An Analysis of the Clinical, Laboratory, and Histological Features of Striped, Punctate, and Nodular Gastric Antral Vascular Ectasia

  • Arul Thomas
  • David Koch
  • William Marsteller
  • David Lewin
  • Adrian Reuben
Original Article
  • 10 Downloads

Abstract

Background

Gastric antral vascular ectasia (GAVE) commonly presents as linear striped (“watermelon stomach”) or punctate phenotypes, to which a newly discovered nodular form was recently added.

Aims

We performed a retrospective cohort study to detail and compare the clinical and histological characteristics of major GAVE phenotypes.

Methods

In 136 GAVE patients (tertiary care ambulatory and inpatient, median age 61.3 years, 73 men, and 63 women), clinical and laboratory results were recorded, with comorbidities, endoscopy indications, and complications of cirrhosis. In 74 patients, GAVE histopathology was cataloged by a pathologist masked to endoscopy results.

Results

Median age 61.3 years, 73 men, and 63 women. GAVE phenotypes were: linear striped—62 (46%), punctate—32 (24%), and nodular—41 (30%). Endoscopy was commonly performed for variceal screening in linear striped (45%) and nodular (34%) GAVE and for gastrointestinal bleeding in punctate (41%) and nodular (29%) GAVE, respectively. Of 89 cirrhotic patients, 37.5% each had linear striped or nodular GAVE, 24.7% had punctate forms (p = 0.03). Child–Turcotte–Pugh and Model for End-Stage Liver Disease scores were similar among phenotypes. Histologically, reactive epithelial hyperplasia and vascular ectasia were universal; smooth muscle proliferation was more common and consistent (78–86%) than microvascular thrombi (27–59%) and fibrohyalinosis (18–53%), which each varied with phenotype.

Conclusions

Nodular GAVE is a gastric mucosal abnormality that is similar to the linear striped and punctate phenotypes, yet has distinct clinical and histological features. Increased awareness of nodular GAVE by endoscopists is needed to avoid its misdiagnosis as nonspecific antral nodules.

Keywords

Gastric nodules Gastrointestinal bleeding Cirrhosis 

Abbreviations

AR

Adrian Reuben

CTP

Child–Turcotte–Pugh

DGK

David Koch

DL

David Lewin

EGD

Esophagogastroduodenoscopy

GAVE

Gastric antral vascular ectasia

H&E

Hematoxylin and eosin

INR

International normalized ratio

IQR

Interquartile range

MELD

Model for End-Stage Liver Disease

MUSC

Medical University of South Carolina

SAS

Statistical Analysis System

Notes

Compliance with ethical standards

Conflict of interest

None of the authors have any financial, professional, or personal conflicts that are relevant to the manuscript.

References

  1. 1.
    Jabbari M, Cherry R, Lough JO, et al. Gastric antral vascular ectasia: the watermelon stomach. Gastroenterology. 1984;87:1165–1170.PubMedGoogle Scholar
  2. 2.
    Ripoll C, Garcia-Tsao G. The management of portal hypertensive gastropathy and gastric antral vascular ectasia. Dig Liver Dis. 2011;43:345–351.CrossRefPubMedGoogle Scholar
  3. 3.
    Ito M, Uchida Y, Kamano S, et al. Clinical comparisons between two subsets of gastric antral vascular ectasia. Gastrointest Endosc. 2001;53:764–770.CrossRefPubMedGoogle Scholar
  4. 4.
    Spahr L, Villeneuve JP, Dufresne MP, et al. Gastric antral vascular ectasia in cirrhotic patients: absence of relation with portal hypertension. Gut. 1999;44:739–742.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kamath PS, Lacerda M, Ahlquist DA, et al. Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis. Gastroenterology. 2000;118:905–911.CrossRefPubMedGoogle Scholar
  6. 6.
    Quintero E, Pigue JM, Bombi JA, et al. Gastric mucosal ectasias causing bleeding in cirrhosis. A distinct entity associated with hypergastrinemia and low serum levels of pepsinogen I. Gastroenterology. 1987;93:1054–1061.CrossRefPubMedGoogle Scholar
  7. 7.
    Marsteller WF, Lewin DN, Reuben A. The biopsy GAVE the diagnosis. Clin Gastroenterol Hepatol. 2012;10:e75–e76.CrossRefPubMedGoogle Scholar
  8. 8.
    Tyagi P, Puri AS, Sharma BC, et al. Nodules in antrum after variceal eradication a new finding in patients with portal hypertension. Indian J Gastroenterol. 2012;31:75–78.CrossRefPubMedGoogle Scholar
  9. 9.
    Stewart CA, Sanyal AJ. Grading portal gastropathy: validation of a portal gastropathy scoring system. Am J Gastroenterol. 2003;98:1758–1765.CrossRefPubMedGoogle Scholar
  10. 10.
    Chawla SK, Ramani K, Lo Presti P. The honeycomb stomach: coalesced gastric angiodysplasia. Gastrointest Endosc. 1990;36:516–518.CrossRefPubMedGoogle Scholar
  11. 11.
    Suit PF, Petras RE, Bauer TW, et al. Gastric antral vascular ectasia. A histologic and morphometric study of “the watermelon stomach”. Am J Surg Pathol. 1987;11:750–757.CrossRefPubMedGoogle Scholar
  12. 12.
    Payen JL, Cales P, Voigt JJ, et al. Severe portal hypertensive gastropathy and antral vascular ectasia are distinct entities in patients with cirrhosis. Gastroenterology. 1995;108:138–144.CrossRefPubMedGoogle Scholar
  13. 13.
    Lucey MR, Brown KA, Everson GT, et al. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Transplantation. 1998;66:956–962.CrossRefPubMedGoogle Scholar
  14. 14.
    Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–470.CrossRefPubMedGoogle Scholar
  15. 15.
    Abraham SC, Singh VK, Yardley JH, et al. Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy. Am J Surg Pathol. 2001;25:500–507.CrossRefPubMedGoogle Scholar
  16. 16.
    Baudet JS, Salata H, Soler M, et al. Hyperplastic gastric polyps after argon plasma coagulation treatment of gastric antral vascular ectasia (GAVE). Endoscopy. 2007;39:E320.CrossRefPubMedGoogle Scholar
  17. 17.
    Kotzampassi K, Eleftheriadis E, Aletras H. The ‘mosaic like’ pattern of portal hypertensive gastric mucosa after variceal eradication by sclerotherapy. J Gastroenterol Hepatol. 1990;5:659–663.CrossRefPubMedGoogle Scholar
  18. 18.
    Gostout CJ, Viggiano TR, Ahlquist DA, et al. The clinical and endoscopic spectrum of the watermelon stomach. J Clin Gastroenterol. 1992;15:256–263.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Arul Thomas
    • 1
  • David Koch
    • 2
  • William Marsteller
    • 2
  • David Lewin
    • 3
  • Adrian Reuben
    • 2
  1. 1.MedStar Georgetown Transplant InstituteMedStar Georgetown University HospitalWashingtonUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of MedicineMedical University of South CarolinaCharlestonUSA
  3. 3.Department of PathologyMedical University of South CarolinaCharlestonUSA

Personalised recommendations