand factor - capsule endoscopy - small intestine - primary hemostasis - Heyde’s syndrome

Schlüsselwörter

Angiodysplasien - gastrointestinale Blutung - Von-Willebrand-Faktor - Kapselendoskopie - Dünndarmblutung - Primäre Hämostase - Heyde-Syndrom

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