title: High variation in treatment strategies for gastrointestinal angiodysplasias.
abstract: OBJECTIVE
  Angiodysplasias (ADs) are the second leading cause of gastrointestinal bleeding in the elderly. The impact extends from no symptoms to chronic anaemia. Treatment guidelines are lacking. The aim of this study was to assess the current practice of gastrointestinal ADs and explore possible new research areas. On the basis of existing evidence, we would like to propose a treatment algorithm.
  
  
  METHODS
  We administered a 19-item web-based survey to gastroenterologists in the Netherlands between February and April of 2015.
  
  
  RESULTS
  A total of 111 (response rate 28%) gastroenterologists completed the survey (mean age=47 years; 24% women). The respondents identified Von Willebrand disease (17%), chronic kidney disease (21%) and aortic stenosis (77%) as risk factors for the development of ADs. Colonoscopy (54%) and esophagogastroduodenoscopy (43%) were the preferred first tools to screen for ADs. The favoured (77%) first treatment option is endoscopic argon plasma coagulation, whereas 20% start iron supplementation or blood transfusions. Treatment strategy is mostly (65%) based on the location of the ADs. Small bowel ADs are considered the most difficult to treat, because of the need for balloon enteroscopy. Of the gastroenterologists, 13% would treat ADs as a coincident finding during endoscopy. Medical therapy is mostly started in refractory ADs, and thalidomide (40%) is preferred over octreotide (19%). Thalidomide is more preferred by gastroenterologists working in a teaching hospital.
  
  
  CONCLUSIONS
  Identification of risk factors and treatment of ADs vary widely between gastroenterologists in the Netherlands. Further research is needed to create an evidence-based guideline and thereby optimize the management of symptomatic ADs.
authors.affiliation: Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Karina V
authors.initials: KV
authors.lastname: Grooteman
authors.forename: Erwin J M
authors.initials: EJ
authors.lastname: van Geenen
authors.forename: Joost P H
authors.initials: JP
authors.lastname: Drenth
mesh_terms: D000328:Adult; D000465:Algorithms; D016888:Angiodysplasia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D019091:Critical Pathways / Q000639:trends; D019317:Evidence-Based Medicine / Q000639:trends; D005260:Female; D000072102:Gastroenterologists / Q000639:trends*; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012307:Risk Factors