Diffuse vascular ectasia of the antrum, duodenum, and jejunum in a patient with nodular regenerative hyperplasia. Lack of response to portosystemic shunt or gastrectomy.

Abstract

The case is reported of a 70 year old man who presented with severe anaemia because of chronic gastrointestinal blood loss. This loss was ascribed to vascular ectasia resembling the gastric antral vascular ectasia syndrome but extended to include the antrum, the duodenum, the jejunum, and, possibly, the cardiac area. This condition was associated with portal hypertension as a result of nodular regenerative hyperplasia. Consecutive treatments including sucralfate, prostaglandin E2, propranolol, organic nitrates, pentoxyphilline, corticosteroids, endoscopic sclerotherapy, portosystemic shunt, total gastrectomy, proved ineffective.

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

“…Procedures aimed at reducing portal pressures include surgical construction of portosystemic shunts (SPSS) and radiological placement of TIPS. Initial case reports showed disappointing results [30, 37]. A small series of 8 (7 TIPS, 1 SPSS) showed a significant reduction in portal pressures in 7 cases.…”

“…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.…”

Application of various endoscopic techniques in the treatment of GAVE-syndrome

“…Типичная локализация GAVE-синдрома -антраль-ный отдел [4]. В единичных случаях характерные проявления могут быть найдены в кардии [5], две-надцатиперстной кишке [6], прямой кишке [7].…”

Duodenal vascular ectasia (DUVE) associated with hematopoietic stem cell transplant

“…We present the second reported case of a patient with GAVE and duodenal vascular ectasia (DUVE) associated with HSCT. GAVE is usually limited to the antrum and rarely involves either the duodenum or jejunum [1,2]. It classically appears as red spots or patches in a linear or diffuse collection endoscopically [3].…”