Bleeding from gastric antral vascular ectasia in marrow transplant patients☆,☆☆,★,★★
Section snippets
Case 1
This 48-year-old man (UPN 6457) developed coffee ground emesis 18 days after transplant. His posttransplant course had been complicated by oral mucositis, VOD of the liver, and renal insufficiency. Endoscopy on day 18 revealed multiple discrete pinpoint hemorrhagic areas in the gastric antrum. When overlying blood was washed away, fresh blood welled up from these pinpoint areas within nonulcerated mucosa. He was treated with omeprazole (40 mg daily) and multiple platelet transfusions, but
DISCUSSION
The most common causes of significant gastrointestinal hemorrhage in marrow transplant patients are GVHD, infectious ulcers, intramural hematomas, and gastric mucosal trauma from retching.4, 10, 11 Bleeding in these patients is exacerbated by low platelet counts.
GAVE is a histologically defined condition that can cause gastric bleeding, usually presenting as iron deficiency anemia. GAVE has been associated with female gender, older age,5, 12, 13 chronic liver disease,14, 15, 16, 17, 18
Acknowledgements
We are grateful to Rodger Haggitt, MD, for his review of the histologic material and his helpful suggestions.
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Cited by (63)
Clinical Characterization of Gastric Antral Vascular Ectasia: A Potential Manifestation of the Metabolic Syndrome
2016, American Journal of MedicineGastric vascular lesions in cirrhosis: Gastropathy and antral vascular ectasia
2015, Gastroenterologia y HepatologiaApproach to the Management of portal hypertensive gastropathy and gastric antral vascular ectasia
2014, Gastroenterology Clinics of North AmericaCitation Excerpt :In addition, GAVE was not described reliably in the past, and it was not until 1995 that the distinction was made between GAVE and PHG in patients with cirrhosis.3 During the evaluation of chronic anemia, GAVE is typically found to be the cause in elderly women and is also is associated with several chronic systemic diseases (chronic renal failure, autoimmune diseases, systemic sclerosis, cardiac diseases, and bone marrow transplantation).2,4 On routine upper endoscopy, GAVE is seen in 3% and 2% of patients with advanced liver disease and those undergoing liver transplantation, respectively.5
Radiofrequency ablation for refractory gastric antral vascular ectasia (with video)
2013, Gastrointestinal EndoscopyUnusual cause of anaemia in scleroderma: Gastric antral vascular ectasia
2011, Indian Journal of RheumatologyThe management of portal hypertensive gastropathy and gastric antral vascular ectasia
2011, Digestive and Liver DiseaseCitation Excerpt :Conversely, PHG is not observed in patients with chronic alcoholism without liver disease or in patients with cirrhosis who do not have portal hypertension [12]. GAVE is also associated to liver disease but, contrary to PHG, it can also be observed in patients with other non-hepatic chronic diseases such as autoimmune connective tissue disorders, bone marrow transplantation and chronic renal failure [13–17]. PHG and GAVE appear to have a completely different pathophysiology although it has not been clearly determined in either case.
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From the Gastroenterology/Hepatology and Pathology Sections, Fred Hutchinson Cancer Research Center, the University of Washington School of Medicine, and the Department of Surgery, Swedish Medical Center, Seattle, Washington.
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Our research is supported by grants from the National Institutes of Health, National Cancer Institute (CA 18029 and CA 15704).
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Reprint requests: George B. McDonald, MD, Gastroenterology/Hepatology (SC 114), Fred Hutchinson Cancer Research Center, 1124 Columbia St., Seattle WA 98104.
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