, Karolinska Hospital, Stockholm, Sweden

Disclosures

June 27, 2002

Discussion

GAVE was initially distinguished by the occurrence of multiple confluent telangiectasias longitudinally oriented and located on the mucosal crests of the antrum, thus giving a watermelon-like appearance.

Two forms of GAVE have been clearly identified: punctate type and striped type. The punctate-type consists of multiple, sharply demarcated red spots (Figures 1 and 2), even involving the proximal stomach The striped type corresponds to the original definition of watermelon stomach, as indicated above.

Because the ectasias in GAVE may be present in the proximal stomach, some investigators have proposed the term "gastric vascular ectasia" as more suitable.

The pathogenesis of GAVE remains unknown. Associations with cirrhosis, autoimmune connective tissue disorders, and chronic renal failure have all been described. The punctate type seems to be primarily associated with cirrhosis, whereas the striped type can be present in cirrhotic and noncirrhotic patients.

Occult upper gastrointestinal bleeding with iron-deficiency anemia represents the most frequent form of clinical presentation. Melena and hematemesis have been documented in a few cases.

At endoscopy, the lesions may resemble hemorrhagic gastritis or comb-like erythema, but careful inspection should help to establish the diagnosis. In cases of uncertainty, mucosal biopsy may establish the diagnosis.

Histologic examination of resected specimens reveals dilatation of mucosal capillaries, with focal thrombosis and tortuous submucosal venous channels.

Antrectomy was initially the preferred treatment, but argon plasma coagulation and laser therapy are currently the endoscopic methods of choice. GAVE does not respond to transjugular intrahepatic portosystemic shunts, and therefore it is not a recommended treatment in cirrhotic patients.

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