Gastric antral vascular ectasia (GAVE) can result in upper gastrointestinal bleeding (UGIB) and is an important diagnostic consideration, especially in the elderly. It is often mistaken for portal hypertensive gastropathy given its similar endoscopic appearances and occurrence in comparable patient populations. We present the case of an elderly patient who presented to the emergency department (ED) with UGIB due to GAVE. A 75-year-old female patient with a past medical history of peptic ulcer disease, hypertension, rheumatoid arthritis, and type II diabetes mellitus presented to the ED for repeat syncopal episodes, nausea, diarrhea, and fatigue. The patient had melanotic stool, significant blood-loss anemia, and an abdominal computed tomography (CT) scan showing hepatic cirrhosis. The patient was administered intravenous packed red blood cells, ceftriaxone, octreotide, and pantoprazole, and was admitted to the hospital. Esophagogastroduodenoscopy (EGD) showed no varices but GAVE, which was then treated with argon plasma coagulation. The patient experienced no further bleeding and was discharged on hospital day 3. GAVE is a rare cause of UGIB with which emergency physicians should be familiar. Immediate stabilization in the ED, followed by prompt and direct endoscopic therapy, is critical for its treatment.
Muhtadi et al. (Wed,) studied this question.