[Diagnosis and treatment of digestive angiodysplasias]

Digestive angiodysplasia are acquired, superficial vascular lesions of the digestive tract, frequently implicated in overt or occult digestive gastrointestinal bleeding episodes. Their pathophysiology is not fully understood. They preferentially affect the elderly and comorbid patients. Their association with aortic stenosis is known as Heyde's syndrome. Diagnosis is based on digestive endoscopy (upper gastrointestinal endoscopy, colonoscopy and small bowel capsule endoscopy). Non-specific treatment includes management of blood thinners, iron supplementation (oral or intravenous) and blood transfusions. The specific first-line treatment is endoscopic destruction (argon plasma electrocoagulation being the most common), if necessary, by deep enteroscopy (with double balloon technique) in their jejunal and ileal locations. If endoscopic treatment fails, other treatments may be considered. In Heyde's syndrome, aortic valve replacement (surgical or transcatheter, TAVI) is often effective. Some pharmacological treatments have been shown to be effective, most notably long-acting release somatostatin analogues, followed by thalidomide (which has a poorer safety and tolerability profile). Bevacizumab, radiological embolization and surgery are only considered in most refractory or salvage cases.