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11/20. The watermelon rectum.

    This is the first reported case of rectal vascular ectasia in association with gastric antral vascular ectasia (watermelon stomach). The patient, a 39-year-old woman with systemic sclerosis, reported chronic gastrointestinal blood loss and iron deficiency anemia. She had aperistalsis of the distal esophagus, decreased lower esophageal sphincter pressure leading to severe gastroesophageal reflux, and dysmotility of the small intestine. diagnosis was made by endoscopic appearance of visible linear watermelon-like vascular stripes in the gastric antrum and rectum. histology confirmed the vascular nature of this disorder, showing dilated and thrombosed capillaries in the lamina propria. Gastric biopsy showed associated fibromuscular hyperplasia in the lamina propria. However, the colonic biopsy showed only focal hyalinization in the lamina propria. The patient was successfully treated using endoscopic bipolar electrocautery. Watermelon stomach has previously been described in association with systemic sclerosis. Based on the histopathologic similarity between rectal vascular ectasia, gastric antral vascular ectasia, and systemic sclerosis, we suggest that the rectal vascular lesion may represent a component of the gastrointestinal manifestations of systemic sclerosis. ( info)

12/20. gastric antral vascular ectasia--a cause of refractory anaemia in systemic sclerosis.

    Recurrent gastrointestinal haemorrhage is an uncommon manifestation of systemic sclerosis. We report a case of gastrointestinal bleeding due to gastric antral vascular ectasia (GAVE) in a patient with systemic sclerosis. Failure to recognise the condition as a cause of gastrointestinal bleeding may delay the instigation of appropriate treatment. GAVE should be considered in the differential diagnosis of anaemia in patients with autoimmune conditions such as systemic sclerosis and primary biliary cirrhosis. ( info)

13/20. Cure of gastric antral vascular ectasia by liver transplantation despite persistent portal hypertension: a clue for pathogenesis.

    gastric antral vascular ectasia (GAVE) is a rare cause of chronic bleeding in cirrhotic patients. It has been suggested that these gastric lesions might be related to portal hypertension, hepatic insufficiency, or both parameters. We report two cases of cirrhotic patients in whom GAVE was the source of recurrent bleeding. These patients also had complete portal vein thrombosis. liver transplantation was performed and an end-to-end cavoportal anastomosis was performed, leaving patients with persistent portal hypertension after surgery. We observed complete disappearance of the antral lesions several weeks after transplantation, which shows that the GAVE is not related to portal hypertension but is rather a direct consequence of liver failure. Possible pathophysiologic mechanisms are discussed. ( info)

14/20. gastric antral vascular ectasia (watermelon stomach) in a patient with Sjogren's syndrome.

    gastric antral vascular ectasia (GAVE), a rare yet treatable cause of upper gastrointestinal bleeding, has been described in a variety of autoimmune diseases. We describe a patient who had typical sjogren's syndrome and iron deficiency anemia requiring blood transfusion. An endoscopy showed characteristic findings of GAVE. After several fulguration therapies with argon-plasma coagulator, the mucosal lesions improved and her hemoglobin levels returned to normal. ( info)

15/20. Gastric vascular ectasia.

    In this paper the condition Gastric Vascular Ectasia (GAVE) is reviewed and two patients of gastric vascular antral ectasia are reported (GAVE). It is suggested that the diagnostic possibility of gastric antral vascular ectasia should be considered in any elderly patient, more so in females, with persistent unexplained iron deficiency anaemia. ( info)

16/20. gastric antral vascular ectasia (GAVE) syndrome.

    gastric antral vascular ectasia (GAVE) syndrome is an uncommon cause of chronic gastrointestinal bleeding and iron deficiency anaemia. We describe two cases of GAVE, one pernicious anaemia related and the other portal hypertension related. In both the cases, progressive mucosal changes, which lead to development of GAVE, were documented. Those changes were progression of multiple antral erythematous spots into linear configuration and lastly to watermelon stomach. One of the cases was treated with tranexamic acid with good response. ( info)

17/20. "Watermelon stomach" in patients on chronic hemodialysis.

    "Watermelon stomach" is a common name for gastric antral vascular ectasia (GAVE syndrome). This endoscopic finding is characterized by the appearance of parallel longitudinal red columns along mucosal folds, along with capillars dilatation and hemorrhagy. Finding reliable method for its recognition is of paramount importance. Patient B.D., a 54-year-old woman, developed renal failure, which led to hemodialysis treatment, on the basis of pyelonephritis chronica. As a consequence of the gastrointestinal bleeding, the patient had black stools and developed severe anemia. The endoscopic finding showed the existence of visible columns of vessels transversing the antrum in longitudinal folds and converging in the pylorus, with clear red spots and surrounding hyperemy covered by drops of fresh blood. The diagnosis of "watermelon stomach" was confirmed after the pathohistological examination of the tissue taken at the biopsy, followed by total gastrectomy. Postoperative status was normal, without gastrointestinal hemorrhagia, and she went on with hemodialysis. Before the surgery she received 105 blood transfusions, and after surgical treatment she has received only 18 so far. At the moment she is in good health condition, and on hemodialysis. The reason we have reported this case of "watermelon stomach" syndrome in patient with chronic renal failure is to indicate that this rare anomaly of gastric blood vessels can lead to gastrointestinal blood loss in these patients. Since it is often the reason for many wrong diagnoses, it should be also taken into consideration in cases like these. ( info)

18/20. Efficacy of neodymium:YAG laser therapy for gastric antral vascular ectasia (GAVE) following hematopoietic cell transplant.

    We determined the incidence of severe bleeding from gastric antral vascular ectasia (GAVE) after myeloablative hematopoietic cell transplant and the outcomes after treatment with endoscopic neodymium:YAG laser photocoagulation. From 1992 to 2005, the incidence of severe bleeding from GAVE was 6/4491 (0.13%). All patients had received oral busulfan and four had sinusoidal obstruction syndrome. Gastrointestinal bleeding began a median of 53 days after transplant (range 15-2952). After GAVE was diagnosed by endoscopic and histologic findings, a median of three (range 2-7) sessions of laser therapy were required to control the bleeding with a median of 2737 J (range 1117-6160 J) per session. A median of 16 units (range 4-44) had been transfused prior to laser therapy and a median of four additional units (range 0-113) were transfused until bleeding was controlled. All patients were followed for at least 70 days after the last laser therapy session, with no further episodes of bleeding. Complications were mild and included abdominal pain and asymptomatic ulceration; however, one patient required gastrectomy due to gastric necrosis following transarterial embolizations. In summary, severe bleeding from GAVE is rare following hematopoietic cell transplant. Treatment with endoscopic therapy using the Nd:YAG laser is safe and effective. ( info)

19/20. gastric antral vascular ectasia (watermelon stomach) in patients with ESRD.

    In 1989, Navab et al suggested that watermelon stomach often is observed in patients with chronic renal insufficiency. On the basis of this and some later reports, an etiopathogenetic association between the 2 disorders was postulated. However, the number of relevant publications is still very limited. We describe 2 patients with end-stage renal disease (ESRD; 1 patient, hemodialysis therapy; 1 patient, peritoneal dialysis therapy) and watermelon stomach who presented with upper gastrointestinal bleeding and severe transfusion-dependent iron-deficiency anemia. In 1 patient, apart from the characteristic endoscopic findings of watermelon stomach affecting the antrum, there were vascular ectatic lesions in the proximal stomach. Both patients were treated successfully by using endoscopic bipolar electrocoagulation (gold probe [GP]; Microvasive boston Scientific, Natick, MA), which led to significant endoscopic and hematologic improvement. However, upper-gastrointestinal bleeding recurred in the second patient (peritoneal dialysis) because she did not consent to undergo endoscopic treatment on a regular basis. Watermelon stomach in patients with ESRD is a serious condition that can cause either acute or chronic upper-gastrointestinal bleeding. It should be considered in patients with upper-gastrointestinal bleeding and those with iron-deficiency anemia, which frequently presents as recombinant human erythropoietin resistance in patients with ESRD. diagnosis is based on the distinctive endoscopic appearance of the antrum, but the proximal stomach also may be involved. Application of GP ablation seems to be a safe and effective treatment for watermelon stomach. ( info)

20/20. Endoscopic ligation for non-esophageal variceal upper gastrointestinal hemorrhage.

    BACKGROUND: Endoscopic ligation can be used for bleeding lesions in non-fibrotic tissue; however, only small numbers of patients with non-esophageal variceal upper gastrointestinal hemorrhage have been treated in this way. To evaluate the utility of the technique, we performed the procedure to treat hemorrhage not from esophageal varices during emergency endoscopy. patients AND methods: Bleeding was identified from gastric Dieulafoy's ulcers (n=4), duodenal ulcers (n=3), gastric angiodysplasia (n=2) and Mallory-Weiss tears (n=3). The bleeding points were aspirated and controlled by endoscopic ligation and complete hemostasis was achieved in all cases. RESULTS: Although these lesions were located in difficult areas where endoscopic injection therapy and clipping sometimes fail, endoscopic ligation was performed easily and effectively without complications. Six of the patients had severe underlying disease, including acute and chronic myelogenous leukemia, liver cirrhosis and chronic renal failure; none suffered deterioration in their general condition after endoscopic ligation. CONCLUSIONS: Our findings suggest that endoscopic ligation is an easy and effective method of treatment for patients with gastrointestinal hemorrhage not from esophageal varices, and is safe even in patients with poor general health. ( info)
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