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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2016  |  Volume : 27  |  Issue : 4  |  Page : 748-751
Gastrointestinal bleeding due to angiodysplasia in patients on hemodialysis: A single-center study


1 Department of Nephrology-Dialysis, Military Hospital Mohammed V, Rabat, Morocco
2 Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco

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Date of Web Publication5-Jul-2016
 

   Abstract 

Gastrointestinal (GI) bleeding due to angiodysplastic lesions is a common problem among patients receiving hemodialysis (HD). We studied 22 HD patients (5 females and 17 males) who had GI bleeding due to angiodysplasia; the mean age of whom was 54 ± 10 years. All patients had upper and lower GI endoscopy. The most common site for the lesion was the right colon in seven cases (31.8%), followed by stomach in 4 cases (18.1%). In eight (36.3%) patients, there were multiple lesions located in the stomach, duodenum, and the right colon. All patients were treated with coagulation; with argon plasma in 14 (63.6%) patients, bipolar coagulation in five (22.7%) patients, and hot clip in three (13.6%) patients. One patient who presented with persistent bleeding despite endoscopic therapy was well-benefited of a complementary treatment, thalidomide. Hemostasis was obtained in all patients after an average of 6.8 sessions of endoscopic coagulation procedure. We conclude that angiodysplasia is a frequent cause of hemorrhage in chronic renal failure that can be managed in most patients by argon plasma and bipolar coagulation.

How to cite this article:
Zajjari Y, Tamzaourte M, Montasser D, Hassani K, Aatif T, El Kabbaj D, Benyahia M. Gastrointestinal bleeding due to angiodysplasia in patients on hemodialysis: A single-center study. Saudi J Kidney Dis Transpl 2016;27:748-51

How to cite this URL:
Zajjari Y, Tamzaourte M, Montasser D, Hassani K, Aatif T, El Kabbaj D, Benyahia M. Gastrointestinal bleeding due to angiodysplasia in patients on hemodialysis: A single-center study. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2021 Oct 18];27:748-51. Available from: https://www.sjkdt.org/text.asp?2016/27/4/748/185237

   Introduction Top


Gastrointestinal (GI) bleeding due to angiodysplastic lesions is a common problem in patients receiving chronic hemodialysis (HD). [1],[2],[3] Association of chronic renal failure with angiodysplasia was first reported in 1981. [4]

Angiodysplasias are intestinal vascular malformations, red, flat, or slightly elevated on the mucus lining with a diameter between two and 10 mm. Prevalence of angiodysplasia as a cause of hemorrhage in chronic renal failure ranges from 19% to 32% compared to 5% in individuals with normal renal function. [5],[6] Many studies have confirmed this association and indicated that telangiectasia is a common cause of initial and recurrent upper GI bleeding in HD patients.

We aimed in this study to present our experience in chronic renal failure patients on HD who had GI bleeding due to angiodysplasia.


   Patients and Methods Top


We retrospectively studied the clinical course of our chronic HD patients with GI bleeding due to angiodysplasia. We included all patients who were diagnosed with GI bleeding due to angiodysplasia by means of endoscopy at our department from January 2009 to December 2013 in the study.

All the patients had similar clinical presentation: GI bleeding as hematemesis and melena with severe anemia that, in all cases, had required repeated blood transfusions. These patients were followed up for 12 months.

The continuous variables were expressed as the mean and standard deviation and the categorical variables were expressed as relative frequency.


   Results Top


There were 22 HD patients [17 (77.3%)] males and five [22.7% (females)] with a mean age of 54 ± 10 years with a range of 40-66 years. Etiology of renal failure and duration of dialysis are shown in [Table 1].
Table 1: Characteristics of the study patients.

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Five patients were on antiplatelet agents for ischemic heart disease, and therapy was continued regardless of the severity of the pathology.

The clinical presentation, biochemical markers, and need of blood transfusions are shown in [Table 2].
Table 2: The clinical presentation, biochemical markers, and need of blood transfusions

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[Table 3] shows the region in which the endoscopic alterations were found. The most common site for the lesion was the right colon in seven (31.8%) cases, followed by stomach in four (18.1%) cases. In eight (36.3%) patients, there were multiple lesions located in the stomach, duodenum, and the right colon. [Figure 1] and [Figure 2] show single angiodysplasia in duodenum and cecum.
Figure 1: Single angiodysplasia in duodenum revealed by endoscopy.

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Figure 2: Single angiodysplasia in cecum revealed by endoscopy

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Table 3: Endoscopic findings of the angiodysplasia.

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All the patients received treatment with coagulation of the lesions; coagulation with argon plasma was used in 14 (63.6%) patients, coagulation with bipolar coagulation was used successfully in five (22.7%) patients, and with hot clip in three (13.6%) patients. One patient who presented with persistent bleeding despite endoscopic therapy was well-benefited from a complementary treatment with thalidomide.

Hemostasis was obtained in all patients after an average of 6.8 sessions of endoscopic coagulation procedure. One case of colonic perforation was encountered in our study, and it was successfully treated with surgery.


   Discussion Top


In the present study, we present our experience in HD patients who had GI bleeding due to angiodysplasia. Angiodysplastic lesions in the general population are usually detected in patients older than 60 years, while they may be detected at a younger age in patients with chronic kidney disease. [7],[8] In our study, the mean age was 54 ± 10 years.

Clinical presentation of angiodysplasia may include unexplained iron deficiency, anemia, hemoccult positive stool, and melena. Hemorrhage is usually painless, ceases spontaneously in at least 90% of the cases, and recurs in 25-47% of them. [9] In our study, 45.4% of the patients developed melena, 27.2% developed occult anemia (anemia without evident GI hemorrhage), 18.1% developed rectal bleeding, and 9.1% developed hematemesis and melena.

Colonoscopy is an effective means of diagnosis of angiodysplasia, which is frequently located in the right colon. Multiple locations of angiodysplasia are frequently observed; [5],[10],[11] the most frequent location was the right colon (31.8%), and multiple locations (stomach, duodenum, and the right colon) were observed in 36.3% of the patients in our study.

In patients with active hemorrhage, endoscopic coagulation therapy is generally the initial form of treatment. Argon plasma and bipolar coagulation were used successfully in the treatment of angiodysplasia with a low complication rate. [1],[12] Endoscopy treatment with argon plasma coagulation was successfully used in 63.6% of the patients, coagulation with bipolar coagulation in 22.7% of the patients, and hot clip in 13.6% of the patients in our study.

Thalidomide is an effective and safe treatment for patients with refractory bleeding from GI vascular malformations. Mechanisms of its action activity are related to a vascular endothelial growth factor. [13] One patient who presented with persistent bleeding despite endoscopic therapy was well-benefited from thalidomide 100 mg daily for four months.


   Conclusion Top


We conclude that our study demonstrated our experience with angiodysplasia as a frequent cause of hemorrhage in chronic renal failure patients. The most frequent location was in the right colon, and cure could be achieved by endoscopic argon plasma coagulation and bipolar coagulation.

Conflict of interest: None declared.

 
   References Top

1.
Galanopoulos G. Angiodysplastic lesions as a cause of colonic bleeding in patients with chronic renal disease: Is there an association? Saudi J Kidney Dis Transpl 2012;23:925-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Etemad B. Gastrointestinal complications of renal failure. Gastroenterol Clin North Am 1998;27:875-92.  Back to cited text no. 2
[PUBMED]    
3.
Kang JY. The gastrointestinal tract in uremia. Dig Dis Sci 1993;38:257-68.  Back to cited text no. 3
[PUBMED]    
4.
Cunningham JT. Gastric telangiectasias in chronic hemodialysis patients: A report of six cases. Gastroenterology 1981;81:1131-3.  Back to cited text no. 4
[PUBMED]    
5.
Kaaroud H, Fatma LB, Beji S, et al. Gastrointestinal angiodysplasia in chronic renal failure. Saudi J Kidney Dis Transpl 2008;19:809-12.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol 1993;88:807-18.  Back to cited text no. 6
[PUBMED]    
7.
Dodda G, Trotman BW. Gastrointestinal angiodysplasia. J Assoc Acad Minor Phys 1997;8:16-9.  Back to cited text no. 7
[PUBMED]    
8.
Jesudason SR, Devasia A, Mathen VI, Bhaktaviziam A, Khanduri P. The pattern of angiodysplasia of the gastrointestinal tract in a tropical country. Surg Gynecol Obstet 1985;161:525-31.  Back to cited text no. 8
[PUBMED]    
9.
Poralla T. Angiodysplasia in the renal patient: How to diagnose and how to treat? Nephrol Dial Transplant 1998;13:2188-91.  Back to cited text no. 9
[PUBMED]    
10.
Dave PB, Romeu J, Antonelli A, Eiser AR. Gastrointestinal telangiectasias. A source of bleeding in patients receiving hemodialysis. Arch Intern Med 1984;144:1781-3.  Back to cited text no. 10
[PUBMED]    
11.
Bronner MH, Pate MB, Cunningham JT, Marsh WH. Estrogen-progesterone therapy for bleeding gastrointestinal telangiectasias in chronic renal failure. An uncontrolled trial. Ann Intern Med 1986;105:371-4.  Back to cited text no. 11
[PUBMED]    
12.
Manzanera MJ, Gutiérrez E, Domínguez-Gil B, García JA, González E, Praga M. Digestive haemorrhage due to angiodysplasia in dialysis patients. Treatment with conjugated estrogens. Nefrologia 2005;25:412-5.  Back to cited text no. 12
    
13.
Ge ZZ, Chen HM, Gao YJ, et al. Efficacy of thalidomide for refractory gastrointestinal bleeding from vascular malformation. Gastroenterology 2011;141:1629-37.  Back to cited text no. 13
[PUBMED]    

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Correspondence Address:
Yassir Zajjari
Department of Nephrology-Dialysis, Military Hospital Mohammed V, Rabat
Morocco
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DOI: 10.4103/1319-2442.185237

PMID: 27424692

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