Presentation
GVE can present as upper gastrointestinal bleeding, occult bleeding with anemia, or as abdominal pain. [revistagastroenterologiamexico.org]
Results: There were no significant differences in the demographics, clinical presentation, associated portal hypertension, or mean hemoglobin values or the mean number of transfusions or hospitalizations between the 2 groups before treatment. [mayoclinic.pure.elsevier.com]
Despite several therapeutic approaches have been successfully tested for preventing chronic bleeding, some patients present recurrence of GAVE lesions. [ncbi.nlm.nih.gov]
Image: Gastrolab/ kolumbus.fi S&S Most patients present with iron deficiency anemia as a result of chronic blood loss; rarely, GAVE may present as acute upper GI bleed. [uptodategastro.wordpress.com]
Entire Body System
- Ascites
In this case, the TIPS procedure achieved a complete ascites regression, allowing a safer surgical treatment of the GAVE-related GIB. [ncbi.nlm.nih.gov]
ascites ( Wiesner 2001 ). [doi.org]
Past History H/O Haematemesis – 4 yrs back Evaluated in PGI, found to have esophageal varices USG showed features of CLD with ascites Etiologic work up was negative EVL was done and varices were eradicated and he was on GUT clinic follow [slideshare.net]
Ascites: The greater pressure in the portal vessels may result in serous fluid (pale yellow liquid) to leak from the liver and the intestine and collect in the region of the stomach, leading to ascites. [news-medical.net]
Although one patient (patient no. 3) developed ascites 1 month before the onset of GAVE, his clinical symptoms did not meet the VOD criteria. 6 Rather, all patients exhibited the typical signs of thrombotic microangiopathy (TMA) 20–53 days (median 33 [nature.com]
- Congestive Heart Failure
A 68-year-old male with a history of coronary artery disease, congestive heart failure and diabetes type II who initially presented with symptomatic anemia 2 weeks after starting aspirin and clopidogrel therapy. [jnsbm.org]
GAVE has also been reported with hepatic cirrhosis, chronic renal failure, bone marrow transplant, diabetes mellitus and congestive heart failure. Figure. Endoscopic view of GAVE. [consultqd.clevelandclinic.org]
Gastrointestinal
- Hematochezia
Melena (Black Tarry stools) Hematochezia (Maroon stools) Abdominal pain and discomfort. Fatigue and weakness. Lack of concentration. [digestion.ygoy.com]
Occasionally, a patient may notice melena and/or hematochezia. The chronicity of the anemia also plays a role in whether the patient protests of subsequent symptoms. [sages.org]
Sometimes, a patient may come to the physician because he or she notices blood in the stools—either melena (black and tarry stools) and/or hematochezia (red bloody stools). [en.wikipedia.org]
Rebleeding was defined as a new onset of hematemesis, coffee-ground vomitus, hematochezia, or melena after 24 h of stable vital signs and hematocrit following endoscopic treatment. [bmcgastroenterol.biomedcentral.com]
She was admitted to hospital with worsening fatigue, pallor, melena, and hematochezia. She also exhibited thrombocytopenia and an increased partial thromboplastin time. Other coagulation tests were normal. [current-oncology.com]
- Delayed Gastric Emptying
Isabelle Marie, Guillaume Gourcerol, Anne‐Marie Leroi, Jean‐François Ménard, Hervé Levesque and Philippe Ducrotté, Delayed gastric emptying determined using the 13C–octanoic acid breath test in patients with systemic sclerosis, Arthritis & Rheumatism, [doi.org]
Another complication observed after repeated treatment sessions, is pyloric stenosis, that can induce either delayed gastric emptying or true obstruction[ 54, 55 ]. [wjgnet.com]
- Constipation
Estrogen and Progesterone Therapy: The condition is treated with artificially given estrogen and progesterone hormones. https://holistickenko.com/constipation-food-sensitivity-abdominal-distension-bloating/ Tags: most viewed [digestion.ygoy.com]
Presence of blood in stools Diarrhea Vomiting and nausea Constipation Endoscopic Signs of PHG Lesions The endoscopic appearance of PHG manifests as pink lesions, bleeding papules, fine speckling, multiple bleeding spots, reddened areas, cherry red spots [news-medical.net]
Cardiovascular
- Vascular Disease
The groups were compared for comorbidities including autoimmune disease, cirrhosis, vascular disease, body mass index (BMI), diabetes mellitus, and cirrhosis due to nonalcoholic steatohepatitis. [ncbi.nlm.nih.gov]
Any condition that affects the vascular system, all of in part, is considered a vascular disease. ISN. Diagnosis Photo of Watermelon Stomach As seen by endoscopy. © ISN Photo Repository. [sclero.org]
Definition / general Also called watermelon stomach Rare acquired vascular disease that may cause blood loss and iron deficiency anemia due to chronic antral hemorrhage Associated with connective tissue diseases, particularly systemic sclerosis, but etiology [pathologyoutlines.com]
Digestive System Diseases Angiodysplasia Vascular Diseases Cardiovascular Diseases [clinicaltrials.gov]
- Hypotension
The mainstay of management of portal hypertensive gastropathy is based on portal-hypotensive pharmacological treatment whilst gastric antral vascular ectasia benefits from endoscopic therapy. [ncbi.nlm.nih.gov]
[…] autonomic dysfunction with GAVE syndrome. 12–14 In a retrospective chart review of our patient, we discovered that she had multiple symptoms suggestive of autonomic neuropathy and dysfunction, including neuropathy of the lower extremities, orthostatic hypotension [doi.org]
- Orthostatic Hypotension
hypotension, frequent hypoglycemia, and gastroparesis. [doi.org]
Liver, Gall & Pancreas
- Hepatomegaly
Contrast computed tomography scan of the abdomen revealed hepatomegaly but no other significant gastrointestinal pathology. [doi.org]
Workup
Long-term corticosteroids and heat probe therapy have been reported as a safe options in older, medically unfit patients, while others have advocated endoscopic laser treatment. 16, 17 Our case shows once again that in the workup for differential diagnosis [doi.org]
Serum
- Hypoglycemia
[…] with GAVE syndrome. 12–14 In a retrospective chart review of our patient, we discovered that she had multiple symptoms suggestive of autonomic neuropathy and dysfunction, including neuropathy of the lower extremities, orthostatic hypotension, frequent hypoglycemia [doi.org]
[…] with GAVE syndrome.12–14 In a retrospective chart review of our patient, we discovered that she had multiple symptoms suggestive of autonomic neuropathy and dysfunction, including neuropathy of the lower extremities, orthostatic hypotension, frequent hypoglycemia [ncbi.nlm.nih.gov]
Treatment
Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation. [mayoclinic.pure.elsevier.com]
The current standard endoscopic treatment is with APC. There have been multiple reports and case series in the literature about successful treatment with EBL for GAVE, even in cases where APC was unsuccessful for treatment of GAVE. [clinicaltrials.gov]
Endoscopic treatment outcomes in watermelon stomach patients with and without portal hypertension. Endoscopy. 2004;36:68-72 2. Rosenfeld G, Enns R. Argon photocoagulation in the treatment of gastric antral vascular ectasia and radiation proctitis. [sages.org]
There was no complication related to APC during endoscopy or after treatment in the 74 treatment sessions of 46 patients of the present study. [bmcgastroenterol.biomedcentral.com]
When facing GAVE patients, we are trapped at the selection of treatments, especially patients with cirrhosis and portal hypertension. Generally speaking, endoscopic therapies such as APC were considered as the preferred treatment. [file.scirp.org]
Prognosis
Renal artery stenosis, aortic stenosis, widespread cutaneous and mucosal telangiectasia and hypertension seem to be associated with poor prognosis and should prompt rapid intervention and careful follow-up. [ncbi.nlm.nih.gov]
Renal artery stenosis, aortic stenosis, widespread cutaneous and mucosal telangiectasia and hypertension seem to be associated with poor prognosis and should prompt rapid intervention and careful follow‐up. [doi.org]
Everybody is different so the prognosis for GAVE is difficult to predict. Some patients do quite well, without any recurring bleeds after their initial treatment protocol. [marcusgi.com]
Additional transfusions may be recommended if gastrointestinal bleeding can not be stopped or controlled. [2] Last updated: 8/2/2016 The long-term outlook ( prognosis ) for people with watermelon stomach varies. [rarediseases.info.nih.gov]
Etiology
Gastric antral vascular ectasia (GAVE) is an angiodysplastic disorder of unclear etiology and rare cause of upper gastrointestinal bleeding. [ncbi.nlm.nih.gov]
A different notion describes a more mechanical etiology. [sages.org]
Rare disease associations and unusual clinical findings should be kept in mind for cases with obscure etiologies. We describe a rare cause of chronic anemia with a unique association. [doi.org]
Epidemiology
Portal Hypertensive Gastropathy, Entheropathy and Colopathy Epidemiology The main cause of PHG is liver cirrhosis. Even though about 65% of patients with portal hypertension develops PHG, it occurs greatly in patients with liver diseases. [news-medical.net]
[…] and GAVE syndrome are male (75%) with a mean age of 65 years. 1,2 Associated medical conditions include heart, liver, and kidney diseases; diabetes; connective-tissue diseases; hypothyroidism; and status as a bone marrow transplant recipient. 1–4 The epidemiologic [doi.org]
Up to the present, there had been more data regarding of the epidemiology, pathology including the outcomes of variable treatment modalities for this condition. [jnsbm.org]
This is similar to the epidemiologic features in human susceptible to cirrhosis and connective-tissue diseases to a certain extent [12,13]. [file.scirp.org]
Pathophysiology
This paper gives an overview of studies examining clinical presentation and pathophysiology, and reviews the current evidence for invasive and non-invasive treatments. [ncbi.nlm.nih.gov]
Prevention
Despite several therapeutic approaches have been successfully tested for preventing chronic bleeding, some patients present recurrence of GAVE lesions. [ncbi.nlm.nih.gov]
TIPS and beta-blockers are ineffective for the long-term prevention of recurrent bleeding from GAVE. [link.springer.com]
Building a case: Immunosuppressive therapy for GAVE Currently, immunosuppressive therapy has no defined role in prevention of acute bleeding episodes from GAVE. [consultqd.clevelandclinic.org]
In the case of vascular ectasia bleeding, the use of PPIs could prevent rebleeding after APC hemostasis and enhance procedure-induced ulcer healing. [bmcgastroenterol.biomedcentral.com]
Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection--an analysis of risk factors. Endoscopy. 2008; 40 :179-183. [doi.org]