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World J Gastrointest Endosc. Jan 16, 2013; 5(1): 6-13
Published online Jan 16, 2013. doi: 10.4253/wjge.v5.i1.6
Diagnosis and management of gastric antral vascular ectasia
Lorenzo Fuccio, Alessandro Mussetto, Liboria Laterza, Leonardo Henry Eusebi, Franco Bazzoli
Lorenzo Fuccio, Liboria Laterza, Leonardo Henry Eusebi, Franco Bazzoli, Department of Clinical Medicine, S.Orsola-Malpighi University Hospital, 40138 Bologna, Italy
Alessandro Mussetto, Department of Gastroenterology, S. Maria delle Croci Hospital, 48121 Ravenna, Italy
Author contributions: Fuccio L contributed to study concept and design; Fuccio L, Mussetto A, Laterza L and Eusebi LH contributed to drafting of the manuscript; Fuccio L, Mussetto A, Laterza L, Eusebi LH and Bazzoli F contributed to critical revision of the manuscript for important intellectual content; Fuccio L contributed to final approval of the version to be published.
Correspondence to: Lorenzo Fuccio, MD, Department of Clinical Medicine, S.Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy. lorenzofuccio@gmail.com
Telephone: +39-51-6363338 Fax: +39-51-6363338
Received: May 5, 2012
Revised: September 26, 2012
Accepted: December 1, 2012
Published online: January 16, 2013
Abstract

Gastric antral vascular ectasia (GAVE) is an uncommon but often severe cause of upper gastrointestinal (GI) bleeding, responsible of about 4% of non-variceal upper GI haemorrhage. 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 radially departing from pylorus, defined as watermelon stomach, or arranged in a diffused-way, the so called honeycomb stomach. The histological pattern, although not pathognomonic, is characterized by four alterations: vascular ectasia of mucosal capillaries, focal thrombosis, spindle cell proliferation and fibrohyalinosis, which consist of homogeneous substance around the ectatic capillaries of the lamina propria. 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 cirrhosis. Autoimmune disorders, mainly represented by Reynaud’s phenomenon and sclerodactyly, are co-present in about 60% of patients with GAVE; other autoimmune and connective tissue disorders are occasionally reported such as Sjogren’s syndrome, systemic lupus erythematosus, primary biliary cirrhosis and systemic sclerosis. In the remaining cases, GAVE syndrome has been described in patients with chronic renal failure, bone marrow transplantation and cardiac diseases. The pathogenesis of GAVE is still obscure and many hypotheses have been proposed such as mechanical stress, humoural and autoimmune factors and hemodynamic alterations. In the last two decades, many therapeutic options have been proposed including surgical, endoscopic and medical choices. Medical therapy has not clearly shown satisfactory results and surgery should only be considered for refractory severe cases, since this approach has significant mortality and morbidity risks, especially in the setting of portal hypertension and liver cirrhosis. Endoscopic therapy, particularly treatment with Argon Plasma Coagulation, has shown to be as effective and also safer than surgery, and should be considered the first-line treatment for patients with GAVE-related bleeding.

Keywords: Gastric antral vascular ectasia; Bleeding; Watermelon stomach; Argon plasma coagulation