Gastric antral vascular ectasia (watermelon stomach)—therapeutic options

Park, R. H.; Danesh, B. J. Z.; Upadhyay, Rajesh Kumar; Howatson, A.F.; Lee, F. D.; Russell, Robin

doi:10.1136/pgmj.66.779.720

Cited by 46 publications

(34 citation statements)

References 15 publications

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“…Initially corticosteroids were used to treat GAVE and case reports showed that 4 out of 11 patients responded to this measure [2,25,26,27,28,29,30,31, 34,36,37,38]. Typical steroid side effects, like steroid-induced diabetes mellitus and/or cushing-like illness, limit its use.…”

Section: Therapymentioning

confidence: 99%

Gastric Antral Vascular Ectasia (GAVE): An Update on Clinical Presentation, Pathophysiology and Treatment

2008

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Gastric antral vascular ectasia (GAVE), though a rare disorder, causes up to 4% of non-variceal upper GI bleeding. This paper gives an overview of studies examining clinical presentation and pathophysiology, and reviews the current evidence for invasive and non-invasive treatments. GAVE is often associated with systemic illnesses, such as cirrhosis of the liver, autoimmune connective tissue disorders, bone marrow transplantation and chronic renal failure. The pathophysiological changes leading to GAVE have not been fully explained and remain controversial. Patient presentation varies from chronic iron-deficiency anaemia to heavy acute gastrointestinal bleeding. It is important to differentiate GAVE from portal hypertensive gastropathy as GAVE does not respond to measures reducing portal pressures. Endoscopic ablation (Nd:YAG-laser or argon plasma coagulation) is the first-line treatment of choice. As evidence for pharmacological therapy with oestrogen (and/or progesterone), tranexamic acid or thalidomide stems from case reports only, these should be used if endoscopic measures have failed to stop chronic blood loss. Surgical antrectomy should be reserved for unresponsive cases as it is associated with a high mortality. Ultimately, treatment of the underlying medical co-morbidities may lead to resolution of GAVE.

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Section: Therapymentioning

confidence: 99%

Gastric Antral Vascular Ectasia (GAVE): An Update on Clinical Presentation, Pathophysiology and Treatment

2008

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“…Few case-reports have suggested a potential benefit from the use of tranexamic acid but reported severe side effects (central venous stasis retinopathy; deep venous thrombosis and pulmonary embolism) limit its use [46][47][48] . A case-report showed complete resolution of GAVE with intravenous infusion of methylprednisolone and cyclophosfamide in a patient with associated systemic sclerosis and pernicious anaemia [49] ; but, such result has not been yet confirmed in larger series.…”

Section: Medical Therapymentioning

confidence: 99%

Diagnosis and management of gastric antral vascular ectasia

Fuccio¹

2013

WJGE

126

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Gastric antral vascular ectasia (GAVE) is an uncommon but often severe cause of upper gastrointestinal (GI) bleeding, responsible of about 4% of non-variceal upper GI haemorrhage. The diagnosis is mainly based on endoscopic pattern and, for uncertain cases, on histology. GAVE is characterized by a pathognomonic endoscopic pattern, mainly represented by red spots either organized in stripes radially departing from pylorus, defined as watermelon stomach, or arranged in a diffused-way, the so called honeycomb stomach. The histological pattern, although not pathognomonic, is characterized by four alterations: vascular ectasia of mucosal capillaries, focal thrombosis, spindle cell proliferation and fibrohyalinosis, which consist of homogeneous substance around the ectatic capillaries of the lamina propria. The main differential diagnosis is with Portal Hypertensive Gastropathy, that can frequently co-exists, since about 30% of patients with GAVE co-present a liver cirrhosis. Autoimmune disorders, mainly represented by Reynaud's phenomenon and sclerodactyly, are co-present in about 60% of patients with GAVE; other autoimmune and connective tissue disorders are occasionally reported such as Sjogren's syndrome, systemic lupus erythematosus, primary biliary cirrhosis and systemic sclerosis. In the remaining cases, GAVE syndrome has been described in patients with chronic renal failure, bone marrow transplantation and cardiac diseases. The pathogenesis of GAVE is still obscure and many hypotheses have been proposed such as mechanical stress, humoural and autoimmune factors and hemodynamic alterations. In the last two decades, many therapeutic options have been proposed including surgical, endoscopic and medical choices. Medical therapy has not clearly shown satisfactory results and surgery should only be considered for refractory severe cases, since this approach has significant mortality and morbidity risks, especially in the setting of portal hypertension and liver cirrhosis. Endoscopic therapy, particularly treatment with Argon Plasma Coagulation, has shown to be as effective and also safer than surgery, and should be considered the first-line treatment for patients with GAVE-related bleeding.

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“…In cirrhosis-associated GAVE, correction of portal hypertension with beta-blockers or transjugular intrahepatic portosystemic shunt has not resulted in a reduction in the incidence of bleeding episodes and transfusion requirements (8,14). Other medical therapies that were used, with variable success rates, include corticosteroids (15 -17), tranexamic acid (18,19) and thalidomide (20).…”

Section: Discussionmentioning

confidence: 99%