Gastric Antral Vascular Ectasia Pathogenesis and the Link to the Metabolic Syndrome

Abstract

Historically, GAVE has been associated with connective tissue disease and liver disease. Based on these associations and its histologic appearance, GAVE has presumed to be caused by mechanical- and hormonally mediated injury. Recent findings have been notable for a clinical association with aspects of the metabolic syndrome. Therefore, the pathogenic etiology may be akin to aspects of the metabolic syndrome via microvascular injury and neoangiogenesis. The potential etiologies of GAVE include hypergastrinemia, mechanical injury, and microvascular injury with neovascular proliferation particularly in the metabolic syndrome. Further research is needed to evaluate these proposed mechanisms and potential targets for treatment.

An Unexpected Association: Might GAVE Pave the Way to How the Metabolic Syndrome Behaves

“…Several theories have arisen, such as hypergastrinemia having a potential relation to GAVE. 15 Investigating these relationships has the potential to advance treatment of GAVE on more than one front. Controlling the underlying metabolic syndrome factors could help treat GAVE in patients without cirrhosis.…”

“…Once liver transplant occurs, these hormones normalize. Several theories have arisen, such as hypergastrinemia having a potential relation to GAVE 15 . Investigating these relationships has the potential to advance treatment of GAVE on more than one front.…”

“…1). The most common suggestion is that GAVE is a manifestation of metabolic syndrome and presents with a similar pathophysiology related to metabolic syndrome 15 . Metabolic syndrome is a series of genetic and acquired factors that create a proinflammatory and prothrombotic state predisposing individuals to vascular disease 10,11,16 .…”

Gastric antral vascular ectasia in a patient with lupus undergoing hemodialysis: a case report

“…GAVE was first reported by Rider et al, characterized with longitudinal streaks of erythematous mucosa, termed as watermelon stomach based on the striped appearance [6]. Previous studies suggested that GAVE is an acquired disease that can be caused by mechanical stress, such as portal hypertension, hormones, such as gastrin, CKD, and connective tissue disease [7].…”

Is endoscopic band ligation the gold standard for gastric antral vascular ectasia?

“…Several hypotheses have been proposed, including mechanical stress due to the relatively higher pressure in the antrum, hormone imbalance mostly related to hypergastrinemic states, and an association with tyrosine kinase inhibitors. 1 2 3 Yet none of the above appears to have any direct implication regarding our current therapeutic options. However, the association with chronic kidney disease, advanced liver disease, systemic sclerosis, and metabolic syndrome is unquestionable, suggesting that optimizing management of these chronic diseases should improve the outcome of secondary conditions such as GAVE.…”