Gastric antral vascular ectasia causing severe anemia

Area of Science:

• Gastroenterology
• Hepatology
• Vascular Medicine

Background:

• Gastric antral vascular ectasia (GAVE) is a rare vascular anomaly that can cause significant gastrointestinal bleeding.
• Severe anemia and the need for blood transfusions are common in patients with GAVE.
• The pathogenesis of GAVE remains unclear, but associations with other conditions are being investigated.

Observation:

• A 76-year-old female presented with continuous gastrointestinal bleeding due to GAVE, leading to severe anemia and requiring transfusions.
• Endoscopy revealed diffuse telangiectasia in the gastric antrum.
• Laboratory findings included elevated SGOT, decreased cholinesterase, and increased serum gastrin and indocyanine green (ICG) levels. Anti-HCV antibody was positive, and splenomegaly was noted on imaging.

Findings:

• The patient was diagnosed with GAVE and co-existing liver cirrhosis.
• Surgical resection of the distal stomach successfully halted the gastrointestinal bleeding.
• Liver biopsy confirmed cirrhotic changes, further supporting the diagnosis.

Implications:

• This case underscores the potential association between GAVE, liver cirrhosis, and hypergastrinemia.
• GAVE should be considered in elderly patients presenting with severe, unexplained gastrointestinal bleeding.
• Effective management strategies, including surgical intervention, can resolve bleeding and improve patient outcomes.