Digestive angiodysplasias are a leading vascular cause of gastrointestinal bleeding, yet prospective studies evaluating predictors of recurrence are rare. Identifying high-risk patients is crucial to guide surveillance and therapy.

We conducted a prospective cohort study including adults aged ≥18 years with at least one endoscopically confirmed angiodysplasia and minimum follow-up of 12 months. Exclusion criteria were hereditary hemorrhagic telangiectasia, portal hypertensive gastropathy, radiation-induced vascular lesions, inflammatory bowel disease, and incomplete records. Lesions were discovered either incidentally or during overt bleeding. Recurrent bleeding was defined as new hematochezia or melena, hemoglobin drop ≥2 g/dL, need for transfusion, or endoscopic evidence. Follow-up included scheduled visits and structured telephone contact.

Among 65 patients, 15.4 % experienced recurrent bleeding. Recurrence was higher in patients with chronic kidney disease versus those without (21.2 % vs 9.4 %, p = 0.08), in patients with initial overt bleeding versus incidental discovery (21 % vs 4 %, p = 0.04), and in those receiving anticoagulants versus not (22 % vs 14 %, p = 0.11). In multivariable logistic regression, chronic kidney disease, anticoagulant therapy, higher age, multiplicity of lesions, and active stigmata were positively associated, while argon plasma coagulation showed a protective trend. Trends aligned with international evidence despite lack of statistical significance.

This prospective study identifies clinically meaningful high-risk profiles for recurrent bleeding in digestive angiodysplasias. Standardized definitions and structured follow-up enhance originality. Findings support development of predictive models to optimize patient monitoring and treatment strategies.