Doc: Angioectasia treatment’s goal to control bleeding
Dear Dr. Roach: I am 40 years old and have been diagnosed with angioectasia of the gastrointestinal tract. From my readings, it seems this is a problem in the elderly. What can I expect with this disease, and what is my prognosis?
Dear E.C.: The word “angioectasia” is from Greek roots, meaning “dilated blood vessel.” This condition is more commonly called angiodysplasia (meaning abnormal growth of blood vessels). It is unclear why these occur more often in the elderly; however, they occur most frequently in the gastrointestinal tract — especially the colon, but also the small intestine and, less frequently, the stomach. They cause problems most often by bleeding, which is a problem in itself, but it also may lead to many prolonged searches for other causes of bleeding, especially colon cancer.
Angiodysplasia can occur by itself or in association with other medical conditions. One I always look for is aortic stenosis, which can be found by physical exam. Another is von Willebrand’s disease, a common but often-undiagnosed bleeding problem. These would be worth considering, especially in a younger person.
The most common location for angiodysplasia to be found in the GI tract is the colon, usually during a colonoscopy. They can be treated immediately upon discovery, by using electricity or other means (laser, injection, ionized gas) to damage the blood vessels to stop bleeding (called cautery). The goal of treatment in angiodysplasia is to slow down or eliminate the bleeding. Iron may be necessary to treat anemia. People with prolonged bleeding may need additional therapies, including medications (estrogens and octreotide in particular), and surgery in a few cases.
Prognosis is highly variable, but only very seldom have I seen people with angiodysplasia of the GI tract that hasn’t been well-controlled.
Dear Dr. Roach: I had a blood transfusion in 2000. Would the fact that someone else’s blood was used affect the results of a DNA test for ethnic breakdown for genealogical purposes?
Dear H.P.S.: Mature red blood cells do not contain DNA, but early red cells do. Although it is possible to find a few persistent cells in some people within a week after blood transfusion using sophisticated testing, it is vanishingly unlikely that it would have any effect on commercial genetic testing for the purpose of mapping ancestry, which uses the cells from saliva. Even people with an organ transplant, with many cells from someone else, should have accurate results using this technique.
Dear Dr. Roach: I suffer with numerous cysts in my pancreas and from rough bouts of diarrhea and stomach bloating. Do you know of a physician that removes cysts from the pancreas, or are there other measures that I can take? The only thing my physician suggests is to take Creon, which I have been on for two or three years.
Dear N.H.: It sounds like the primary problem with your pancreas is that it isn’t doing its major job, which is to secrete digestive enzymes into the intestines. Without those enzymes, you can’t properly digest foods, causing bloating and diarrhea (largely from fat not being absorbed). This condition is called pancreatic insufficiency. Creon is a brand of replacement pancreatic enzymes: These can reduce pain and dramatically improve digestion.
Cysts in the pancreas can be asymptomatic, but I am concerned that you may have chronic pancreatitis, which can cause not only the pancreatic insufficiency, but also cystic structures in and around the pancreas (these usually are not actual cysts inside the pancreas, but pseudocysts outside it). A surgeon would be the person to evaluate whether pseudocysts need treatment.
I would recommend that you get more complete information from your physician about the diagnosis and future management.
Email questions to ToYourGoodHealth@med.cornell.edu.