Gastric antral vascular ectasia as an early manifestation of systemic sclerosis

Abstract

Gastric antral vascular ectasia (GAVE) is an infrequent but severe cause of chronic gastrointestinal bleeding, associated with iron deficiency anemia, the diagnosis is endoscopic, with the characteristic description of watermelon stomach or honeycomb stomach. The autoimmune disease is strongly associated, which forces its diagnostic suspicion, one of the leading causes is systemic sclerosis, Raynaud's phenomenon, and Sclerodactyly, these are present in 60% of patients. Case: A 76-year-old woman with a history of multiple episodes of upper gastrointestinal bleeding required endoscopic interventions with argon. Physical examination revealed tachycardia, a depressed abdomen on deep palpation without signs of peritoneal irritation. The paraclinical tests showed hypochromic microcytic anemia, endoscopy reported ectasias in a rising sun pattern compatible with antral gastric vascular ectasias. Due to recurrence and refractoriness, the patient underwent subtotal gastrectomy plus Roux-en-Y reconstruction; Before the debut of GAVE, immunological studies were carried out, which were positive for systemic sclerosis. Discussion: Antral gastric vascular ectasias occur in less than 4% of cases, the clinical presentation is upper digestive tract bleeding, associated with chronic anemic syndromes with iron deficiency, diagnosis and management are endoscopic, to control bleeding and reduce recurrence actively, through pharmacological therapy has not presented good results and in the event of GAVE episodes refractory to management, the indication is surgery.