Gastrointestinal telangiectasia: a study by EGD, colonoscopy, and capsule endoscopy in 75 patients

Background: The distribution of lesions in the gastrointestinal tract in patients with sporadic telangiectasia is at present unknown. Patients and methods: 75 patients with sporadic telangiectasia underwent esophagogastroduodenoscopy (EGD), capsule endoscopy, and colonoscopy. Endoscopic diagnosis of telangiectasia and gastrointestinal bleeding were required for enrollment in the study. Hemorrhagic diathesis, co-morbidity, number of blood transfusions, and subsequent management were also noted. Results: 35 of the patients presented with gastroduodenal vascular lesions, 51 with small-bowel lesions, and 28 with colonic lesions. 67% of patients in whom EGD found telangiectasia also presented small-bowel vascular lesions at capsule endoscopy and 43% colonic lesions at colonoscopy. 54% percent of patients with positive colonoscopy also presented gastroduodenal lesions and 48% small-bowel lesions. Patients with known duodenal lesions were more likely to have small-bowel lesions at capsule endoscopy (odds ratio [OR] 10.19, 95% CI 2.1-49.33, P= 0.003). Patients with associated diseases, such as liver cirrhosis, chronic renal failure, or heart valvulopathy, presented more severe disease requiring blood transfusions (OR 6.37, 95% Cl 1.39-29.2, P= 0.015). The number of blood transfusions correlated with the number of sites affected (R = 0.35, P = 0.002). The detection of new lesions at capsule endoscopy allowed new treatment in 46% of patients. Mean follow-up was 18 months. Conclusions: Sporadic telangiectasia is a multifocal disease potentially involving the whole digestive tract. Patients with duodenal telangiectasia show a higher risk of jejunal or ileal lesions. Capsule endoscopy is a useful diagnostic tool for the detection of such small-bowel vascular lesions, indicating a more specific prognosis and treatment strategy.