Gastric Antral Vascular Ectasia in Systemic Sclerosis: Current Concepts

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.

HSCT-GAVE as a Manifestation of Chronic Graft versus Host Disease: A Case Report and Review of the Existing Literature

“…GAVE has been well described in patients with systemic sclerosis/scleroderma with an estimated prevalence of 5.7% in this population [ 18 ]. In fact, some studies suggest that this number may be substantially higher considering asymptomatic patients with endoscopic findings of GAVE.…”

Gastrointestinal manifestations of systemic sclerosis: An updated review

“…GAVE is part of the spectrum of vascular disease in these patients[ 16 , 24 ]. The prevalence is variable, with reports between 1%-76%[ 85 ]. A study that evaluated abnormalities of the GI mucosa by video capsule endoscopy found “watermelon stomach” (34.6%), gastric and/or SB telangiectasia (26.9%), and gastric and/or SB angiodysplasia (38.5%).…”

“…GAVE can present with asymptomatic or symptomatic iron deficiency anemia (weakness, fatigue, or dyspnea), occult blood in the stool, and overt bleeding due to melena or hematemesis[ 14 , 85 ]. Endoscopically, the typical "watermelon stomach" is found with prominent, flat, or raised erythematous stripes that radiate from the antrum with a tendency to converge towards the pylorus, the finding of which is the most frequent, and the “honeycomb stomach”, where vascular ectasia appears as a coalescence of multiple round angiodysplasias in the antrum[ 88 ].…”

“…Treatment is symptomatic and includes pharmacological, endoscopic, and surgical management[ 85 ]. There are no controlled clinical trials comparing the different types of treatment.…”

“…In a recent meta-analysis, radiofrequency ablation was found to have efficacy and tolerability comparable to APC and appears to be effective in patients with APC-refractory GAVE[ 92 ]. Surgical treatment, mainly antrectomy, is reserved for patients who do not respond to medical or endoscopic therapy[ 85 ].…”