Endoscopic biopsy is diagnostic in gastric antral vascular ectasia

Gilliam, John H.; Geisinger, Kim R.; Wu, Wallace C.; Weidner, Noel; Richter, Joel E.

doi:10.1007/bf01540274

Cited by 97 publications

(58 citation statements)

References 5 publications

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“…Both lesions also can be differentiated by pathologic criteria, with a combination of fibrohyalinosis, spindle cell proliferation, vascular ectasia, and thrombi, being highly suggestive of GAVE. 3,4 On the other hand, the two gastric mucosal lesions can occur simultaneously in the same patient.The role of portal hypertension in the pathophysiology of PHG is well shown. However, the relationship between GAVE and both portal hypertension and liver insufficiency is still unclear.…”

mentioning

confidence: 99%

Cure of gastric antral vascular ectasia by liver transplantation despite persistent portal hypertension: A clue for pathogenesis

Vincent

Pomier‐Layrargues

Dagenais

et al. 2002

Liver Transplantation

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Gastric antral vascular ectasia (GAVE) is a rare cause of chronic bleeding in cirrhotic patients. It has been suggested that these gastric lesions might be related to portal hypertension, hepatic insufficiency, or both parameters. We report two cases of cirrhotic patients in whom GAVE was the source of recurrent bleeding. These patients also had complete portal vein thrombosis. Liver transplantation was performed and an end-to-end cavoportal anastomosis was performed, leaving patients with persistent portal hypertension after surgery. We observed complete disappearance of the antral lesions several weeks after transplantation, which shows that the GAVE is not related to portal hypertension but is rather a direct consequence of liver failure. Possible pathophysiologic mechanisms are discussed. (Liver Transpl 2002;8:717-720.) G astric antral vascular ectasia (GAVE) is now a well-recognized complication of cirrhosis and its estimated prevalence is around 3%. 1 The endoscopic distinction between GAVE and portal hypertensive gastropathy (PHG), the other gastric lesion commonly found in cirrhosis, is relatively well defined and in most cases can be performed easily by experienced endoscopists.GAVE lesions are described as longitudinal rows of ectatic, sacculated, mucosal vessels (red spots) mainly located in the antrum. These red spots may be aggregated in linear stripes (watermelon stomach) but may be confluent (honeycomb pattern). 2 By contrast, PHG is observed mostly in the fundus and body of the stomach and is characterized by superficial erythema of an edematous mucosa with cherry-red spots arranged in a mosaic pattern, with or without diffuse bleeding. Both lesions also can be differentiated by pathologic criteria, with a combination of fibrohyalinosis, spindle cell proliferation, vascular ectasia, and thrombi, being highly suggestive of GAVE. 3,4 On the other hand, the two gastric mucosal lesions can occur simultaneously in the same patient.The role of portal hypertension in the pathophysiology of PHG is well shown. However, the relationship between GAVE and both portal hypertension and liver insufficiency is still unclear. In the present report, we describe 2 cases of cirrhotic patients with GAVE and portal vein thrombosis. Persistence of the portal hypertension after transplantation provides an unique opportunity to delineate the respective roles of liver failure and portal hypertension in the pathophysiology of these lesions. Case 1A 60-year-old man with alcoholic cirrhosis (abstinent since 1984) was repeatedly admitted since 1998 for upper gastrointestinal bleeding secondary to typical GAVE lesions, as shown by successive upper gastrointestinal endoscopies. He required serial blood transfusions in the ensuing 2 years to maintain stable hemoglobin levels. Small, nonbleeding esophageal varices also were noted. In addition, he presented a deep calf thrombophlebitis secondary to hypercoagulation associated with a methylentetrahydrofolate reductase (MTHFR) prothrombin mutation and was anticoagulated. He was refe...

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mentioning

confidence: 99%

Cure of gastric antral vascular ectasia by liver transplantation despite persistent portal hypertension: A clue for pathogenesis

Vincent

Pomier‐Layrargues

Dagenais

et al. 2002

Liver Transplantation

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“…GAVE can be safely biopsied with only minimally increased and minor bleeding because of its low-intravascular pressure. Biopsy of the involved gastric folds reveals characteristic findings of dilated, tortuous mucosal capillaries often occluded by bland fibrin thrombi in the lamina propria and dilated submucosal veins without inflammatory infiltration 15,16 , together with foveolar Estômago em melancia, pericardite hemorrágica, tumor de pequenas células do pulmão e carcinoma pavimentocelular síncrono da base da língua hyperplasia and fibromuscular spindle cell hyperplasia of the lamina propria 17 . The cause of GAVE is unknown, but Jabbari 1 had proposed that it could result from repetitive low-grade trauma caused by repeated prolapse of the loosely attached mucosa of the distal antrum into the duodenum during gastric peristalsis due to antral hypercontractility, primary or acquired, with consequent elongation and secondary reactive muscular hyperplasia and ectasia of the mucosal vessels.…”

Section: Discussionmentioning

confidence: 99%

Watermelon stomach, hemorrhagic pericarditis, small cell carcinoma of the lung and synchronous squamous cell carcinoma of the tongue base

Murinello

Damásio

Figueiredo³

et al. 2010

Revista Portuguesa de Pneumologia (English Edition)

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ResumoBaseados num caso de gastropatia antral com ectasia vascular (estômago em melancia) associado a pericardite hemorrágica e a um carcinoma de pequenas células do pulmão com metástases ganglionares ao longo do mediastino e a um carcinoma pavimentocelular sín-crono da base da língua, os autores fazem uma revisão dos aspectos clínicos, endoscópicos e histopatológicos deste tipo de gastropatia, da sua associação a outras doenças e das possibilidades terapêuticas actuais por via endoscópica. Referem-se igualmente as causas mais frequentes de pericardite hemorrágica, salientando-se a AbstractBased on a case of gastric antral vascular ectasia (watermelon stomach) that was associated with hemorrhagic pericarditis, small cell lung carcinoma with mediastinal lymph node metastases and a synchronous squamous cell carcinoma of the base of the tongue, the authors made a review of the clinical, endoscopic and histopathological aspects of this type of gastropathy, and its association with other diseases, and of the results of its endoscopic therapy. The causes of hemorrhagic pericarditis are considered, emphasizing the necessity to know if the effusion has Estômago em melancia, pericardite hemorrágica, tumor de pequenas células do pulmão e carcinoma pavimentocelular síncrono da base da língua Watermelon stomach, hemorrhagic pericarditis, small cell carcinoma of the lung and synchronous squamous cell carcinoma of the tongue base

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“…The mucosa shows no or mild chronic inflammation or atrophy with intestinal metaplasia. [46] GAVE must be distinguished from "portal hypertensive gastropathy" and from "gastric vascular ectasia". [47] …”

Section: Inflammatory Conditionsmentioning

confidence: 99%