26/07/2026
Gastric AVM (arteriovenous malformation), that striking bright-red, frond-like / “sea-anemone” vascular lesion is classic.
Perfect example of a source of chronic occult bleeding causing iron-deficiency anaemia.
Gastric Angiodysplasia
1. Gastric angiodysplasia is a degenerative vascular malformation of the gastric mucosa and submucosa, consisting of dilated, fragile blood vessels.
2. It commonly presents with occult gastrointestinal bleeding, iron deficiency anemia, or recurrent melena, especially in older adults.
3. Risk factors include advanced age, chronic kidney disease, aortic stenosis (Heyde syndrome), and von Willebrand disease.
4. Upper GI endoscopy is the investigation of choice and typically shows flat, bright-red, fern-like or spider-like vascular lesions.
5. Argon plasma coagulation (APC) during endoscopy is the preferred first-line treatment for active bleeding or recurrent blood loss.
6. Patients with ongoing bleeding may require iron supplementation, blood transfusion, and occasionally medications such as octreotide if endoscopic therapy fails or lesions recur.
7. In an elderly patient with recurrent iron deficiency anemia and a normal peptic ulcer workup, always consider gastric angiodysplasia as a potential source of chronic gastrointestinal bleeding.
Keith Siau
