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Gastric antral vascular ectasia (GAVE)
Published in Mohammad Ibrarullah, Atlas of Diagnostic Endoscopy, 2019
Gastric antral vascular ectasia (GAVE) accounts for nearly 4% of non-variceal UGI bleeding. The entity commonly occurs in association with chronic liver disease, chronic renal failure, autoimmune connective tissue disorder, bone marrow transplantation, ischemic or valvular heart disease, hypertension, familial Mediterranean anemia and acute myeloid anemia. The pathogenesis of the entity is not clearly understood. The presentation ranges from occult to frank GI bleeding. Two types of lesions have been identified on endoscopy: punctuate or striped. Because of similarity in appearance, the striped variety is also known as “watermelon” stomach. Though the antral region shows predominant involvement, occasionally it may extend to the gastric fundus as well. In chronic liver disease, it must be differentiated from portal hypertensive gastropathy as the treatment modalities for both are quite different. Unlike PHG, reduction in portal pressure has no effect on GAVE. Argon plasma coagulation, laser photocoagulation and heater probe application are the accepted modalities of treatment. Rarely, antrectomy may be required for uncontrolled hemorrhage.
Investigations and diagnosis
Published in Aparna Palit, Arun C. Inamadar, Systemic Sclerosis, 2019
Arun C. Inamadar, Ajit B. Janagond
Upper GI endoscopy is indicated to look for esophagitis, strictures, bleeding, and Barrett’s esophagus.3,4,8 Some patients may require periodic upper GI endoscopy to rule out gradual development of esophageal malignancy.3,8 The gastric antral vascular ectasia (GAVE) can be diagnosed by endoscopy as longitudinal convergent red strips of vasculature at the pylorus (watermelon stomach).4,8
Esophageal and Gastric Bleeding
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
Gastric antral vascular ectasia (GAVE) is a rare cause of gastric bleeding often associated with systemic illnesses: cirrhosis of the liver, autoimmune connective tissue diseases, and chronic renal failure. It is important to differentiate GAVE from diffuse gastropathy due to portal hypertension. GAVE affects mostly the gastric antrum while portal gastropathy commonly affects the gastric cardia and fundus. GAVE-associated bleeding cannot be controlled with measures that reduce portal pressure. Endoscopic ablation with either Nd:YAG-laser or argon plasma coagulation is the treatment of choice. Partial antrectomy is reserved for severe unresponsive bleeding.
Narrow band endoscopic diagnosis of portal hypertensive gastropathy in cirrhotic patients
Published in Alexandria Journal of Medicine, 2022
Randa Salah Eldin Abdelmoneim Ibrahim, Amr Aly Abdelmoety, Nahed Baddour, Perihan Salem, Marwa Metawea
PHG is diagnosed mainly by endoscopic tool rather than histopathology examination due to the fact of poor correlation between endoscopic and histological findings [8]. Over years, different classifications were proposed to define the degrees of PHG and to decrease the interobserver disagreement like McCormak classification, New Italian Endoscopy Club (NIEC) classification, and Baveno classification [6]. McCormak was the first to describe PHG and he proposed a classification that divided the forms of PHG into mild and severe. But the problem was in the intermediate forms and their descriptions. After that in 1994, NIEC proposed another classification to overcome the defects in the previous one and deals more with the intermediate stage. But this classification was too complex with several grades in the intermediate stage, as it divided the mosaic pattern into pink, red center, or red. In 1996, Baveno score system was proposed depending on a score system where it divided red markings in either isolate or confluent and the mosaic pattern in mild (pink mosaic pattern) and severe (red mosaic pattern). In addition, the presence of gastric antral vascular ectasia was added [9]. The aim of any classification is to be simple, accurate and to increase interobserver reliability. But unfortunately, till now there is no ideal classification.
Comment on “Mucosal miR-3677 is over-expressed in cirrhotic patients with gastric antral vascular ectasia (GAVE)”
Published in Scandinavian Journal of Gastroenterology, 2019
Yue Zhang, Yan Xu, Chenyu Li, Lin Che, Yanfei Wang
We read with great interest the article by Michał Żorniak and colleagues [1]. The study’s findings are instructive for developing therapeutic regimen in Gastric antral vascular ectasia (GAVE) in liver cirrhosis. On the other hand, in our opinion, the bioinformatics analyses need further context as the statistics for differential fold changes in expression data are not explained fully. For example, the authors seem to use unadjusted p values for detecting differentially expressed genes (DEGs) between the endoscopically changed gastric tissue and control tissue obtained from the same liver cirrhosis patient. Due to the high false positives caused by a large number of probes and multiple comparisons, it seems essential to analyze microarray data properly to reach a reliable result by a statistical method. Only selecting DEGs with unadjusted p values <0.05 by one-way analysis of variance is not reliable and suitable for high-level microarray analysis.
Gastrointestinal bleeding in von Willebrand patients: special diagnostic and management considerations
Published in Expert Review of Hematology, 2023
Edwin Ocran, Nicholas L.J. Chornenki, Mackenzie Bowman, Michelle Sholzberg, Paula James
Recurrent GI tract bleeding from angiodysplasia is a significant problem seen in up to 38% of individuals with VWD [29] and has been reported in all the VWD types, with the majority of cases in type 2, particularly those missing the HMWM of VWF, and type 3 VWD [30,31]. A multicenter European study evaluating bleeding symptoms in Type 1 VWD revealed that compared to the general population, Type 1 VWD patients had only a slightly increased risk of GI bleeding [32]. As well, although specific literature is limited with regard to the association between VWD clearance defects and angiodysplasia, a seven-year prospective study of patients with the clearance defect, VWD Vicenza, reported no GI bleeding symptoms in patients [33]. Interestingly, GI tract bleeding from angiodysplasia appears to be mainly small bowel in nature and while gastric angiodysplasia lesions have been reported, to our knowledge gastric antral vascular ectasia (GAVE) syndrome is not known to be associated with VWD [20]. Angiodysplasia-related GI-bleeding is also common in AVWS [34]. Particularly susceptible are individuals with AVWS caused by aortic stenosis (AS) and left ventricular assist devices (LVAD) [35,36]. The triad of AS, AVWS and recurrent GI bleeding due to angiodysplasia is referred to as Heyde syndrome [37]. AWVS in these circumstances is characterized by a loss of HMWM of VWF due to elevated shear stress from the stenotic valve, which induces a conformational change in the VWF protein, exposing cryptic exosites and scissile bonds to degradation by a disintegrin-like and metalloprotease with thrombospondin-type 1 repeats, member-13 (ADAMTS-13) [38,39].