Nottingham Digestive Diseases Centre & NIHR Biomedical research Unit, Queens Medical Centre, Nottingham, UK.
Aliment Pharmacol Ther. 2014 Jan;39(1):15-34. doi: 10.1111/apt.12527. Epub 2013 Oct 20.
Angiodysplasia (AD) of the gastrointestinal (GI) tract is an important condition that can cause significant morbidity and -rarely - mortality.
To provide an up-to-date comprehensive summary of the literature evaluating this disease entity with a particular focus on pathogenesis as well as current and emerging diagnostic and therapeutic modalities. Recommendations for treatment will be made on the basis of the current available evidence and consensus opinion of the authors.
A systematic literature search was performed. The search strategy used the keywords 'angiodysplasia' or 'arteriovenous malformation' or 'angioectasia' or 'vascular ectasia' or 'vascular lesions' or 'vascular abnormalities' or 'vascular malformations' in the title or abstract.
Most AD lesions (54-81.9%) are detected in the caecum and ascending colon. They may develop secondary to chronic low-grade intermittent obstruction of submucosal veins coupled with increased vascular endothelial growth factor-dependent proliferation. Endotherapy with argon plasma coagulation resolves bleeding in 85% of patients with colonic AD. In patients who fail (or are not suitable for) other interventions, treatment with thalidomide or octreotide can lead to a clinically meaningful response in 71.4% and 77% of patients respectively.
Angiodysplasia is a rare, but important, cause of both overt and occult GI bleeding especially in the older patients. Advances in endoscopic imaging and therapeutic techniques have led to improved outcomes in these patients. The choice of treatment should be decided on a patient-by-patient basis. Further research is required to better understand the pathogenesis and identify potential therapeutic targets.
胃肠道（GI）的血管发育不良（AD）是一种重要的疾病，可导致严重的发病率，并且在极少数情况下可导致死亡率。
提供有关该疾病实体的最新综合文献综述，重点是发病机制以及当前和新兴的诊断和治疗方法。将根据现有证据和作者的共识意见提出治疗建议。
进行了系统的文献检索。该搜索策略在标题或摘要中使用了关键字“血管发育不良”或“动静脉畸形”或“血管扩张”或“血管扩张”或“血管病变”或“血管异常”或“血管畸形”。
大多数 AD 病变（54-81.9％）在盲肠和升结肠中检测到。它们可能继发于黏膜下静脉的慢性低度间歇性阻塞，伴有血管内皮生长因子依赖性增殖增加。氩等离子凝固的内镜治疗可使 85％的结肠 AD 患者的出血得到缓解。对于那些对其他干预措施无效（或不适合）的患者，沙利度胺或奥曲肽的治疗可使 71.4％和 77％的患者分别获得有临床意义的反应。
血管发育不良是一种罕见但重要的显性和隐性胃肠道出血的原因，尤其是在老年患者中。内镜成像和治疗技术的进步使这些患者的预后得到改善。应根据患者的具体情况选择治疗方法。需要进一步研究以更好地了解发病机制并确定潜在的治疗靶点。
