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Vascular lesions As a Cause of Upper Gastrointestinal Bleeding

🩸 Vascular Lesions as a Cause of Upper Gastrointestinal Bleeding (UGIB) Vascular lesions are an important but often under-recognized cause of UGIB. They can be congenital, acquired, or part of systemic syndromes. Here's a breakdown of the key types and their clinical relevance: 🔍 Common Vascular Lesions Causing UGIB Lesion Type Description Typical Location Bleeding Pattern Dieulafoy Lesion Large submucosal artery erodes through mucosa Proximal stomach Sudden, massive bleeding Gastric Antral Vascular Ectasia (GAVE) Dilated vessels in antral mucosa ("watermelon stomach") Gastric antrum Chronic or occult bleeding Angiodysplasia Dilated, tortuous vessels (ectasias) Can occur anywhere; often colon, but also stomach/duodenum Intermittent, painless bleeding Hereditary Hemorrhagic Telangiectasia (HHT) Autosomal dominant disorder with mucocutaneous telangiectasias Entire GI tract Recurrent bleeding, often after age 50 Arteriovenous Malformations (AVMs) Congenital abnormal connections between arteries and veins Small intestine, stomach Variable bleeding severity Radiation-induced Vascular Changes Post-radiation mucosal damage with fragile vessels Stomach, duodenum Delayed bleeding post-radiotherapy 🧪 Diagnosis Endoscopy: First-line for identifying lesions; may show active bleeding or characteristic vascular patterns. Capsule Endoscopy / Deep Enteroscopy: Useful for small bowel lesions. CT Angiography / Visceral Angiography: For active bleeding or when endoscopy is inconclusive. Technetium-99m RBC Scan: Helps localize bleeding but less specific. 🛠️ Treatment Options Endoscopic Therapy: Coagulation (argon plasma, heater probe, laser) Hemostatic clips Pharmacologic: Octreotide: May reduce bleeding from angiodysplasias Interventional Radiology: Angiographic embolization for refractory bleeding Surgery: Reserved for persistent or massive bleeding unresponsive to other measures 📌 Clinical Pearls Vascular lesions often cause recurrent or occult bleeding, especially in older adults. Dieulafoy lesions can cause massive hemorrhage despite appearing small or subtle. GAVE is strongly associated with cirrhosis and may mimic portal hypertensive gastropathy. #Gastrointestinal