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Lancho Muñoz A, Abellán Alfocea P, Redondo Cerezo E. Gastric antral ectasia and diaphragmatic hernia: A rare cause of iron deficiency anemia. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:S0210-5705(24)00167-5. [PMID: 38740328 DOI: 10.1016/j.gastrohep.2024.502209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Ana Lancho Muñoz
- Department of Digestive Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | | | - Eduardo Redondo Cerezo
- Department of Digestive Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Alsaeed BH, AlAbdulqader AA, Al-Qadhi AA, Alaswad HA, Foula MS, Alshomimi SJ. Successful Surgical Management of Gastric Antral Vascular Ectasia in a Patient with End-Stage Renal Disease: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e938543. [PMID: 36908039 PMCID: PMC10024934 DOI: 10.12659/ajcr.938543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Gastric antral vascular ectasia (GAVE) is a rare clinical entity that presents with acute upper-gastrointestinal bleeding or chronic anemia. It is characterized by endoscopic watermelon appearance of the stomach. It is usually associated with other comorbidities; however, few articles have previously described GAVE in patients with end-stage renal disease. Its management is controversial, and endoscopic management is considered the treatment of choice. CASE REPORT A middle-age female patient, on regular hemodialysis for ESRD, was referred to the surgical out-patient clinic as a refractory GAVE after failure of endoscopic management as she became blood transfusion-dependent. She underwent laparoscopic subtotal gastrectomy with a Billroth II reconstruction of gastrojejunostomy. She had a smooth postoperative course and was followed up in the clinic for 12 months with no complications. Her hemoglobin level was stable at 9.4 g/dL without further blood transfusion. CONCLUSIONS Gastric antral vascular ectasia is usually associated with other comorbidities; however, an association between GAVE and CKD is rare. Its management is controversial, and endoscopic management is considered the preferred method of treatment. Laparoscopic subtotal gastrectomy is an effective management modality for GAVE, with dramatic improvement and good outcomes in terms of bleeding, blood transfusion requirements, and nutritional status.
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Fortuna L, Bottari A, Bisogni D, Coratti F, Giudici F, Orlandini B, Dragoni G, Cianchi F, Staderini F. Gastric Antral Vascular Ectasia (GAVE) a case report, review of the literature and update of techniques. Int J Surg Case Rep 2022; 98:107474. [PMID: 35963152 PMCID: PMC9386635 DOI: 10.1016/j.ijscr.2022.107474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/30/2022] [Accepted: 07/30/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction and importance Gastric Antral Vascular Ectasia is a rare disorder that causes up to 4 % of severe acute gastrointestinal bleeding. It affects elderly females with iron deficiency anemia due to chronic blood loss as a common presenting sign. Case presentation We report the case of a 70-year-old man admitted to the Urgency Department for severe asthenia associated with abdominal pain and severe anemia. An urgent upper endoscopic examination showed antral hyperemic streaks and vascular ectasias extending from the pyloric ring to the gastric body as well as signs of recent bleeding. Histological results demonstrated the pathognomonic features of GAVE. Clinical discussion The first line treatment is considered argon plasma coagulation (APC), given its wider availability, safety, efficacy and cost-effectiveness. In current literature, other therapies and different types of endoscopic treatments have been proposed, such as EBL, RFA and Yag: laser. To date, there is no specific recommendation that privileges one method over another in the treatment of GAVE, although APC has proven effective and even better in terms of complications and costs than the other techniques. Conclusion In our experience, endoscopic coagulation with APC probes is a relatively easy-to-use technique with low cost, minimal invasiveness and provides immediate results. On the other hand, a standardized algorithm is also required concerning to the different subtypes to give the best treatment in every case.
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Morrisroe K, Hansen D, Stevens W, Sahhar J, Ngian GS, Hill C, Roddy J, Walker J, Proudman S, Nikpour M. Gastric antral vascular ectasia in systemic sclerosis: a study of its epidemiology, disease characteristics and impact on survival. Arthritis Res Ther 2022; 24:103. [PMID: 35538587 PMCID: PMC9087964 DOI: 10.1186/s13075-022-02790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe the epidemiology, determinants and survival impact of gastric antral vascular ectasia (GAVE) in systemic sclerosis (SSc). METHODS Consecutive SSc patients prospectively enrolled in the Australian Scleroderma Cohort Study (ASCS) were included. Univariable and multivariable logistic regression were used to determine the associations of GAVE with clinical manifestations and serological parameters. Kaplan-Meier (K-M) survival curves were used to estimate survival. RESULTS The prevalence of GAVE in this SSc cohort of 2039 SSc patients was 10.6% (n = 216) over a median follow-up period of 4.3(1.7-8.4) years. SSc patients with a history of GAVE compared with those without a history of GAVE were older at SSc onset [49.5 (40.0-58.2) vs 46.7 (36.0-56.7) years, p = 0.05]; more likely to have diffuse disease subtype (dcSSc) (35.3% vs 24.1%, p < 0.001); be negative for Scl-70, U1RNP and Scl/PM antibody (4.0% vs 16.1%, p < 0.001, 3.5% vs 7.4%, p = 0.041, 0.0% vs 2.0%, p = 0.042; and respectively) and positive for RNAP III antibody (24.9% vs 8.3%, p < 0.001). Those with GAVE had a worse HRQoL (p = 0.002). Independent determinants of GAVE included the presence of RNAP III antibody (OR 3.46, p < 0.001), absence of Scl-70 antibody (OR 0.23, p = 0.001), presence of GIT dysmotility (OR 1.64, p = 0.004), and digital ulcers; pits; or digital amputation (OR 1.59, p = 0.014). CONCLUSIONS GAVE is an underestimated and underappreciated SSc manifestation of SSc, which occurs with a relatively high frequency. Identifying an at-risk GAVE phenotype, as presented herein, is of practical importance as screening may prove advantageous given GAVE can be easily diagnosed and treated.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia. .,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Joanne Sahhar
- Department of Medicine, Monash University, Clayton and Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Gene-Siew Ngian
- Department of Medicine, Monash University, Clayton and Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Catherine Hill
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.,Rheumatology Unit, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA, 5011, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre (Adelaide), Flinders Drive, Bedford Park, South Australia, 5042, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
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Fábián A, Bor R, Szabó E, Kardos V, Bálint A, Farkas K, Milassin Á, Rutka M, Szántó K, Molnár T, Szűcs M, Lőrinczy K, Orbán-Szilágyi Á, Gyökeres T, Gyimesi G, Szepes A, Kovács V, Rácz I, Szepes Z. Endoscopic treatment of gastric antral vascular ectasia in real-life settings: Argon plasma coagulation or endoscopic band ligation? J Dig Dis 2021; 22:23-30. [PMID: 33128340 DOI: 10.1111/1751-2980.12958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 09/15/2020] [Accepted: 10/27/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The efficacy of argon plasma coagulation (APC) on gastric antral vascular ectasia (GAVE) may be impaired over time and depends greatly on the application settings. Endoscopic band ligation (EBL) may be an alternative, but study on its efficacy is limited. This study aimed to evaluate and compare the clinical efficacy of APC and EBL in treating GAVE. METHODS Changes in the need for blood transfusion, number of treatment sessions and hospitalizations were retrospectively assessed in 63 transfusion-dependent patients with GAVE (mean age: 67.1 y, 54.0% female) treated with either APC or EBL (45 and 18 patients, respectively) in four tertiary endoscopic centers. RESULTS Both methods substantially increased hemoglobin levels and decreased patients' need for a transfusion (22.0 ± 4.0 g/L and -5.62 ± 2.30 units of packed red blood cells [RBC] with APC, and 27.4 ± 6.1 g/L and -4.79 ± 2.46 units of packed RBC with EBL), without a significant statistical difference between the methods. However, fewer EBL sessions were required both for the cessation of need for a transfusion compared with those for the resolution of GAVE lesions (0.90 ± 0.10 vs 1.69 ± 0.31, P = 0.028). CONCLUSIONS Both APC and EBL are effective in GAVE treatment. EBL may be superior in terms of number of treatment sessions, but not in its influence on hemoglobin level and need for transfusion. Further prospective studies with large, homogeneous sample size and standardized APC settings are needed.
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Affiliation(s)
- Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ella Szabó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Viktor Kardos
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Katalin Lőrinczy
- Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Ákos Orbán-Szilágyi
- Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Tibor Gyökeres
- Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - György Gyimesi
- Department of Gastroenterology, Bács-Kiskun County University Teaching Hospital, Kecskemét, Hungary
| | - Attila Szepes
- Department of Gastroenterology, Bács-Kiskun County University Teaching Hospital, Kecskemét, Hungary
| | - Valéria Kovács
- Internal Medicine Department and Gastroenterology, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - István Rácz
- Internal Medicine Department and Gastroenterology, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
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Abdul Jalal M, Iqbal K, Mukkada R, Ratnakaran R, Basheer S. Gastric Antral Vascular Ectasia Associated with Asymptomatic Mixed Connective Tissue Disease Refractory to Endoscopic Treatment: A Rare Case. CASE REPORTS IN ACUTE MEDICINE 2020. [DOI: 10.1159/000509014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Gastric antral vascular ectasia (GAVE) constitutes 4% of all nonvariceal upper GI bleedings. It is characterized by the presence of erythematous or hemorrhagic ectatic vessels within the antrum that are distributed either in a striped or diffuse punctate pattern. We report a 64-year-old female without any co-morbidities, who presented with multiple episodes of blood in stools. Laboratory studies revealed a hemoglobin level of 5 g/dL with a hematocrit of 18.3%. Iron studies revealed a serum iron level of 35 μg/dL. She underwent an upper GI endoscopy, and biopsy was consistent with gastric antral vascular ectasia. ANA (antinuclear antibody), RA (rheumatoid factor), and anti-centromere antibody were all strongly positive. Erythrocyte sedimentation rate was 56. She was asymptomatic as far as connective tissue disease was concerned. Her anemia improved, but argon plasma coagulation failed to sustain the suppression of GAVE, and she required a blood transfusion for severe anemia on two occasions. With regard to recurrent episodes of melena, she was started on oral methyl prednisolone in a tapering dosage. She improved with medications, and her hemoglobin is maintained at 11.3 g/dL. This is the first unique case of GAVE in a patient without any other systemic illness or portal hypertension refractory to endoscopic treatment responding to monotherapy with corticosteroids.
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Pérez Martín B, Rodríguez Martínez E, Baamonde de la Torre I, Suárez Pazos N, Díaz Tie M. Gastric Antral Vascular Ectasia Refractory to Endoscopic Treatment. Cir Esp 2019; 98:416-418. [PMID: 31812265 DOI: 10.1016/j.ciresp.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/22/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Berta Pérez Martín
- Servicio de Cirugía General y Aparato Digestivo, Hospital Arquitecto Marcide, Ferrol, A Coruña, España.
| | - Elisa Rodríguez Martínez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Arquitecto Marcide, Ferrol, A Coruña, España
| | - Iván Baamonde de la Torre
- Servicio de Cirugía General y Aparato Digestivo, Hospital Arquitecto Marcide, Ferrol, A Coruña, España
| | - Natalia Suárez Pazos
- Servicio de Cirugía General y Aparato Digestivo, Hospital Arquitecto Marcide, Ferrol, A Coruña, España
| | - Manuel Díaz Tie
- Servicio de Cirugía General y Aparato Digestivo, Hospital Arquitecto Marcide, Ferrol, A Coruña, España
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Patel U, Desai R, Desai J, Damarlapally N, Zalavadia D, Yousef M, Coman R, Bansal P, Goyal H. Predictors of blood transfusion and in-hospital outcomes in patients with gastric antral vascular ectasia (GAVE): a nationwide population-based analysis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:46. [PMID: 30906750 DOI: 10.21037/atm.2019.01.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Gastric antral vascular ectasia (GAVE) is a rare cause of chronic non-variceal upper gastrointestinal (GI) bleeding and can turn into life-threatening bleed in some patients. Packed red blood cell (PRBC) transfusions are often required in these patients during hospitalization. We aimed to investigate the hospitalization outcomes and predictors of PRBC transfusions in patients with GAVE lesions. Methods Using the ICD-9-CM codes (537.82, 537.83), we queried the National Inpatient Sample (NIS) [2010-2014] to recognize hospitalized GAVE patients. A 1:2 random sample was obtained from the non-GAVE cohort and these groups were compared (GAVE vs. non-GAVE). The predictors of PRBC transfusion in GAVE cohort were analyzed with multivariate analysis by using SPSS Statistics 22.0. Results We included weighted 89,081 GAVE and 178,550 non-GAVE hospitalized patients. The GAVE patients were tended to be older, female and white. Significantly higher proportions of comorbidities such as congestive heart failure, diabetes, hypertension, hypothyroidism, liver disease, renal failure, Sjogren syndrome, systemic sclerosis and portal hypertension, etc. were present in these patients. The all-cause inpatient mortality was found to be 1.4%. The mean hospital charges and length of stay (LOS) per GAVE hospitalization were $36,059 and 4.63±5.3 days, respectively. A total of 6,276 (weighted 31,102) (34.9%) of these patients received at least one PRBC transfusion during hospitalization. Advanced age, multiple comorbidities, non-elective admissions, male gender, and African American race were the independent factors associated with higher chances of receiving PRBC transfusion. Conclusions Our analysis showed that hospitalized patients with GAVE lesions had lower overall mortality rate despite having multiple comorbidities. There was no difference in the LOS and hospital charges between the two cohorts. Nearly 35% of the GAVE patients received at least one PRBC transfusion.
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Affiliation(s)
- Upenkumar Patel
- Division of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | | | - Jiten Desai
- Division of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Nanush Damarlapally
- Department of Health Sciences, Coleman College of Health Sciences, Houston, TX, USA
| | - Dipen Zalavadia
- Division of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Mohamad Yousef
- Division of Gastroenterology and Hepatology, University of Missouri at Columbia, Columbia, MO, USA
| | - Roxana Coman
- Division of Gastroenterology, Medical Center Navicent Health, Macon, GA, USA
| | - Pardeep Bansal
- Department of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
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El-Hawary AT, Mostafa EF, Mohamed SY, Kotb LI. Improvement of iron-deficiency anemia resulting from gastric antral vascular ectasia in patients with systemic sclerosis: cyclophosphamide versus argon plasma coagulation. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2019. [DOI: 10.4103/ejim.ejim_8_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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10
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Matsumoto Y, Hayashi H, Tahara K, Yasuda T, Tsubouchi S, Yamamoto Y, Mizuuchi T, Mori H, Sawada T. Intravenous Cyclophosphamide for Gastric Antral Vascular Ectasia Associated with Systemic Sclerosis Refractory to Endoscopic Treatment: A Case Report and Review of the Pertinent Literature. Intern Med 2019; 58:135-139. [PMID: 30101944 PMCID: PMC6367100 DOI: 10.2169/internalmedicine.1431-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Gastric antral vascular ectasia (GAVE) is a rare cause of chronic gastric hemorrhaging and iron deficiency anemia and is characterized by a distinctive endoscopic appearance. The main treatment of GAVE is endoscopic; however, medication is necessary in refractory cases. We herein report a 69-year-old woman with systemic sclerosis (SSc) who developed recurrent severe anemia after endoscopic treatment of GAVE that was successfully managed using intravenous cyclophosphamide (IVCY). The recurrence of GAVE after discontinuation of IVCY was successfully managed using a combination of IVCY and endoscopic treatment, without blood transfusion. Long-term IVCY may be indicated for refractory GAVE associated with SSc.
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Affiliation(s)
- Yuki Matsumoto
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Haeru Hayashi
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Koichiro Tahara
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Takuya Yasuda
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Shoko Tsubouchi
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Yusuke Yamamoto
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Takahiro Mizuuchi
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Hiroaki Mori
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
| | - Tetsuji Sawada
- Department of Rheumatology, Tokyo Medical University Hospital, Japan
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HSCT-GAVE as a Manifestation of Chronic Graft versus Host Disease: A Case Report and Review of the Existing Literature. Case Rep Transplant 2018; 2018:2376483. [PMID: 29721346 PMCID: PMC5867646 DOI: 10.1155/2018/2376483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 11/17/2022] Open
Abstract
Gastric antral vascular ectasia or “watermelon stomach” is a significant cause of nonvariceal upper GI bleeding and is characterized by red, tortuous ectatic vessels along longitudinal folds in the gastric antrum. The existing literature links GAVE to patients with cirrhosis, scleroderma, bone marrow transplantation, and chronic renal failure among other associations, but its pathophysiology remains ill-defined. Over 30 cases of hematopoietic stem cell transplant-related GAVE (HSCT-GAVE) have been reported in the literature to date and there are likely many more that go undiagnosed or are attributed to another cause of upper gastrointestinal bleeding. Interestingly, a busulfan-containing conditioning regimen has been the primary factor implicated in the etiology of HSCT-GAVE because this was common to all cases in the literature to date. Here, we present the first case of HSCT-GAVE in a patient that was treated with a non-busulfan-containing conditioning regimen. We propose a link between chronic GVHD and the development of HSCT-GAVE that is supported by a similar development of GAVE in patients with systemic sclerosis.
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12
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Huang HL, Leung CY, Cheng CJ. Mass-like Dieulafoy's lesion associated with advanced gastric cancer at the antrum of stomach: a case report and literature review. Diagn Pathol 2017; 12:73. [PMID: 29017601 PMCID: PMC5635578 DOI: 10.1186/s13000-017-0663-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/04/2017] [Indexed: 12/22/2022] Open
Abstract
Background Dieulafoy’s lesion, also known as a caliber-persistent artery, is a shallow, small, and rare lesion that occurs along the lesser curvature of proximal stomach. It is rare for a Dieulafoy’s lesion to present as a mass-like lesion that coexists with gastric cancer. To our best knowledge, we report the first case and histopathological pictures of a mass-like Dieulafoy’s lesion coexisting with advanced gastric cancer in the antrum of the stomach. Case presentation A 57-year-old female presented with a 6-month history of intermittent epigastric dull pain and dyspepsia. Subsequent upper gastrointestinal endoscopy revealed a friable mass that was located between the distal antrum and the pyloric ring. Biopsy revealed it to be an intestinal type adenocarcinoma. Subtotal gastrectomy was performed after neoadjuvant chemotherapy. Grossly, a large irregular plaque-like tumor lesion was noted at the anterior wall of the distal antrum and pylorus ring near the lesser curvature, measuring 5.6 × 4.8 × 1.0 cm. Histopathological examination of the resected stomach revealed that the plaque-like lesion largely consisted of numerous abnormally large-caliber and tortuous arteries in the submucosa. The increased fibrosis of the submucosa resulted in the formation of elevated plaque. The intestinal type adenocarcinoma was noted to be largely confined to the mucosa layer, with focal submucosal and muscular propria involvement. The patient was discharged one week after the subtotal gastrectomy, and she was alive and well 17 months after discharge, with no major complications. Conclusion This is the first case of a mass-like Dieulafoy’s lesion coexisting with advanced gastric cancer at the distal antrum area. This case highlights the possibility of life-threatening gastric bleeding after mucosal resection or biopsy that could be encountered by endoscopists.
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Affiliation(s)
- Hsi-Lan Huang
- Department of Pathology, Taipei Medical University Hospital, No.252, Wu Hsing Street, Taipei City, 110, Taiwan.,Department of Global Health Policy, Medical Building No. 3, Hongo Campus, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Chi Yan Leung
- Department of Global Health Policy, Medical Building No. 3, Hongo Campus, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Chien-Jui Cheng
- Department of Pathology, Taipei Medical University Hospital, No.252, Wu Hsing Street, Taipei City, 110, Taiwan.
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Upper gastrointestinal bleeding (watermelon stomach) in a patient with limited scleroderma (CREST syndrome). ACTA ACUST UNITED AC 2016; 13:361-362. [PMID: 27353193 DOI: 10.1016/j.reuma.2016.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 01/19/2023]
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Dias de Castro F, Boal Carvalho P, Cúrdia Gonçalves T, Magalhães J, Moreira MJ, Marinho C, Cotter J. Treating Gastric Antral Vascular Ectasia - When Argon Therapy Is Not Enough. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 23:249-253. [PMID: 28868470 PMCID: PMC5579983 DOI: 10.1016/j.jpge.2016.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/03/2016] [Indexed: 02/07/2023]
Abstract
Gastric antral vascular ectasia (GAVE) is a capillary-type vascular malformation of the gastric antrum and an infrequent cause of chronic gastrointestinal blood loss and iron deficiency anemia. The authors describe a case report of GAVE in a female cirrhotic patient presenting with severe symptomatic iron deficiency anemia. After failure of argon plasma coagulation (APC), the patient was treated with endoscopic band ligation (EBL) with resolution of anemia, without new episodes of rebleeding and no need for further hospitalizations or transfusion requirements. Even though APC is the current treatment of choice for GAVE recurrence-free survival at one year is achieved in less than 50% of the patients and failed therapy has been described in up to 14% of the patients. EBL has been reported to be a relatively easy technique for GAVE therapy and has been shown to be safe and effective with lower complication rates in comparison with APC. This technique may in the future be used as the initial endoscopic treatment to eradicate GAVE.
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Affiliation(s)
- Francisca Dias de Castro
- Gastroenterology Department, Hospital da Senhora da Oliveira, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Joana Magalhães
- Gastroenterology Department, Hospital da Senhora da Oliveira, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital da Senhora da Oliveira, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Carla Marinho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Centro Hospitalar do Alto Ave, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães, Portugal
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15
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Gjeorgjievski M, Cappell MS. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy. World J Hepatol 2016; 8:231-62. [PMID: 26855694 PMCID: PMC4733466 DOI: 10.4254/wjh.v8.i4.231] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/30/2015] [Accepted: 01/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepatic-portosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. CONCLUSION PHG is important to recognize in patients with cirrhotic or non-cirrhotic portal hypertension because it can cause acute or chronic GI bleeding that often requires pharmacologic therapy.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Mihajlo Gjeorgjievski, Mitchell S Cappell, Division of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, MI 48073, United States
| | - Mitchell S Cappell
- Mihajlo Gjeorgjievski, Mitchell S Cappell, Division of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, MI 48073, United States
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16
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Gastric Antral Vascular Ectasia in Systemic Sclerosis: Current Concepts. Int J Rheumatol 2015; 2015:762546. [PMID: 26633973 PMCID: PMC4655054 DOI: 10.1155/2015/762546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction. Gastric antral vascular ectasia (GAVE) is a rare entity with unique endoscopic appearance described as “watermelon stomach.” It has been associated with systemic sclerosis but the pathophysiological changes leading to GAVE have not been explained and still remain uncertain. Methods. Databases Medline, Scopus, Embase, PubMed, and Cochrane were searched for relevant papers. The main search words were “Gastric antral vascular ectasia,” “Watermelon Stomach,” “GAVE,” “Scleroderma,” and “Systemic Sclerosis.” Fifty-four papers were considered for this review. Results. GAVE is a rare entity in the spectrum of manifestations of systemic sclerosis with unknown pathogenesis. Most patients with systemic sclerosis and GAVE present with asymptomatic anemia, iron deficiency anemia, or heavy acute gastrointestinal bleeding. Symptomatic therapy and endoscopic ablation are the first-line of treatment. Surgical approach may be recommended for patients who do not respond to medical or endoscopic therapies. Conclusion. GAVE can be properly diagnosed and treated. Early diagnosis is key in the management of GAVE because it makes symptomatic therapies and endoscopic approaches feasible. A high index of suspicion is critical. Future studies and a critical review of the current findings about GAVE are needed to understand the role of this condition in systemic sclerosis.
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17
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Jana T, Thosani N, Fallon MB, Dupont AW, Ertan A. Radiofrequency ablation for treatment of refractory gastric antral vascular ectasia (with video). Endosc Int Open 2015; 3:E125-7. [PMID: 26135652 PMCID: PMC4477020 DOI: 10.1055/s-0034-1391323] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/21/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Gastric antral vascular ectasia (GAVE) is a known cause of gastrointestinal bleeding and chronic iron deficiency anemia. Endoscopic therapy with argon plasma coagulation (APC) is widely used for treatment of GAVE, but most patients continue to require repeated blood transfusions and multiple endoscopic procedures (refractory GAVE). We describe our initial experience regarding safety and efficacy of radiofrequency ablation (RFA) therapy in treating patients with refractory GAVE. PATIENTS AND METHODS We prospectively enrolled seven patients with refractory GAVE who had multiple prior treatments with APC. These patients were treated with RFA (HALO90 ULTRA Ablation Catheter System; Covidien, GI Solutions, Sunnyvale, CA) at Ertan Digestive Disease Center at our tertiary University Hospital. RESULTS Seven patients underwent a total of 12 RFA procedures for treatment of refractory GAVE. The median number of RFA procedures was 2 (Range, 1 - 3). Average pre- and post-procedural hemoglobin were 9.3 g/dL and 10.16 g/dL, respectively. Five of seven patients (71 %) were transfusion-free after the RFA treatments while two patients continued to require blood transfusions. There were no complications in this series. CONCLUSION RFA can be an effective alternative to APC for treatment of GAVE refractory to previous endoscopic therapy. Additional studies are needed to identify which subset of patients will benefit the most with RFA treatment.
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Affiliation(s)
- Tanima Jana
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Nirav Thosani
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States,Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Stanford, California, United States
| | - Michael B. Fallon
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States,Ertan Digestive Disease Center, Memorial Hermann Hospital, Houston, Texas, United States
| | - Andrew W. Dupont
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States,Ertan Digestive Disease Center, Memorial Hermann Hospital, Houston, Texas, United States
| | - Atilla Ertan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States,Ertan Digestive Disease Center, Memorial Hermann Hospital, Houston, Texas, United States
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18
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Nagaraja V, McMahan ZH, Getzug T, Khanna D. Management of gastrointestinal involvement in scleroderma. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2015; 1:82-105. [PMID: 26005632 DOI: 10.1007/s40674-014-0005-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastrointestinal tract (GIT) commonly affects patients with systemic sclerosis (SSc). The GI involvement is quite heterogeneous varying from asymptomatic disease to significant dysmotility causing complications like malabsorption, weight loss and severe malnutrition. This review focuses on the management of GI involvement in SSc and has been categorized based on the segment of GIT involved. A brief discussion on the role of patient reported outcome measures in SSc-GI involvement has also been incorporated.
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Affiliation(s)
- Vivek Nagaraja
- Division of Rheumatology, University of Toledo, Toledo, Ohio
| | | | - Terri Getzug
- Division of Rheumatology, University of Toledo, Toledo, Ohio
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
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