Elsevier

Gastrointestinal Endoscopy

Volume 44, Issue 3, September 1996, Pages 223-229
Gastrointestinal Endoscopy

Bleeding from gastric antral vascular ectasia in marrow transplant patients,☆☆,,★★

https://doi.org/10.1016/S0016-5107(96)70155-4Get rights and content

Abstract

Background: Gastric antral vascular ectasia (GAVE) leads to blood loss in the disorders of “watermelon stomach” and portal gastropathy, but is not a commonly recognized complication of marrow transplantation.

Methods: GAVE was diagnosed when capillary ectasia, focal capillary thromboses, and fibromuscular hyperplasia were identified in antral mucosal biopsy specimens. Marrow transplant patients bleeding from GAVE were reviewed to ascertain common variables in their pretransplant, posttransplant, and bleeding course.

Results: Six patients developed bleeding due to GAVE. The onset of bleeding was 18 to 94 days after transplant and required an average of 37 U of blood (range, 2 to 130 U). Two patients stopped bleeding after restoration of platelet counts. Two patients had surgical antral resections; both died of multiorgan failure after surgery. Two patients had successful endoscopic laser ablation of vascular lesions and survived. Factors possibly associated with GAVE included male gender, VOD of the liver, oral busulfan as part of the conditioning regimen, and growth factor use after transplant.

Conclusions: GAVE was a cause of gastric bleeding in six patients with marrow transplant patients. Restoration of platelet counts and endoscopic laser photocoagulation are the therapies of choice for ongoing bleeding in these patients. (Gastrointest Endosc 1996:44;223-9.)

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.

References (37)

  • JL Petrini et al.

    Heat probe treatment for antral vascular ectasia

    Gastrointest Endosc

    (1989)
  • KF Binmoeller et al.

    Bipolar electrocoagulation for watermelon stomach

    Gastrointest Endosc

    (1990)
  • JD Frager et al.

    Treatment of a patient with watermelon stomach using transendoscopic laser photocoagulation

    Gastrointest Endosc

    (1988)
  • CJ Gostout et al.

    Endoscopic laser therapy for watermelon stomach

    Gastroenterology

    (1989)
  • MC Shuhart et al.

    Gastrointestinal and hepatic complications

  • GB McDonald et al.

    Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients

    Ann Intern Med

    (1993)
  • GB McDonald et al.

    The human gastrointestinal tract after allogeneic marrow transplantation

  • JL Wolford et al.

    Gastrointestinal bleeding after marrow transplant: a prospective study of risk factors, etiology, and outcome

    Gastroenterology

    (1987)
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      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

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      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.

    ☆☆

    Our research is supported by grants from the National Institutes of Health, National Cancer Institute (CA 18029 and CA 15704).

    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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