Small bowel lymphangiectasia and angiodysplasia: a positive association; novel clinical marker or shared pathophysiology?
BACKGROUND
Small bowel angiodysplasia accounts for 30 to 40% of cases of obscure gastrointestinal bleeding and is associated with significant morbidity and mortality. Identifying lesions can be difficult. Small bowel capsule endoscopy (SBCE) is a significant advance on earlier diagnostic techniques. The cause of angiodysplasia is unknown and the natural history poorly understood. Many lesions are thought to arise from a degenerative process associated with ageing, local vascular anomalies, and tissue hypoxia. Nonpathologic lymphangiectasias are commonly seen throughout the small bowel and are considered a normal finding.


OBJECTIVE
To determine whether there is an association between lymphangiectasias, angiodysplasia, and atherosclerosis related conditions.


METHODS
Relevant information was collected from a dedicated SBCE database. Logistic regression analysis was used to examine associations between angiodysplasia, lymphangiectasia, patient demographics, and comorbidity.


RESULTS
In all, 180 patients underwent SBCE during the study period, 46 (25%) had angiodysplasia and 47 (26%) lymphangiectasia. Lymphangiectasia were seen in 24 (52%) of 46 with angiodysplasia, in 16 (19%) of 84 with obscure gastrointestinal bleeding without angiodysplasia and in 7 (14%) of 50 without gastrointestinal bleeding. Logistic regression analysis confirmed a strong positive association between angiodysplasia and lymphangiectasia; odds ratio 4.42, P<0.003. Angiodysplasias were also associated with increasing age; odds ratio 1.1. There was no correlation with any other patient characteristic.


CONCLUSIONS
Lymphangiectasia are strongly associated with the presence of small intestinal angiodysplasia and may represent a useful clinical marker for this condition. Angiodysplasia are also associated with increasing age. Conditions associated with systemic atherosclerosis did not increase the risk of angiodysplasia.
Department of Gastroenterology, Aberdeen Royal Infirmary & University of Aberdeen, Aberdeen, Scotland.
Jonathan
J
Macdonald
Victoria
V
Porter
Neil W
NW
Scott
Deirdre
D
McNamara
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016888:Angiodysplasia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D050197:Atherosclerosis / Q000503:physiopathology*; D053704:Capsule Endoscopy / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000503:physiopathology; D016015:Logistic Models; D008201:Lymphangiectasis, Intestinal / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult