Gastric Antral Vascular Ectasia: Case Report and Review of the Literature

Abstract

Gast ric antral vascular ectasia (GAVE) is a rare cause of upper gastrointestinal (GI) bleeding, accounting for 4% of nonvariceal upper GI bleeding and associated with occult bleeding that manifests as iron deficiency anemia. 1 In recent years, it has emerged as a distinctive, well-defined entity within the spectrum of acquired vasculopathies of the stomach.We report two cases of GAVE presenting with two different endoscopy findings. We discuss the etiology, endoscopic features, histology, pathogenesis, and management options of this rare entity, and present a review of the pertinent literature. Case 1A man, age 57 years, presented with a one-week history of hematemesis. He described three episodes of coffee ground emesis, about a half-cupful on each occasion. The most recent episode occurred on the day of admission. His past medical history was significant for alcoholic cirrhosis with portal hypertension. He had an episode of hematochezia in the past that was diagnosed as a diverticular bleed on colonoscopy. His social history was significant for alcohol abuse, but he had quit drinking about 10 years prior.His vital signs showed a temperature of 98.9 o F, pulse 102 beats/minute, respiratory rate 16 breaths/minute, and blood pressure 120/79 mm Hg. Physical examination revealed a pale, jaundiced, malnourished male with ascites, pedal edema, and bilateral basal crackles. Initial laboratory studies were significant for hemoglobin of 8.8 gm/dL (reference range 12.9-17.3 g/dL). Serum liver tests Gastric antral vascular ectasia is the source of up to 4% of nonvariceal upper gastrointestinal bleeding. It can present with occult bleeding requiring transfusions or with acute gastrointestinal bleeding. It is associated with significant morbidity and mortality and has been associated with such underlying chronic diseases as scleroderma, diabetes mellitus, and hypertension. Approximately 30% of cases are associated with cirrhosis. We report two cases of gastric antral vascular ectasia with two strikingly different endoscopic appearances. We further describe the clinical, endoscopic, histologic, and therapeutic aspects of this entity.

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

“…Inflammatory cells and fibrin thrombi are generally absent [3,139] . Characteristic histologic features of GAVE include presence of fibrin thrombi in dilated capillaries and fibromuscular proliferation within the lamina propria [96,216] .…”

Mass-like Dieulafoy’s lesion associated with advanced gastric cancer at the antrum of stomach: a case report and literature review

“…However, any association of GAVE and gastric cancer is reportedly rare [14]. Patients diagnosed are predominantly elderly females with mean age of 73 years, and they are usually associated with underlying chronic diseases, particularly cirrhosis (30%) and autoimmune diseases (62%) [15]. The characteristic endoscopic finding is “watermelon stomach” – alternating hyperemic streaks with normal mucosa radiating in a spoke-like fashion from the pylorus to the antrum.…”

GAVE: An interesting cause of iron deficiency anemia

“…4 Although several theories including achlorhydria, hypergastrinemia, and low pepsinogen levels have been proposed; the pathophysiology of GAVE remains unclear. 8 One of the pathogenetic mechanisms proposed is partial prolapse of loosely attached gastric mucosa of antrum due to vigorous gastric peristalsis. So there is intermittent obstruction of submucosal blood vessels and hence vascular ectasia.…”