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

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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.

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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

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Authors and Affiliations

  1. MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC, 20007, USA

    Arul Thomas

  2. Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA

    David Koch, William Marsteller & Adrian Reuben

  3. Department of Pathology, Medical University of South Carolina, Charleston, SC, 29425, USA

    David Lewin

Authors
  1. Arul Thomas
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  2. David Koch
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  3. William Marsteller
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  4. David Lewin
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  5. Adrian Reuben
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Corresponding author

Correspondence to David Koch.

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

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Thomas, A., Koch, D., Marsteller, W. et al. An Analysis of the Clinical, Laboratory, and Histological Features of Striped, Punctate, and Nodular Gastric Antral Vascular Ectasia. Dig Dis Sci 63, 966–973 (2018). https://doi.org/10.1007/s10620-018-4965-z

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  • DOI: https://doi.org/10.1007/s10620-018-4965-z

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