Watermelon stomach: a rare cause of anemia in patients with end-stage renal disease

Pisharam, Jayakrishnan K.; Ramaswami, Arunachalam; Chong, Vui Heng; Tan, Jackson

doi:10.5414/cn107527

Cited by 6 publications

(4 citation statements)

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“…In autoimmune and connective tissue diseases, mechanical stress, dysfunction of antropyloric motility and disordered peristaltic waves can prolapse of gastric mucosa in the distal part of the stomach which can lead to the development of ectatic blood vessels (16,17). Many cases of GAVE were reported with endstage renal disease (18)(19)(20). Similarly, we found renal failure (23.3%) was highly associated with GAVE cohorts too.…”

Section: Discussionsupporting

confidence: 79%

Predictors of blood transfusion and in-hospital outcomes in patients with gastric antral vascular ectasia (GAVE): a nationwide population-based analysis

Patel¹,

Desai²,

Desai³

et al. 2019

Ann. Transl. Med

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Background: Gastric antral vascular ectasia (GAVE) is a rare cause of chronic non-variceal upper gastrointestinal (GI) bleeding and can turn into life-threatening bleed in some patients. Packed red blood cell (PRBC) transfusions are often required in these patients during hospitalization. We aimed to investigate the hospitalization outcomes and predictors of PRBC transfusions in patients with GAVE lesions. Methods: Using the ICD-9-CM codes (537.82, 537.83), we queried the National Inpatient Sample (NIS) [2010-2014] to recognize hospitalized GAVE patients. A 1:2 random sample was obtained from the non-GAVE cohort and these groups were compared (GAVE vs. non-GAVE). The predictors of PRBC transfusion in GAVE cohort were analyzed with multivariate analysis by using SPSS Statistics 22.0. Results: We included weighted 89,081 GAVE and 178,550 non-GAVE hospitalized patients. The GAVE patients were tended to be older, female and white. Significantly higher proportions of comorbidities such as congestive heart failure, diabetes, hypertension, hypothyroidism, liver disease, renal failure, Sjogren syndrome, systemic sclerosis and portal hypertension, etc. were present in these patients. The all-cause inpatient mortality was found to be 1.4%. The mean hospital charges and length of stay (LOS) per GAVE hospitalization were $36,059 and 4.63±5.3 days, respectively. A total of 6,276 (weighted 31,102) (34.9%) of these patients received at least one PRBC transfusion during hospitalization. Advanced age, multiple comorbidities, non-elective admissions, male gender, and African American race were the independent factors associated with higher chances of receiving PRBC transfusion. Conclusions: Our analysis showed that hospitalized patients with GAVE lesions had lower overall mortality rate despite having multiple comorbidities. There was no difference in the LOS and hospital charges between the two cohorts. Nearly 35% of the GAVE patients received at least one PRBC transfusion.

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Section: Discussionsupporting

confidence: 79%

Predictors of blood transfusion and in-hospital outcomes in patients with gastric antral vascular ectasia (GAVE): a nationwide population-based analysis

Patel¹,

Desai²,

Desai³

et al. 2019

Ann. Transl. Med

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“…The association of CKD and end-stage renal disease with GAVE is not well defined in the literature and is mainly described in case reports of patients with CKD, including those on hemodialysis [18,[42][43][44][45]. The pathogenesis of CKDassociated GAVE is unknown but has been theorized to be linked to poor renal excretion of vasoactive mediators such as gastric and prostaglandin E2, poor gastric motility, and uremic platelet dysfunction [18,[46][47][48].…”

Section: Discussionmentioning

confidence: 99%

Portal Hypertension and Chronic Kidney Disease Significantly Increase the Risk of Early Unplanned Readmissions in GAVE- Related Admissions

Pioppo

Bhurwal

Mutneja

et al. 2020

JGLD

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Background & Aims: Gastric antral vascular ectasia (GAVE) is an uncommon cause of non-variceal upper gastrointestinal bleeding that is characterized by dilation of blood vessels in the antrum of the stomach. Various co-morbidities are associated with the development of GAVE, but the impact of co-morbidities on unplanned GAVE readmissions is unclear. The aim of this study was to assess the national incidence, 30-day mortality rate, and 30-day readmissions related to GAVE. Secondary outcomes were evaluation of predictors of early readmission, hospital length of stay (LOS) and total hospitalization charges. Methods: Using the 2016 National Readmission Database, we analyzed discharges for GAVE. ICD-10 CM codes were utilized to identify associated comorbidities and inpatient procedures during the index admission. 30-day readmissions were identified for GAVE. Secondary measures of outcomes including LOS and hospitalization charges were also calculated. Risk factors for early readmission were also evaluated using multivariate analysis to adjust for confounders. Results: A total of 18,375 index admissions for GAVE were identified. 20.49% (n=3,720) of the discharged patients were readmitted within 30 days. 30-day mortality of GAVE-related admissions was 1.82% (n=335). Early readmissions accounted for 20,157 hospital days along with $189 million in hospitalization costs. Multivariate analysis revealed that the presence of portal hypertension (OR 1.63; 95% CI 1.37-1.93; p=0.0001) and chronic kidney disease (CKD) (OR 1.62, 95% CI 1.44-1.82; p<0.0001) significantly increased the odds of early readmission. Conclusions: Our analysis demonstrates that the overall 30-day mortality rate of GAVE-related admissions is relatively low, but the 30-day readmission rate is significantly high. Patients with comorbid CKD and portal hypertension have a significantly higher risk of readmission. Further studies are required to determine if therapeutic interventions such as argon plasma coagulation or radiofrequency ablation during the index admission may prevent readmissions in these specific subgroups.

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“…6 GAVE was first described by Rider et al in 1953 and defined as watermelon stomach by Jabbari et al in 1984 to describe the classic endoscopic appearance. [6][7][8] There are two main forms of GAVE. 6,9 The diffuse variety presents vascular ectasia extending from the proximal region of the stomach to the antrum with erythematous patches secondary of dilated vessels that are diffusely located and it is usually associated with cirrhosis and portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Non-cirrhotic patients are more likely to have classic watermelon stomach. [6][7][8][9] The etiology of GAVE syndrome remains unknown and has been associated with several disease states, including autoimmune disease (e.g., systemic sclerosis, systemic lupus erythematosus, atrophic gastritis with pernicious anemia), renal failure, heart disease, liver cirrhosis and bone marrow transplantation. 6,[9][10][11] In this patient some factors were discarded such as autoimmune disease, coagulopathy, evident inflammation, vitamin deficiency, hemolysis, liver or heart disease by physical examination and laboratory tests.…”

Section: Discussionmentioning

confidence: 99%

Resistência à eritropoetina em paciente com IRC e ectasia vascular gástrica

Lee¹,

Fragata²,

Pestana³

et al. 2015

Jornal Brasileiro De Nefrologia

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We observed a case of recombinant human erythropoietin resistance caused by Gastric Antral Vascular Ectasia in a 40-year-old female with ESRD on hemodialysis. Some associated factors such as autoimmune disease, hemolysis, heart and liver disease were discarded on physical examination and complementary tests. The diagnosis is based on the clinical history and endoscopic appearance of watermelon stomach. The histologic findings are fibromuscular proliferation and capillary ectasia with microvascular thrombosis of the lamina propria. However, these histologic findings are not necessary to confirm the diagnosis. Gastric Antral Vascular Ectasia is a serious condition and should be considered in ESRD patients on hemodialysis with anemia and resistance to recombinant human erythropoietin because GAVE is potentially curable with specific endoscopic treatment method or through surgical procedure.

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Watermelon stomach: a rare cause of anemia in patients with end-stage renal disease

Cited by 6 publications

References 0 publications

Predictors of blood transfusion and in-hospital outcomes in patients with gastric antral vascular ectasia (GAVE): a nationwide population-based analysis

Predictors of blood transfusion and in-hospital outcomes in patients with gastric antral vascular ectasia (GAVE): a nationwide population-based analysis

Portal Hypertension and Chronic Kidney Disease Significantly Increase the Risk of Early Unplanned Readmissions in GAVE- Related Admissions

Resistência à eritropoetina em paciente com IRC e ectasia vascular gástrica

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