İntestinal Anjiodisplazi
Özet
İntestinal anjiodisplazi, gastrointestinal sistemde en sık görülen vasküler malformasyon olup özellikle 70 yaş üstü bireylerde görülen kanamaların temel nedenidir. Genellikle sağ kolonda izlenen bu edinsel lezyonlar, mukoza ve submukozadaki damarların ektazik ve tortiyoze hale gelmesiyle karakterizedir. Patogenezinde venöz obstrüksiyon ve anjiopoetin ekspresyonu gibi faktörler rol oynarken; kronik böbrek yetmezliği, aort stenozu (Heyde sendromu) ve von Willebrand hastalığı risk faktörleri arasında sayılmaktadır. Çoğu vaka asemptomatik seyretse de semptomatik hastalarda tekrarlayıcı kanamalar ve demir eksikliği anemisi görülür. Tanıda kolonoskopi ve ince bağırsak değerlendirmesi için kapsül endoskopi temel yöntemlerdir; şiddetli vakalarda ise anjiyografi ve sintigrafi kullanılabilir. Tedavi yaklaşımı hastanın klinik durumuna göre belirlenmekte olup asemptomatik lezyonlar müdahale gerektirmez. Endoskopik tedavide Argon Plazma Koagülasyonu (APC) güvenilirliği ve etkinliği ile ön plana çıkarken, dirençli vakalarda medikal ajanlar (okreotid, talidomid) veya cerrahi rezeksiyon alternatif seçenekler sunmaktadır.
Intestinal angiodysplasia is the most common vascular malformation of the gastrointestinal tract and the primary cause of bleeding in patients over the age of 70, typically manifesting as ectatic and tortuous vessels in the mucosa and submucosa of the right colon. While its exact pathogenesis remains unclear, hypotheses include chronic venous obstruction and angiopoietin overexpression, with significant risk factors identified as chronic kidney disease, aortic stenosis (Heyde’s syndrome), and von Willebrand disease. Although frequently asymptomatic and discovered incidentally, symptomatic cases present with recurrent gastrointestinal bleeding or iron deficiency anemia, necessitating diagnostic evaluation through colonoscopy, capsule endoscopy, or angiography in severe instances. Management is guided by clinical presentation, where asymptomatic lesions require no intervention, whereas symptomatic ones are primarily treated with endoscopic methods like Argon Plasma Coagulation (APC) due to its efficacy and safety. In cases where endoscopic or radiological treatments fail, pharmacological options such as octreotide and thalidomide or surgical resection are considered to manage persistent bleeding and transfusion requirements.
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