GI/LIVER INVOLVEMENT

 

GI Tract

The small bowel is the most common site of gastro-intestinal bleeding (GIB) in those with HHT.

 

From the top, the small bowel lining is very difficult to visualize through traditional upper GI endosocopy (also known as "gastroscopy" - through which the specialist can only see the very top part of the small bowel). 

 

From the bottom, the small bowel lining is very difficult to visualize through traditional lower GI endoscopy (also known as "colonoscopy" - through which the specialist can only see the very bottom part of the small bowel, the terminal ileum).

 

Therefore recently special techniques have been developed to better assess the small bowel mucosa, which can have hundreds of telangiectasiae along the mucous membrane lining, which can intermittently bleed. One especially important procedure is "Small Bowel Enteroscopy" or "Push Pull Enteroscopy". This should only be done by Gastroenterologists who are familiar with HHT and understand the implications (i.e. operator-dependant). Treatment with lasers is feasible, however once again needs to be done in expert hands to avoid complications such as bowel perforation.

 

In Alberta, this is available in Edmonton and Calgary. We are attempting to develop the capacity for this in Lethbridge for Southern Alberta where sub-specialist expertise exists, but the hospital equipment does not as yet. 

 

Videocapsule endoscopy is a way to visualize the small bowel (but cannot be used to treat the small bowel). It is also somewhat operator-dependant, and small lesions can be missed in the small bowel.

 

LIVER

The liver can be affected in HHT very commonly (70% of individuals), often "asymptomatic" or have abnormal findings on ultrasound done for another purpose, especially if there is no note made of the patient having "HHT" on the requisition. At the other extreme, some require a liver transplant.