Gastric vascular ectasia in patients undergoing bone marrow transplantation

The authors reviewed all gastric biopsy specimens from patients who had undergone bone marrow transplantation at our institution between 1986 and 1991. Ten of 28 patients had gastric vascular ectasia (GVE), a distinct lesion consisting of telangiectatic vessels within the superficial gastric mucosa. All patients undergoing bone marrow transplantation had received a standard chemotherapeutic transplantation regimen consisting of busulfan and cyclophosphamide without total-body irradiation. Eight of the 10 patients with GVE had evidence of upper gastrointestinal tract bleeding, as compared with 4 of 18 patients without GVE. In all 10 patients with GVE, the results of liver chemistry analyses were abnormal. Five patients had hepatic veno-occlusive disease, and 8 patients had graft-versus-host disease. Endoscopic biopsy samples of GVE showed markedly dilated vascular spaces similar to those seen in gastric antral vascular ectasia and diffuse antral vascular ectasia. However, no thrombi were identified in these enlarged vessels. Digital morphometry showed the mean cross-sectional area of GVE vessels was significantly greater (P < .001, Wilcoxon's rank-sum test) than the mean vessel areas of 10 chemical gastritis and 10 normal antral (control) biopsy samples. Gastric vascular ectasia may be a significant cause of gastrointestinal bleeding in patients undergoing bone marrow transplantation. The pathogenesis of GVE is unknown; transplantation regimen toxicity may play a role.