Aortic Valve Stenosis, a Precipitating Factor of Recurrent Bleed in Colonic Angiodysplasia: A Literature Review.

Adejoke M Johnson,Praise E Chovwen,Anna Patel,Ezekiel J Akpan

doi:10.7759/cureus.15903

Adejoke M Johnson, Praise E Chovwen + Show 2 more

Open Access

https://doi.org/10.7759/cureus.15903

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Abstract

Angiodysplasia (also known as angioectasia) is a lesion characterized by abnormal, dilated small blood vessels in the mucosa and submucosal layers of the GI tract. With the estimated low incidence of active GI bleeding from these lesions, angiodysplasia can be challenging to diagnose. The presence of aortic stenosis has increased the recognition rate of angiodysplasia, especially in the elderly. Despite the associations between aortic stenosis and angiodysplasia (Heyde's syndrome) revealed in several studies, the etiology of Heyde syndrome is still debatable, which has led to the proposition of several hypotheses that are reviewed in this article. This activity will help review the meaning of Heyde's syndrome, epidemiology, proposed pathophysiology, diagnosis, and management by surveying articles published between 1955 and 2021 on PubMed. We used search terms such as "colonic angiodysplasia," "arteriovenous malformation," "Heyde syndrome," "refractory gastrointestinal bleed," "aortic valve stenosis," and "acquired von Willebrand disease." Findings revealed an association between aortic stenosis and lower gastrointestinal (GI) bleed.

Highlights

BackgroundAngiodysplasia, a common cause of gastrointestinal (GI) bleeding in the elderly, is the malformation of blood vessels in the GI tract
Despite the associations between aortic stenosis and angiodysplasia (Heyde's syndrome) revealed in several studies, the etiology of Heyde syndrome is still debatable, which has led to the proposition of several hypotheses that are reviewed in this article
We used search terms such as "colonic angiodysplasia," "arteriovenous malformation," "Heyde syndrome," "refractory gastrointestinal bleed," "aortic valve stenosis," and "acquired von Willebrand disease." Findings revealed an association between aortic stenosis and lower gastrointestinal (GI) bleed

Summary

Introduction

Angiodysplasia, a common cause of gastrointestinal (GI) bleeding in the elderly, is the malformation of blood vessels in the GI tract. Angiodysplasia is a common abnormality of blood vessels in the GI tract and the second leading cause of lower gastrointestinal bleeding in patients older than 60 years, with the first being diverticulosis [7]. A study revealed that T lymphocytes and the expression of the Interleukin-2 receptor were predominant in a stenosed aortic valve [17] This same inflammatory reaction is seen in angiodysplasia of the colon and could serve as a contributing factor. Extensive workup should be done in elderly patients presenting with any combination of aortic valve stenosis, gastrointestinal bleeding, or evidence suggestive of acquired Von-Willebrand syndrome. The effects of valve replacement have been described in the case of a 78-year-old female with diagnoses of minimal coronary artery disease, aortic stenosis, and resection of the sigmoid colon due to diverticulosis She had multiple episodes of lower intestinal bleeding and coffee-brown vomitus. Patients unable to undergo aortic valve replacement have a poorer prognosis due to recurrent gastrointestinal bleeding from angiodysplastic lesions with 95% of patients having recurrent episodes of bleeding [35]

Conclusions

Disclosures

Findings

Heyde EC