Gastric antral vascular ectasia ("watermelon stomach") is characterized by a prominent longitudinalerythematous fold of gastric antrum. Because it has usually been diagnosed by gastroscopy and biopsy, itsradiologic findings have not been well described. We report a case of gastric antral vascular ectasia, anddescribe its findings, as seen on UGIS, ultrasonography, and computed tomography.
Biopsy ; Gastric Antral Vascular Ectasia* ; Gastroscopy ; Pyloric Antrum ; Stomach ; Ultrasonography

Argon ; Gastric Antral Vascular Ectasia ; physiopathology ; therapy ; Humans ; Laser Coagulation ; methods ; Male ; Middle Aged

Gastric antral vascular ectasia (watermelon stomach) is a rare cause of chronic gastrointestinal bleeding, characterized endoscopically by a distinctive appearance of prominent red vascular folds traversing the gastric antrum and radiating to the pyloric sphincter; this appearance has been likened to the dark stripes on the surface of a watermelon. The etiology is unknown, and the usual presentations are iron-deficiency anemia and melena due to chronic gastric blood loss. Diagnosis is made by the characteristic endoscopic appearance and histologic findings. The treatment of choice is not known yet; surgical resection is curative method, but results from endoscopic treatment with heat probes or lasers are promising. We experienced a case of gastric antral vascular ectasia presenting with epigastric pain and melena in a 34-year-old female. The patient was treated with hemigastrectomy and Billroth II anastomosis.
Adult ; Anemia, Iron-Deficiency ; Citrullus* ; Diagnosis ; Female ; Gastric Antral Vascular Ectasia* ; Gastroenterostomy ; Hemorrhage ; Hot Temperature ; Humans ; Melena ; Pyloric Antrum ; Pylorus

Gastric antral vascular ectasia (GAVE) is a rare but important cause of chronic gastrointestinal bleeding. Endoscopically, it has characteristic thickened red vascular folds radiating from the pylorus to the antrum. Diagnosis is made primarily by endoscopy. Histologic examination of the endoscopic mucosal biopsies may confirm the endoscopic diagnosis. Many treatment modalities of the gastric antral vascular ectasia exist. One of them, the argon plasma coagulation (APC) is an excellent therapeutic tool. Inactive argon gas is converted to ionized form by means of electrical energy. Ionized argon plasma conducts high frequency electrical energy to tissues and leads coagulation necrosis of tissues. We experienced a case of gastric antral vascular ectasia presenting melena for about one month in a 72-year-old man treated endoscopically in four sessions with argon plasma coagulation.
Aged ; Argon Plasma Coagulation* ; Argon* ; Biopsy ; Diagnosis ; Endoscopy ; Gastric Antral Vascular Ectasia* ; Hemorrhage ; Humans ; Melena ; Necrosis ; Plasma ; Pylorus

A major cause of cirrhosis related morbidity and mortality is the development of variceal bleeding, a direct consequence of portal hypertension. Less common causes of gastrointestinal bleeding are peptic ulcers, malignancy, angiodysplasia, etc. Upper gastrointestinal bleeding has been classified according to the presence of a variceal or non-variceal bleeding. Although non-variceal gastrointestinal bleeding is not common in cirrhotic patients, gastroduodenal ulcers may develop as often as non-cirrhotic patients. Ulcers in cirrhotic patients may be more severe and less frequently associated with chronic intake of non-steroidal anti-inflammatory drugs, and may require more frequently endoscopic treatment. Portal hypertensive gastropathy (PHG) refers to changes in the mucosa of the stomach in patients with portal hypertension. Patients with portal hypertension may experience bleeding from the stomach, and pharmacologic or radiologic interventional procedure may be useful in preventing re-bleeding from PHG. Gastric antral vascular ectasia (GAVE) seems to be different disease entity from PHG, and endoscopic ablation can be the first-line treatment.
Gastric Antral Vascular Ectasia/complications ; Gastric Mucosa/pathology ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Hypertension, Portal/*complications/prevention & control ; Liver Cirrhosis/complications ; Peptic Ulcer/complications

BACKGROUND/AIMS: Portal hypertension (PH) is a syndrome characterized by chronic increase in the pressure gradient between the portal vein and inferior vena cava. Previous studies have suggested an increased frequency of antral elevated erosive gastritis in patients with PH, as well as an etiologic association; however, there has not been any histological evidence of this hypothesis to date. Our aim was to evaluate the histological features found in elevated antral erosions in patients with portal hypertension. METHODS: Sixty-nine patients were included; 28 with and 41 without PH. All patients underwent endoscopy, and areas with elevated antral erosion were biopsied. RESULTS: In the PH group, 24 patients had inflammatory infiltration with or without edema and vascular congestion, and 4 patients had no inflammation. In the group without PH, all patients showed inflammatory infiltration of variable intensity. There was no statistical significance between the two groups in the presence of Helicobacter pylori. There as a histological similarity between the two groups, if PH patients without inflammation were excluded; however, more edema and vascular congestion were observed in the PH group (p=0.002). CONCLUSIONS: The findings show that elevated antral erosions in patients with PH have more evident edema and vascular congestion in addition to lymphocytic infiltration.
Edema ; Endoscopy ; Estrogens, Conjugated (USP)* ; Gastric Antral Vascular Ectasia ; Gastritis ; Helicobacter pylori ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Portal* ; Inflammation ; Lymphocytes ; Portal Vein ; Pyloric Antrum* ; Vena Cava, Inferior

Watermelon stomach or gastric antral vascular ectasia is a rare disorder causing gastric blood loss and iron deficicncy anemia. Endoscopically, it has characteristic thickened red vascular folds radiating from the pylorus to the antrum. This condition is often mis- diagnosed as antral hemorrhagic gastritis. Diagnosis is made primarily by endoscopy. Histologic examination of the endoscopic mucosal biopsies may confirm the endoscopic diagnosis. Treatment for watermelon stomach includes steroids, estrogen-progesterone combinations, somatostatin antagonists, tranexamic acid, heater probe, and laser therapy. Herein we report a case of watermelon stomach presenting with general weakness and persistent iron deficiency anemia for about 2 years in a 70-year-old woman.
Aged ; Anemia ; Anemia, Iron-Deficiency ; Biopsy ; Citrullus* ; Diagnosis ; Endoscopy ; Female ; Gastric Antral Vascular Ectasia* ; Gastritis ; Humans ; Iron ; Laser Therapy ; Pylorus ; Somatostatin ; Steroids ; Tranexamic Acid

OBJECTIVE: To characterize the endoscopic features of upper gastrointestinal tract in patients with systemic sclerosis (SSc) compared with those in the healthy controls. METHODS: Data on esophagogastroduodenoscopy (EGD) in 180 patients with SSc (SSc group) were compared with that from the 181 age- and sex-matched healthy control who underwent EGD for routine check-up (control group). Clinical data of participants at the time of EGD (defined as baseline) were collected from electric medical record. Endoscopic findings were evaluated by two experts with blinded to their clinical features. Primary outcome of the study was prevalence of each endoscopic lesion between the two groups. RESULTS: The mean±standard deviation age and disease duration in the SSc group at baseline were 55.3±11.8 and 2.9±3.7 years, respectively. Compared to the control group, SSc group more frequently showed reflux esophagitis (32.8% vs. 9.4%, p < 0.001). In contrast, prevalence of atrophic gastritis was significantly lower in the SSc group (8.3% vs. 29.3%, p < 0.001). This result was consistent in the multivariable analysis where patients' age and concomitant proton pump inhibitor use were adjusted. There was no case of gastric antral vascular ectasia (GAVE) in both groups. However, 29 (16.1%) patients in SSc group showed a clinically significant anemia (hemoglobin < 10 mg/dL), with none of the endoscopic features showed significant associations with the outcome. CONCLUSION: Patients with SSc showed significantly lower prevalence of atrophic gastritis. There was no case of GAVE, which suggests that clinical phenotype of the SSc could be different according to the ethnicity or geographic region.
Anemia ; Endoscopy ; Endoscopy, Digestive System ; Esophagitis, Peptic ; Gastric Antral Vascular Ectasia ; Gastritis ; Gastritis, Atrophic ; Humans ; Medical Records ; Phenotype ; Prevalence ; Proton Pumps ; Scleroderma, Systemic* ; Upper Gastrointestinal Tract*

Portal hypertensive gastropathy (PHG) is a term used to define the endoscopic findings of gastric mucosa with a characteristic mosaic-like pattern with or without red spots, and a common finding in patients with portal hypertension. These endoscopic findings correspond to dilated mucosal capillaries without inflammation. The pathogenesis of PHG in not well known, but portal hypertension and some humoral factors seem to be crucial factors for its development. Pharmacological (e.g. propranolol), or interventional radiological (such as transjugular intrahepatic portosystemic shunt) procedures may be useful in preventing re-bleeding from PHG. The classic features of gastric antral vascular ectasia (GAVE) syndrome include red, often haemorrhagic lesions predominantly located in the gastric antrum which can result in significant blood loss. Although the pathogenesis of GAVE is not clearly defined, it seems to be a separate disease entity from PHG, because GAVE generally does not respond to a reduction of portal pressures. Endoscopic ablation (such as argon plasma coagulation) is the first-line treatment of choice. This review will focus on the incidence, clinical importance, etiology, pathophysiology, and treatment of PHG and GAVE syndrome in the setting of portal hypertension.
Esophageal and Gastric Varices/*diagnosis/etiology/therapy ; Gastric Antral Vascular Ectasia/*diagnosis/etiology/therapy ; Gastric Mucosa/metabolism/pathology ; Humans ; Hypertension, Portal/*complications ; Portasystemic Shunt, Transjugular Intrahepatic ; Vasodilator Agents/therapeutic use

The term "vascular ectasia" is defined to include angiodysplasia, gastric antral vascular ectasia (GAVE) and telangiectasis, and these are the leading causes of acute or chronic gastrointestinal bleeding. We describe here the first 2 Korean cases of GAVE with rectal vascular ectasia in patients with liver cirrhosis. A 70-year-old woman was admitted to the hospital with hematochezia. The finding on endoscopy showed diffuse nonconfluent spots with oozing bleeding on the antrum and several vascular spots with oozing bleeding on the rectum. The lesions were successfully treated by argon plasma coagulation (APC). We report on another case of rectal vascular ectasia in a patient with liver cirrhosis. A 77-year-old man was admitted to the hospital with hematochezia. The findings on colonoscopy showed diffuse vascular spots with oozing bleeding on the rectum. The lesions were successfully treated by APC. These two patients have had no bleeding since their treatment, and they are currently being evaluated by follow-up studies at the outpatient department.
Aged ; Angiodysplasia ; Argon ; Argon Plasma Coagulation ; Carbamates ; Colonoscopy ; Dilatation, Pathologic ; Endoscopy ; Female ; Follow-Up Studies ; Gastric Antral Vascular Ectasia ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Liver ; Liver Cirrhosis ; Organometallic Compounds ; Outpatients ; Rectum ; Telangiectasis