f Esophageal Angiodysplasia: A Strange Place for One of Those!

Angiodysplasia, also known as angioectasia, is the most common vascular malformation of the gastrointestinal tract, most often found in patients above the age of sixty. Patients with cirrhosis are at increased risk of bleeding and re-bleeding of these lesions. Angiodysplasias can be found throughout the gastrointestinal (GI) tract and are uncommonly found in the esophagus. The recommended treatment for these lesions is Argon Plasma Coagulation (APC); however, there are numerous mechanical and medical strategies that can also be used to treat angiodysplasia.

This is a case of a 65-year-old woman with decompensated alcoholic cirrhosis and a history of recurrent GI bleeding complicated by hemorrhagic shock presented for anemia. Esophagogastroduodenoscopy (EGD) following her hospitalization was remarkable for bleeding esophageal and gastric angiodysplasias that were successfully treated with APC. The patient returned months later with a recurrent upper GI bleed with EGD, colonoscopy, and video capsule remarkable for angiodysplasias throughout the gastric body, small bowel, and colon without recurrence of the esophageal angiodysplasia.

The purpose of this case is to demonstrate a rare but possible cause of upper GI bleed in patients with decompensated cirrhosis. While angiodysplasia can occur commonly in the stomach, small bowel, and colon, esophageal angioectasia can occur and contribute to a recurrent GI bleed. These should be considered in the differential diagnosis of upper GI bleed and anemia.