Gastric antral vascular ectasia (GAVE) in patients with cirrhosis

Abstract

INTRODUCTION: GAVE or watermelon stomach is an important cause of anaemia and blood loss with a unique endoscopic appearance. GAVE is a well recognized complication of liver cirrhosis. Anaemia and blood loss attributable to GAVE in cirrhotics do not usually respond to beta blockers, TIPPS or shunt surgery; it is more lively to respond to laser coagulation, oestrogen or tranexamic acid therapy. OBJECTIVES: To assess the prevalence and severity of GAVE and its contribution to chronic blood loss in a cohort of patients with cirrhosis. DESIGN, SETTING AND METHODS: We carried out routine upper GI endoscopy in 75 consecutive patients with cirrhosis between October 2005 to October 2006. In addition to the presence and severity of oesophageal and gastric fundat varices and evidence of portal hypertensive gastropathy, the presence and type of GAVE was also documented. RESULTS: 32 (42%) patients (28 males) had endoscopic evidence of GAVE. 27 had linear GAVE (watermelon stomach) and 5 had the diffuse type. Two patients had transfusion dependent anaemia attributable to GAVE CONCLUSIONS: GAVE appears to be a common endoscopic finding in patients with cirrhosis. Classic watermelon stomach with linear lesions was the commonest type. GAVE can be the predominant cause of upper GI blood loss in a few patients with cirrhosis.