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gastric antral vascular ectasia

Monday 12 March 2012

Gastric Antral Vascular Ectasia (Watermelon Stomach)

Gastric antral vascular ectasia (GAVE) differs from PHG inits clinical features, gross appearance, and histologic features.

However, both conditions are common to patients with cirrhosis.

GAVE presents clinically with bleeding and typically affects elderly females with an average age of 66.5 years.

GAVE associates with various conditions, including cirrhosis, chronic heart disease, bulimia, bone marrow transplantation, and autoimmune connective tissue disorders.

In contrast to the hemodynamic disturbances seen in PHG, motility disturbances may play a role in the pathogenesis ofGAVE.

It is conceivable that antral mucosal prolapse into the duodenum causes some of the changes that are present.

GAVE is characterized by aggregates of mucosal red spots in the distal stomach.

The ectatic red spots may be more diffuse and occasionally involve the proximal stomach.

If the red spots are present on a background mosaic pattern, the disorder is more likely to be PHG than GAVE, in which the background mucosa appears normal without the mosaic appearance.

Its most distinctive appearance consists of nearly parallel, intensely red, longitudinal stripes situated at the crests of hyperplastic mucosal folds traversing the gastric antrum creating the pattern of a “watermelon stomach”.

These stripes correspond to markedly dilated, tortuous mucosal capillaries.

The ectatic mucosal capillaries often contain fibrin thrombi, and they are surrounded by fibrohyalinosis with fibromuscular hyperplasia of the lamina propria.

The fibrohyalinosis appears as a homogeneous light pink substance surrounding ectatic capillaries in the lamina propria and submucosa.

The presence of the hyalinosis and the fibrin thrombi are important in differentiating GAVE from severe PHG.

Epithelial damage from gastric acid, intraluminal food, or other factors can disrupt the mucosal barrier in mucosal areas overlying engorged vessels and may explain the presence of the fibrin thrombi.

The lesions usually show patchy mild chronic inflammation in the superficial lamina propria.

One may also see coexisting atrophic gastritis with intestinal metaplasia.

The muscularis mucosae often appears thickened and hyperplastic, perhaps reflective of mucosal prolapse.

Submucosal vessels appear dilated and congested, but no vascular malformations are evident.

See also

- gastric vascular anomalies