Gastric Antral Vascular Ectasia - Risk Factors and Treatment

What Is Gastric Antral Vascular Ectasia?

Gastric antral vascular ectasia is a rare condition that causes the stomach lining to bleed. It is also commonly known as a watermelon stomach. The hallmark sign of GAVE is red strips on the stomach lining, that give an appearance like that of a watermelon. Though some people experience no symptoms, others feel tired and notice blood in their stool. This condition makes the blood vessels of the stomach lining fragile and bleed. Red vertical stripes develop along the inside of the stomach. The stomach lining looks like the outer appearance of a watermelon.

What Are the Causes of Gastric Antral Valve Ectasia?

The exact cause of gastric antral vascular ectasia remains unclear. But various theories have been proposed. They include:

• Hypergastrinemia (increased level of gastrin in the stomach).

• Achlorhydria (a condition that makes the stomach restrict the production of hydrochloric acid, an acid that breaks down food).

• Low levels of pepsinogen enzymes.

• Failure of the liver due to hormone buildup which dilates blood vessels.

What Are the Symptoms of Gastric Antral Vascular Ectasia?

GAVE can sometimes cause no symptoms at all. If a person experience symptoms they include:

• Vomiting blood.

• Fatigue.

• Nausea.

• Abdominal pain.

• Blood in stools.

• Internal bleeding.

• Chronic blood loss.

• Lack of iron in the blood (iron deficiency anemia).

Iron deficiency anemia often results in this condition. Individuals lose blood and lose iron it contains. Iron is used to make hemoglobin, a substance that enables blood to carry oxygen. Lack of oxygen in the blood can make the individual tired and have shortness of breath.

What Are the Risk Factors of Gastric Antral Vascular Ectasia?

Gastric antral valve ectasia is associated with certain risk factors. Females are more likely to get this condition than males and mostly affects older adults.

Gastric antral vascular ectasia also occurs along with other conditions like:

• Vascular disease (the condition that affects the blood vessels that carry oxygen and nutrients through the body and remove waste from tissues).

• Hypertension (high blood pressure).

• Metabolic syndrome (combination of hypertension, diabetes, and obesity).

• Cardiac disease.

• Autoimmune conditions (conditions where an individual's immune system mistakenly attacks the own body).

• Diabetes.

• Chronic renal failure (a condition where the kidney fails to filter the waste products from the body).

• Cirrhosis (scarring of the liver).

• Atrophic gastritis (condition leading to inflammation of stomach lining).

• Pernicious anemia (reduction in red blood cells due to lack of vitamin B12).

• Scleroderma (a condition that results in the thickening of the skin).

How Is Gastric Antral Vascular Ectasia Diagnosed?

Diagnosis of gastric antral vascular ectasia is done by doing an endoscopy. Endoscopy is a procedure where a thin flexible tube with a camera light head is used to insert the gastrointestinal tract via the throat, and this helps in capturing images of the stomach.

Individuals with gastric antral vascular ectasia have visible signs like vertical red stripes over the stomach lining. Along with endoscopy, a tissue sample from the affected part is taken for external examination known as a biopsy to confirm the diagnosis. A complete blood test is also done to have a clear picture of the signs of anemia.

What Is the Treatment Provided for Gastric Antral Vascular Ectasia?

The treatment for gastric antral vascular ectasia initially after the diagnosis is done by providing iron supplements to the individual. Iron deficiency anemia is treated by iron replacement tablets and with regular blood transfusions. Medications to control bleeding are also prescribed. Still, it is being studied for the safety and long-term effectiveness of the medication. Medications used for treatment include:

• Hormone therapy.

• Corticosteroids.

• Thalidomide (not suitable for pregnant females or females trying to conceive).

• Tranexamic acid.

• Octreotide.

Various endoscopic treatments also help in stopping the bleeding. The treatments include:

• Endoscopic Band Ligation (EBL): This procedure involves using elastic bands around the enlarged blood vessels that help in preventing bleeding. These bands pinch in a small loop of blood and cut off the flow of blood. The pinched loop drops off and the blood vessel repairs itself. This procedure has a higher rate of bleeding control and reduces the need for blood transfusions.

• Argon Plasma Coagulation (APC): This treatment procedure is the gold standard treatment for gastric antral vascular ectasia. It uses ignited argon gas to seal and burn the blood vessels that are bleeding. They can remove around 80 to 100 percent of the lesions and can also reduce the need for blood transfusions within three sessions.

• Neodymium-Doped Yttrium Aluminum Garnet (ND: YAG) Laser Coagulation: The procedure is done by heat to burn the affected blood vessels and seal the bleeding vessels. They are effective in preventing the need for blood transfusions and further bleeding in a maximum of four sessions.

• Radiofrequency Ablation (RFA): This treatment procedure uses heat produced by radio waves to destroy the blood vessels that are affected. Studies prove that it is helpful in increasing hemoglobin levels and reducing the need for blood transfusions.

• Cryotherapy: This procedure uses nitrous oxide to freeze blood vessels that have been affected by gastric antral vascular ectasia. Five in seven individuals had no signs of bleeding after an average of 3.6 sessions of cryotherapy. Studies on a larger basis are needed to confirm these findings.

Both EBL and APC are reliable and effective in treating gastric antral vascular ectasia to a greater extent still surgery may be required for those individuals who do not respond to the treatment. This involves the removal of the affected parts of the stomach. In extreme cases, surgery is the only reliable mode of treatment left.

Conclusion

Gastric antral vascular ectasia is an important diagnosis that is considered in older individuals with severe anemia. This syndrome can be inadvertently overlooked as a remediable cause of gastrointestinal bleeding among individuals with hepatic and renal disease. Gastric antral vascular ectasia mimics portal hypertensive gastropathy (PHG) and antral gastritis. One in forty cases is diagnosed with gastric antral vascular ectasia during screening gastroscopies. Though the exact cause is unknown it is associated with many underlying conditions.