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PTH-093 Small bowel angiodysplasia and lymphangiectasia: a positive association. A novel clinical marker or a shared pathophysiology?
  1. J C Macdonald1,
  2. V Porter2,
  3. N W Scott3,
  4. D McNamara1
  1. 1Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
  2. 2Department of GI Physiology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
  3. 3Department of Medical Statistics, University of Aberdeen, Aberdeen, Scotland, UK

Abstract

Introduction The cause of sporadic angiodysplasia is unknown and the natural history poorly understood. Many lesions are thought to arise from a degenerative process associated with ageing. Most cases of hereditary haemorrhagic telangiectasia appear to result from mutations in two genes, ENG and ACVRL1. These mutations alter the function of 2 key endothelial receptor proteins, endoglin and ALK-1 (part of the transforming growth factor β super-family), which ordinarily play a key role in maintaining vascular integrity. It has been observed that endoglin is over expressed in smooth muscle cells in atherosclerotic plaques, suggesting a role for this protein in plaque progression, atherosclerosis and associated cardiovascular disease.

Methods To determine if there is an association between angiodysplasia, lymphangiectasias and conditions traditionally associated with atherosclerosis. Consecutive patients referred to a single tertiary referral centre for a capsule endoscopy (CE) over a 3-year period were identified from a dedicated CE database. Indications, findings, demographic information, and the presence of diabetes, ischaemic heart disease, hypertension, hyperlipidaemia were recorded, along with body mass index. Only patients with a complete CE were included for analysis. Logistic regression analysis (LRA) was employed to examine associations between angiodysplasia, lymphangiectasia, patient demographics, obesity and the diseases described.

Results In all 180 patients were identified, 46 (25%) had angiodysplasia and 47 (26%) lymphangiectasia. Lymphangiectasias were seen in 24 (52%) of 46 with angiodysplasia, in 16 (19%) of 84 with obscure GI bleeding without angiodysplasia and in 7 (14%) of 50 without GI bleeding. LRA confirmed a strong positive association between angiodysplasia and lymphangiectasia, OR 4.42, p<0.003. Angiodysplasias were also associated with increasing age, odds ratio 1.1. There was no correlation with any other patient characteristic (Abstract 093).

Abstract PTH-093

Results of LRA predicting angiodysplasia

Conclusion This study reveals a strong association between small bowel angiodysplasia, lymphangiectasia and ageing, but not between angiodysplasia and conditions associated with increased risk of atherosclerosis. Lymphangiectasias may represent a useful clinical marker for the presence of angiodysplasia.

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