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      Gastric antral vascular ectasia: a case report

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          Abstract

          Gastric antral vascular ectasia (GAVE) is a vascular gastric malformation which represents a rare cause of upper gastrointestinal system bleeding, mostly in elderly. It is usually presented with a significant anemia and it is diagnosed with an endoscopic examination of the upper gastrointestinal system. The disease is often associated with other chronic illnesses such as liver cirrhosis, scleroderma, diabetes mellitus and arterial hypertension. It is treated symptomatically in terms of anemia correction with blood transfusions and iron supplements, proton pump inhibitors, beta-blockers and endoscopic procedures such as argon plasma coagulation which currently represents the treatment of choice in Sy. GAVE cases. We report a case of a 76 years old female patient who was admitted to the hospital because of general weakness, exhaustion and abdominal pain. Laboratory analysis of blood went in favor of anemia. Proximal endoscopy showed no changes on the esophagus, the stomach had a normal volume with pale mucosa and signs of antral vascular ectasia which is presented typically as a “watermelon” stomach due to the longitudinal creases oriented toward pylorus. The patient was treated symptomatically in terms of anemia correction with blood transfusions and iron supplements, proton pump inhibitors, beta-blockers. Five months later control proximal endoscopy findings were identical to those found in the previous hospitalization.

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          Band ligation of gastric antral vascular ectasia is a safe and effective endoscopic treatment.

          Gastric antral vascular ectasia (GAVE) or 'watermelon stomach' is a rare and often misdiagnosed cause of occult upper gastrointestinal bleeding. Treatment includes conservative measures such as transfusion and endoscopic therapy. A recent report suggests that endoscopic band ligation (EBL) offers an effective alternative treatment. The aim of the present study is to demonstrate our experiences with this novel technique, and to compare argon plasma coagulation (APC) with EBL in terms of safety and efficacy.
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            Gastric antral vascular ectasia: case report and review of the literature.

            Gastric antral vascular ectasia is the source of up to 4% of nonvariceal upper gastrointestinal bleeding. It can present with occult bleeding requiring transfusions or with acute gastrointestinal bleeding. It is associated with significant morbidity and mortality and has been associated with such underlying chronic diseases as scleroderma, diabetes mellitus, and hypertension. Approximately 30% of cases are associated with cirrhosis. We report two cases of gastric antral vascular ectasia with two strikingly different endoscopic appearances. We further describe the clinical, endoscopic, histologic, and therapeutic aspects of this entity.
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              Post-transplant gastric antral vascular ectasia after intra-venous busulfan regimen.

              Gastric antral vascular ectasia (GAVE) is an angiodysplastic disorder that causes gastric bleeding. GAVE can develop as a complication of hematopoietic stem cell transplantation (HSCT-GAVE), and it has been suggested that it may be associated with oral administration of busulfan. We report two cases of HSCT-GAVE after a conditioning regimen containing intra-venous busulfan (ivBu), not oral busulfan. The first case, a 42-year-old woman with blastic plasmacytoid dendritic cell neoplasm, underwent second allogeneic HSCT with conditioning regimen consisting of cyclophosphamide (120 mg/kg) and ivBu (12.8 mg/kg). HSCT-GAVE developed on day 84 post-transplant, and argon plasma coagulation (APC) was performed successfully. The second case, a 60-year-old woman with acute myelogenous leukemia, underwent allogeneic HSCT with the conditioning regimen consisting of ivBu (12.8 mg/kg) and fludarabine (150 mg/kg). She developed melena and was diagnosed with GAVE by endoscopy on day 145 post-transplant. Although complete hemostasis was not achieved despite four administrations of APCs, the melena spontaneously terminated on day 235 post-transplant. To our knowledge, this is the first report describing HSCT-GAVE after ivBU-based HSCT. Although there is no established therapy for HSCT-GAVE, APC may be an option for HSCT-GAVE.
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                Author and article information

                Journal
                JHS
                Journal of Health Sciences
                University of Sarajevo Faculty of Health Studies (Bosnia )
                2232-7576
                1986-8049
                2014
                : 4
                : 2
                : 130-133
                Affiliations
                [1 ]Department of Internal Medicine, General Hospital “Prim. dr Abdulah Nakaš”, Sarajevo, Bosnia and Herzegovina
                Author notes
                [* ]Corresponding author: Amir Ćehajić, MD, Department of Internal Medicine, General Hospital “Prim.dr. Abdulah Nakaš”, Kranjčevičeva 12, 71 000, Sarajevo Bosnia and Herzegovina, Phone: 387 33 285 100, E-mail: amircehajic@ 123456hotmail.com
                Article
                JHS-4-130
                cc65f752-6cef-4e47-9f60-06f498809ba9
                Copyright: © Amir Ćehajić, et al

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 July 2014
                : 06 September 2014
                Categories
                CASE REPORT

                Nursing,General medicine,Medicine,Molecular medicine,Life sciences
                endoscopy,GAVE,gastric antral vascular ectasia,gastrointestinal bleeding

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