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Spatial clustering of simultaneous nonhereditary gastrointestinal angiodysplasia

Small but significant correlation between nonhereditary colonic and upper gastrointestinal angiodysplasia

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Abstract

Simultaneous nonhereditary colonic and upper gastrointestinal angiodysplasia were spatially clustered in an endoscopic study of 46 consecutive patients. For example, clustering of colonic angiodysplasia was demonstrated using a nonparametric test of clustering (Kruskal-Wallis statistic with 29 degrees of freedom=76.2,P<0.0005), and a parametric test of clustering (F test statistic with 29 and 101 degrees of freedom=6.91,P<0.0005). In accord with spatial clustering, only two of 13 patients (15%) with colonic angiodysplasia who underwent panendoscopy had upper gastrointestinal angiodysplasia. Two of nine patients (22%) with upper gastrointestinal angiodysplasia who underwent colonoscopy had colonic angiodysplasia. These findings suggest that local factors may be important in the pathogenesis of simultaneous nonhereditary angiodysplasia. Possible local factors include intermittent venous obstruction, increased intraluminal pressure, intermittent abnormal arterial flow, and local vascular degeneration. Due to the approximately 20% correlation between upper and lower nonhereditary gastrointestinal angiodysplasia, the upper and lower tract should be examined by endoscopy prior to elective local resection for bleeding from gastrointestinal angiodysplasia.

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References

  1. Bronner MH, Pate MB, Cunningham JT, Marsh WH: Estrogen-progesterone therapy for bleeding gastrointestinal telangiectasias in chronic renal failure. Ann Intern Med 105:371–374, 1986

    Google Scholar 

  2. Cappell MS, Lebwohl O: Cessation of recurrent bleeding from gastrointestinal angiodysplasias after aortic valve replacement. Ann Intern Med 105:54–57, 1986

    Google Scholar 

  3. Weaver GA, Alpern HD, Davis JS, Ramsay WH, Reichelderfer M: Gastrointestinal angiodysplasia associated with aortic valve disease: Part of a spectrum of angiodysplasia of the gut. Gastroenterology 77:1–11, 1979

    Google Scholar 

  4. Zuckerman GR, Cornette GL, Clouse RE, Harter HR: Upper gastrointestinal bleeding in patients with chronic renal failure. Ann Intern Med 102:588–592, 1985

    Google Scholar 

  5. Richter JM, Christensen MR, Colditz GA, Nishioka NS: Angiodysplasia: Natural history and efficacy of therapeutic interventions. Dig Dis Sci 34:1542–1546, 1989

    Google Scholar 

  6. Howard OM, Buchanan JD, Hunt RH: Angiodysplasia of the colon: Experience of 26 cases. Lancet 2:16–19, 1982

    Google Scholar 

  7. Aassar OS, Friedman CM, White RI Jr: The natural history of epistaxis in hereditary hemorrhagic telangiectasia. Laryngoscope 101:977–980, 1991

    Google Scholar 

  8. Cappell MS, Forde KA: Spatial clustering of multiple hyperplastic, adenomatous and malignant colonic polyps in individual patients. Dis Colon Rectum 32:641–652, 1989

    Google Scholar 

  9. Cappell MS: Profound spatial clustering of polyps in individuals with multiple nonmalignant polyps of the stomach and duodenal bulb: A combined endoscopic and radiographic study. Am J Gastroenterol 85:953–958, 1990

    Google Scholar 

  10. Cappell MS: Profound spatial clustering of simultaneous peptic ulcers. Gut 30:1329–1333, 1989

    Google Scholar 

  11. Ostle B, Malone LC: Statistics in Research: Basic Concepts and Techniques for Research Workers, 4th ed. Ames, Iowa, Iowa University Press, 1988, pp 176–203

    Google Scholar 

  12. Baum S, Athanasoulis CA, Waltman AC, Galdabini J, Schapiro RH, Warshaw AL, Ottinger LW: Angiodysplasia of the right colon: A cause of gastrointestinal bleeding. Am J Roentgenol 129:789–794, 1977

    Google Scholar 

  13. Meyer CT, Troncale FJ, Galloway S, Sheahan DG: Arteriovenous malformations of the bowel: An analysis of 22 cases and review of the literature. Medicine 60:36–47, 1981

    Google Scholar 

  14. Richter JM, Hedberg SE, Athanasoulis CA, Schapiro RH: Angiodysplasia: Clinical presentation and colonoscopic diagnosis. Dig Dis Sci 29:481–485, 1984

    Google Scholar 

  15. Santos JCM Jr, Aprilli F, Guimaraes AS, Rocha JJR: Angiodysplasia of the colon: Endoscopic diagnosis and treatment. Br J Surg 75:256–258, 1988

    Google Scholar 

  16. Gilliam JH III, Geisinger KR, Wu WC, Weidner N, Richter JE: Endoscopic biopsy is diagnostic in gastric antral vascular ectasia. Dig Dis Sci 34:885–888, 1989

    Google Scholar 

  17. Gostout CJ, Ahlquist DA, Radford CM, Viggiano TR, Bowyer BA, Balm RK: Endoscopic laser therapy for watermelon stomach. Gastroenterology 96:1462–1465, 1989

    Google Scholar 

  18. Kruger R, Ryan ME, Dickson KB, Nunez JF: Diffuse vascular ectasia of the gastric antrum. Am J Gastroenterol 82:421–426, 1987

    Google Scholar 

  19. Blackstone MO: Endoscopic Interpretation: Normal and Pathologic Appearances of the Gastrointestinal Tract. New York, Raven Press, 1984, p 523

    Google Scholar 

  20. Boley SJ, Sammartano R, Brandt LJ, Sprayregen S: Vascular ectasias of the colon. Surg Gynecol Obstet 149:353–359, 1979

    Google Scholar 

  21. Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S: On the nature and etiology of vascular ectasias of the colon. Gastroenterology 72:650–660, 1977

    Google Scholar 

  22. Richtmeier W, Weaver G, Strech W, Jacobson H, Dewell R, Olson J: Estrogen and progesterone receptors in hereditary hemorrhagic telangiectasia. Otolaryngol Head Neck Surg 92:564–570, 1984

    Google Scholar 

  23. van Cutsem E, Rutgeerts P, Vantrappen G: Treatment of bleeding gastrointestinal vascular malformations with oestrogen-progesterone. Lancet 335:953–955, 1990

    Google Scholar 

  24. Bank S, Aftalion B, Anfang C, Altman H, Wise L: Acquired angiodysplasia as a cause of gastric hemorrhage: A possible consequence of cholesterol embolization. Am J Gastroenterol 78:206–209, 1983

    Google Scholar 

  25. Bird RM, Jaques WE: Vascular lesions of hereditary hemorrhagic telangiectasia. N Engl J Med 260:597–599, 1959

    Google Scholar 

  26. Gottlieb AJ. Hereditary hemorrhagic telangiectasia.In Hematology, 3rd ed. WJ Williams, E Beutler, AJ Erslev, MA Lichtman (eds). New York, McGraw-Hill, 1983, pp 1378–1380

    Google Scholar 

  27. Horne MK III: Hereditary hemorrhagic telangiectasia.In Textbook of Internal Medicine. WN Kelley (ed). Philadelphia, JB Lippincott 1988, pp 1415–1416

    Google Scholar 

  28. Williams RC: Aortic stenosis and unexplained gastrointestinal bleeding. Arch Intern Med 108:859–863, 1961

    Google Scholar 

  29. Cynamon HA, Milov DE, Andres JM: Multiple telangiectasias of the colon in childhood. J Pediatr 112:928–930, 1988

    Google Scholar 

  30. Mayer IE, Hersh T: Endoscopic diagnosis of hereditary hemorrhagic telangiectasia. J Clin Gastroenterol 3:361–365, 1981

    Google Scholar 

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Cappell, M.S. Spatial clustering of simultaneous nonhereditary gastrointestinal angiodysplasia. Digest Dis Sci 37, 1072–1077 (1992). https://doi.org/10.1007/BF01300289

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  • DOI: https://doi.org/10.1007/BF01300289

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