gastric antral vascular ectasia

Gastric Antral Vascular Ectasia (GAVE): A Rare Cause of Gastrointestinal Bleeding

Gastric antral vascular ectasia, also known as "watermelon stomach," is a rare but significant cause of severe acute or chronic gastrointestinal blood loss in the elderly. It is characterized by dilated small blood vessels in the gastric antrum, which is a distal part of the stomach.

Symptoms and Causes

The symptoms of GAVE include abdominal pain, blood in stool, fatigue, internal bleeding, and iron-deficiency anemia. The condition is associated with heterogeneous medical conditions, including hepatic, renal, and cardiac diseases, but its pathogenesis is unknown [1-3].

GAVE is a capillary-type vascular malformation primarily seen in the prepyloric gastric antrum [4]. Endoscopically, lesions are either arranged as longitudinal streaks converging at the pylorus (stripe type) or as multiple spots (diffuse type) [5].

Prevalence and Diagnosis

GAVE is an uncommon but often severe cause of upper gastrointestinal bleeding, responsible for about 4% of non-variceal upper GI haemorrhage [6]. 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 or as multiple spots [7].

Treatment and Management

Successful treatment of GAVE continues to be a challenge and has evolved through the years. Currently, given the rapid progression of the disease, early diagnosis and management are crucial to prevent complications and improve patient outcomes [8].

References: [1] Rider et al. (1953) [2] Jabbari et al. (1984) [3] Fuccio et al. (2013) [4] Jalil et al. (2013) [5] Fuccio et al. (2013) [6] Fuccio et al. (2013) [7] Rider et al. (1953) [8] Fuccio et al. (2013)

Common Signs and Symptoms of Gastric Antral Vascular Ectasia (GAVE)

Gastric antral vascular ectasia, also known as "watermelon stomach," is a rare condition characterized by abnormal tiny blood vessels in the stomach lining that become prone to bleeding. The symptoms of GAVE can vary from person to person, but here are some common signs and symptoms:

• Blood in stool (poop): One of the most common symptoms of GAVE is the presence of blood in the stool, which can be a sign of gastrointestinal bleeding.
• Fatigue: Due to chronic anemia caused by blood loss, people with GAVE may experience fatigue, weakness, and a lack of energy.
• Abdominal pain: Some individuals with GAVE may experience abdominal pain or discomfort, which can range from mild to severe.
• Internal bleeding: In some cases, the bleeding in GAVE can be internal, leading to symptoms like dizziness, lightheadedness, or fainting.
• Iron-deficiency anemia: The chronic blood loss in GAVE can lead to iron-deficiency anemia, which can cause symptoms like pale skin, shortness of breath, and headaches.
• Nausea and vomiting: Some people with GAVE may experience nausea and vomiting, especially if the bleeding is severe.

It's essential to note that some individuals with GAVE may not exhibit any symptoms at all, or they might only experience mild symptoms. If you suspect you have GAVE or are experiencing any of these symptoms, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

References:

• [1] (Source 4) Gastric antral vascular ectasia (GAVE) is an uncommon cause of chronic gastrointestinal bleeding or iron deficiency anemia.
• [2] (Source 4) The condition is associated with dilated small blood vessels in the gastric antrum, which is a distal part of the stomach.
• [3] (Source 5) GAVE syndrome, also known as watermelon stomach, is a rare but significant cause of severe acute or chronic gastrointestinal blood loss in the elderly.
• [4] (Source 6) Symptoms of GAVE may include chronic anemia, fatigue, abdominal pain, internal bleeding, iron-deficiency anemia, nausea, and vomiting.

Gastric antral vascular ectasia (GAVE) can be diagnosed through several tests, which are used to confirm the presence of abnormal blood vessels in the stomach lining.

• Endoscopic examination: This is the primary diagnostic test for GAVE. During an endoscopy, a flexible tube with a camera and light on the end is inserted through the mouth and into the stomach. The doctor can then view the stomach lining and look for the characteristic "watermelon" stripes or other abnormalities that are indicative of GAVE [1][2][3].
• Endoscopic biopsy: This involves taking a small sample of tissue from the stomach lining during an endoscopy, which is then examined under a microscope to confirm the presence of abnormal blood vessels and spindle cells [4].
• Upper gastrointestinal (GI) endoscopy: This test is similar to an endoscopic examination but may be used in conjunction with other tests such as biopsies or imaging studies.
• Computed tomography (CT) scan: A CT scan can help identify any complications of GAVE, such as bleeding or perforation [5].
• Endoscopic ultrasound (EUS): This test uses a specialized endoscope that has an ultrasound probe on the tip to take images of the stomach lining and surrounding tissues. It can be used to confirm the diagnosis of GAVE and rule out other conditions [6].

It's worth noting that the diagnosis of GAVE is often made based on the characteristic "watermelon" appearance seen during an endoscopy, but in some cases, additional tests may be necessary to confirm the diagnosis.

References: [1] 2. Gastric antral vascular ectasia (GAVE) syndrome, also known as watermelon stomach, is a rare gastrointestinal disorder characterized by abnormal blood vessels in the lining of the stomach. [2] 10. Gastric Antral Vascular Ectasia 570 (Watermelon Stomach) By: Shajan Peter, MD, Division of Gastroenterology and Hepatology, ... Endoscopic examination is the primary diagnostic test. Seen through the endoscope, GAVE stomachs have stripes of redness ("watermelon appearance"), or show honeycombing or nodules. [3] 11. by L Fuccio · 2013 · Cited by 128 — The diagnosis is mainly based on endoscopic pattern and, for uncertain cases, on histology. [4] 13. by JH Gilliam 3rd · 1989 · Cited by 138 — Endoscopic biopsies can reliably diagnose gastric antral vascular ectasia, a vascular disorder characterized by abnormal mucosal vessels and spindle cell ... [5] 14. Diagnosis · an endoscopy · a biopsy of the stomach lining · an endoscopic ultrasound (ultrasound probe on the tip of an endoscope) computed tomography (CT) scan · a ... [6] 15. The least invasive – and clearest – way to diagnose GAVE is to have upper endoscopy. Using a gentle, flexible scope, we send it down through the throat, the ...

Treatment Options for Gastric Antral Vascular Ectasia (GAVE)

While there are various treatment options available for GAVE, drug therapy is one of the approaches that have been explored. However, it's essential to note that the efficacy and safety of pharmacotherapy in treating GAVE have not been sufficiently established [10].

Hormonal Therapy

One of the hormonal therapies that have been tried for GAVE is octreotide, a long-acting somatostatin analogue [3]. Octreotide has been shown to effectively control chronic bleeding related to vascular abnormalities. However, its use in treating GAVE is not without controversy, and more research is needed to confirm its efficacy.

Other Drug Therapies

Besides octreotide, other drug therapies have been tried for GAVE, including:

• Cyproheptadine: This antihistamine has been used to treat GAVE, but its effectiveness is unclear [1].
• Cyclophosphamide: This chemotherapy agent has also been used to treat GAVE, but its use is not without risks and side effects [1].

Fibrinolytic Inhibitors

In some cases, fibrinolytic inhibitors like tranexamic acid have been used to manage bleeding in patients with GAVE. However, the effectiveness of this approach is limited, and more research is needed to confirm its benefits.

Thalidomide

A very few patients may be treated with thalidomide, a medication that has been shown to be effective in treating chronic transfusion-dependent GAVE [13].

It's essential to note that the treatment of choice for GAVE is endoscopic intervention with argon plasma coagulation (APC) [5]. However, drug therapy may be considered as an adjunctive or alternative approach in certain cases.

References:

[1] Context 1 [3] Context 3 [10] Context 10

Differential Diagnosis of Gastric Antral Vascular Ectasia (GAVE)

Gastric antral vascular ectasia (GAVE) is a rare disorder that can be challenging to diagnose, as it shares similar symptoms with other conditions. The main differential diagnosis for GAVE includes:

• Portal Hypertensive Gastropathy (PHG): This condition is often associated with liver cirrhosis and can present with similar endoscopic findings as GAVE. In fact, about 30% of patients with GAVE co-present with PHG [4][11].
• Antral Gastritis: This is another condition that can be mistaken for GAVE on endoscopy, particularly in the antrum.
• Portal Hypertension: The underlying mechanism for portal hypertension can sometimes be confused with GAVE, especially when clinical findings are considered.

Key Points to Consider

• GAVE is often associated with chronic iron-deficiency anemia due to occult or profuse gastrointestinal bleeding [5][10].
• Endoscopic findings of columns of red tortuous vessels along the longitudinal folds of the antrum are characteristic of GAVE [5].
• PHG, on the other hand, is more commonly seen in the fundus and gastric body, whereas GAVE is mostly confined to the antrum [15].

References

[4] Fuccio L. (2013). 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...

[5] Introduction Gastric antral vascular ectasia (GAVE) is a rare disorder characterised by upper GI bleeding, chronic iron-deficiency anaemia and endoscopic findings of columns of red tortuous vessels along the longitudinal folds of the antrum of the stomach.

[10] Gastric antral vascular ectasia (GAVE) is a rare but an important cause of upper gastrointestinal bleeding (UGIB) and commonly presents as occult bleeding that manifests as iron deficiency anemia (IDA).

[11] The main differential diagnosis is with Portal Hypertensive Gastropathy, that can frequently co-exists, since about 30% of patients with GAVE...

[15] 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.