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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastric antral vascular ectasia is a recently recognized cause of chronic gastrointestinal blood loss. Immunohistochemical and electron-microscopic studies were performed on the surgically resected antrum of a patient with antral vascular ectasia. These revealed extraepithelial and intraepithelial neuroendocrine cell proliferations. Staining for a wide range of neural and endocrine markers demonstrated that these cells contain large quantities of 5-hydroxytryptamine and vasoactive intestinal polypeptide. Gastric vascular ectasia is of unknown etiology but has been associated with achlorhydria and liver cirrhosis. The findings suggest that locally released neurotransmitters may be responsible for local vasodilation and hence a propensity to bleed.
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PMID:Neuroendocrine cell proliferations in gastric antral vascular ectasia. 278 44

Watermelon stomach is a rare disorder causing gastric blood loss and iron deficiency anemia. We report a case that occurred during the course of post-hepatitis C cirrhosis, which condition was dramatically improved by alpha-interferon treatment.
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PMID:Dramatic improvement of watermelon stomach with alpha-interferon. 777 96

Watermelon stomach is an unusual cause of gastrointestinal bleeding and iron deficiency anemia. Its etiology is unknown, but it has been reported to be associated with a variety of diseases, including autoimmune disorders and cirrhosis. We report on the long-term outcome of 15 patients (13 women, 2 men) treated with neodymium-yttrium-aluminum-garnet (Nd:YAG) laser therapy. The mean age of patients at presentation was 71.6 years (range, 59 to 85 years). Fourteen patients were transfusion-dependent, requiring an average of 9.6 units of blood in the 12 months preceding diagnosis and treatment. Associated diseases included scleroderma (3 patients), mixed connective tissue disease (1 patient), history of cancer (3 patients), cryptogenic cirrhosis (3 patients), and chronic renal failure (3 patients). In 7 of 9 patients who had an antinuclear antibody test, an elevated titer greater than 1:160 in a speckled pattern was noted. Nd:YAG laser coagulation therapy was administered to all patients without complications and was successful in reducing bleeding in every case. Five patients died during the course of follow-up without signs of recurrent gastrointestinal bleeding. The remaining 10 patients have had both endoscopic and hematologic improvement during a mean follow-up period of 4.4 years from the time of initial diagnosis (range, 2 to 8 years). The 10 survivors are no longer transfusion-dependent and have stable hematocrits.
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PMID:The watermelon stomach: long-term outcome in patients treated with Nd:YAG laser therapy. 749 2

The authors describe a case of antral Watermelon Stomach (WS) in a seventy-eight year old woman with severe iron-deficient chronic anemia, liver cirrhosis and diabetes mellitus. Endoscopy was diagnostic on the 3rd-4th examination because of the disease's rarity and the concomitance of systemic pathologies, such as portal hypertension, in which often a congestive gastropathy with similar aspects is associated. Whether out of clinical evolution, or capillary thrombosis, or vertical fibromuscular hyperplasia of the lamina propria were considered distinctive elements. By means of literature review it wasn't possible to establish the portal hypertension's prevalence out of the WS cases, but it could be a chance factor. In this way some polycentric prospective trials could be useful. The endoscopic practice is important not only for diagnosis but also for therapeutical means, even if in our case surgery was the chosen treatment.
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PMID:[A case of watermelon stomach]. 805 94

Gastric antral vascular ectasia (GAVE) that caused continuous gastrointestinal bleeding is reported in a 76-year-old woman who had been treated with repeated blood transfusions because of severe anemia. Endoscopic examination was performed and diffuse speckled telangiectasia of the entire antrum was observed. Laboratory data showed SGOT > SGPT, decreased chE level and the increased levels of serum gastrin and ICG at 15 min. Anti-HCV antibody was positive. Image examination revealed splenomegaly. There was no family history of telangiectasia, and no telangiectasia was found in other organs. The diagnosis was established as GAVE with liver cirrhosis. Surgical resection of the distal stomach resulted in termination of the bleeding, and the cirrhotic changes of the surface of the liver were revealed at that time, providing further evidence of liver cirrhosis. Although the pathogenesis of GAVE is unknown, liver cirrhosis and hypergastrinemia are thought to be associated with the condition. Importantly, this condition is a cause of severe gastrointestinal bleeding in elderly patients.
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PMID:Gastric antral vascular ectasia causing severe anemia. 888 39

Gastric antral vascular ectasia is an important cause of chronic gastrointestinal blood loss. However, its development and progression have not yet been clarified. We investigated its early lesions and progression by reviewing endoscopic films of five patients with gastric antral vascular ectasia followed for liver cirrhosis. In all patients, early findings were prepyloric red spots. In two patients, anemia due to gastrointestinal bleeding was already observed when vascular lesions were confined to the distal antrum. In the other three patients, anemia was observed 1-2 years after they showed a diagnostic pattern of gastric antral vascular ectasia. The vascular lesions gradually thickened and extended throughout the antrum, with the complete picture shown in 1.5-5 years. The pattern of distribution was classified into three types: diffuse spotty, diffuse confluent, and striped. These types could be predicted before the complete formation. Gastric antral vascular ectasia associated with liver cirrhosis started as prepyloric red spots and extended to the proximal antrum in various ways and varying time courses of less than 5 years; this entity may cause hemorrhage even in the early stage.
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PMID:Endoscopic follow-up study of development of gastric antral vascular ectasia associated with liver cirrhosis. 934 82

Watermelon stomach is a rare cause of chronic gastroinestinal bleeding. It is often associated with some other diseases, as for example the primary billiary cirrhosis, autoimmune diseases or connective tissue disorders. Pathogenesis is still unclear. The role of chronic prolaps of gastric mucosa, influence of other diseases or local neurohormon disturbancies are taken into account. The most important in diagnosis is typical endoscopic view and characteristic histology. The fundamental thing in management is to stop chronic and massive blood loss, requiring multiple transfusions. Farmacotherapy does not bring satisfactory results and definite treatment is antrectomy. A very good alternative is endoscopic therapy by means of heater probe, bipolar electrocoagulation or laser photocoagulation, especially in patients with poor operation risk. Patients who cannot undergo endoscopic treatment can be offered sterydotherapy, also quite effective method but with its typical side effects.
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PMID:[Watermelon stomach]. 1033 83

Portal hypertenisive gastropathy (PHG) and GAVE syndrome are recently discovered entities who can be associated with bloodloss from gastrointestinal tract at patients with or without liver cirrhosis. PHG will be developed at 65% of patients with portal hypertension caused by liver cirrhosis but it could be developed at portal hypertension which is not caused by the liver cirrhosis. PHG is often assosiated with portal hypertension patients and presence of esofageal and /or gastric varices. Mechanism of pathogenesis PHG is still not completely cleared up, but regulation of gastric nitric oxide level, postaglandins, tumor necrosis factor (TNF) and epidermal growth factor production could be important factors in development of portal hypertensive gastropathy. Mechanisms who participate in originating of Gastric Antral Vascular Ectasia (GAVE) are also not completly clear. Classic characteristics of this syndrome are red, often haemorrhagic lesions most often located in stomach antrum, and who could result in blood loss. More than 70% of patients with GAVE syndrome have no cirrhosis or portal hypertension. But when liver cirrhosis is present, it is very difficult to make difference between GAVE and PHG. This review will be focused on incidence, clinical importance, etiology, pathofisiology and treatment of PHG, and how to differentiate between GAVE syndrom and PHG in a case that there exists.
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PMID:Portal hypertensive gastropathy (PHG). 1564 38

Watermelon stomach (WMS), or gastric antral vascular ectasia, is an uncommon but clinically important cause of chronic occult or overt gastrointestinal (GI) blood loss. Patients typically present with symptomatic anemia and hemoccult positive stools. Although the diagnosis is based primarily on the typical endoscopic appearance, the lesion may be overlooked on initial evaluation or interpreted as "gastritis." Gastric biopsy may be helpful in confirming the diagnosis by showing vascular ectasia, typically without inflammation. WMS is idiopathic but is often associated with autoimmune diseases or cirrhosis of the liver. The majority of patients with classic WMS are elderly and female. In contrast, there is no gender predominance with the diffuse pattern associated with cirrhosis. General supportive care includes transfusion of blood products as necessary to control symptomatic anemia and coagulopathy, iron replacement therapy by oral or parenteral routes, identification and treatment of iatrogenic (eg, warfarin) or hereditary (eg, von Willebrand's disease) coagulopathy, and avoidance of substances that might cause gastric mucosal damage and/or bleeding (eg, aspirin, NSAIDs, alcohol). The goals of therapy are to eliminate or decrease the need for blood transfusions, hospitalization, office visits, and endoscopic therapy sessions aimed at cessation of GI blood loss and resolution of symptomatic anemia. Multipolar electrocoagulation is our preferred technique for endoscopic ablation of WMS. A 10-Fr probe (3.2 mm in diameter) is used at a generator setting of 12 to 16 W. Pulse duration can be as short as 1 to 2 seconds if a pinpoint coagulation technique is used, or continuous if a paint-stroke technique is used to coagulate all vascular stripes in the classic WMS pattern or as many small lesions as possible in the diffuse type. Other techniques we currently use are argon plasma coagulation (APC) or heater probe. In the past, lasers (neodymium: yttrium-aluminum-garnet , KTP, or argon) were successfully used for such treatments. An initial treatment interval of 4 to 8 weeks should allow for interim healing of iatrogenic ulcers. Patients are routinely given standard doses of available proton-pump inhibitors (PPIs) to facilitate healing of iatrogenic ulcers and to prevent secondary bleeding. The treatment interval can be gradually lengthened as the long-term goals of obliteration of angiomata and resolution of anemia are reached. Side effects may include iatrogenic ulceration at the site of treatment, bleeding, and transient abdominal pain. Antral scarring (after APC or Nd:YAG laser) and hyperplastic polyps have also been reported after endoscopic treatment of classic WMS. Surgical antrectomy is very effective in the prevention of bleeding but has substantial (5% to 10%) mortality in older patients with comorbidity and is now reserved for endoscopic failures.
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PMID:Treatment of watermelon stomach. 1653 78

Gastric antral vascular ectasia is an important cause of gastric bleeding. We herein report a case of gastric outlet syndrome due to a gastric antral vascular ectasia in a patient with a negative history for anemia or gastric bleeding. The patient underwent an antral resection. The specimen showed vascular ectasia, fibromuscular hyperplasia, and fibrin thrombosis, especially localized in the submucosa. The pathogenesis of this syndrome remains unclear. Surgery in cases of gastric outlet obstruction is the only reliable method to cure the patient. An antrectomy has been shown to be the procedure of choice. It carries a remarkably low rate of long-term sequelae and it can be performed in the majority of cases with low risk, especially in those patients not affected by cirrhosis or portal hypertension.
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PMID:Gastric antral vascular ectasia--an unusual cause of gastric outlet obstruction: report of a case. 1752 71


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