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April 24, 1995

Angiodysplasia and Lower Gastrointestinal Tract Bleeding in Elderly Patients

Author Affiliations

From the Section of Geriatric Medicine, Department of Medicine, The Cleveland (Ohio) Clinic Foundation. Dr Gorbien is now with the Section of General Internal Medicine, University of Chicago (Ill) Medical Center.

Arch Intern Med. 1995;155(8):807-812. doi:10.1001/archinte.1995.00430080037005

Angiodyplasia of the colon is one of the most common causes of major lower intestinal tract bleeding in the elderly; it occurs predominantly in the cecum and on the right side of the colon and is thought to result from degenerative changes associated with aging. The clinical presentation is varied, ranging from hematochezia or melena to iron-deficiency anemia resulting from long-term blood loss. Accurate diagnosis may require a combination of diagnostic techniques, such as angiography, nuclear scanning, and colonoscopy. The management plan should be individualized for each patient depending on severity, rate of rebleeding, and issues of comorbidity. Although conservative medical management is a reasonable option for many patients, endoscopic treatment has generally replaced surgery as the first line of definitive treatment for angiodysplasias in most of these patients. The risk of rebleeding is a considerable problem, and surgical therapy yields better results in this aspect. The role of hormonal therapy is not clearly established.

(Arch Intern Med. 1995;155:807-812)