Gastric Antral Vascular Ectasia (GAVE): When to Suspect as the Cause of Anemia or Bleeding

Introduction: Gastric antral vascular ectasia (GAVE) is the cause of non-variceal upper gastrointestinal bleeding in approximately 4% of cases. The purpose of this study was to describe the characteristics of patients diagnosed with GAVE and to determine when clinical suspicion for GAVE should be aroused. Methods: We retrospectively assessed patients diagnosed with GAVE at a tertiary care facility between January 2004 and December 2014, collecting information regarding demographics, clinical presentation, comorbid medical conditions, medications, endoscopic appearance, and treatment efficacy. Results: We identified 66 patients diagnosed with GAVE via endoscopy, of which 62% were female with a mean age of 70.6 years. The majority of patients presented with anemia (80.3%). Comorbid conditions were common, particularly overweight or obesity, which was observed in 44 (66.7%) patients. Other common conditions included hypertension (34.8%), cirrhosis (31.8%), chronic kidney disease (27.3%), diabetes mellitus (22.7%), diverticulosis (19.7%), autoimmune disease (15%), and coronary artery disease (13.6%). Medication use was common, particularly beta blockers, in 56% of patients. Portal hypertensive gastropathy (PHG) with GAVE was found in 14/21 (66.6%) patients with cirrhosis, 8 of whom required transfusions. In those with PHG and GAVE, average hemoglobin was 6.1 compared to 9.3 in those without cirrhosis. In those with cirrhosis, watermelon stomach was the most commonly found endoscopic appearance in 18/21 (86.7%) with the classic punctate appearance noted in only 3/21 (14.3%) cirrhotic patients. Argon plasma coagulation was the treatment of choice in most patients (51.5%), particularly in those with actively bleeding or oozing lesions. Conclusion: GAVE should be suspected as a cause of anemia or bleeding in elderly female patients with obesity, hypertension, cirrhosis, chronic kidney disease, diabetes mellitus, or diverticulosis. The classic watermelon stomach presentation of GAVE is common, even in individuals with cirrhosis. GAVE associated with PHG appears to cause more severe anemia than GAVE alone.