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

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 ADand 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 ADwas 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 ADcorrelated significantly with age (r=0.36; p=0.01). ADwere 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 ADis clearly correlated to the age of the patient. A higher number of ADs and inhibition of primary hemostasis increase the risk of bleeding.