Ectasia vascular gástrica antral: reporte de un caso

Abstract

Gastric antral vascular ectasia is a rare and severe cause of upper gastrointestinal bleeding, responsible for about 4% of non-variceal upper gastrointestinal haemorrhage. The diagnosis is mainly based on endoscopic findings, usually represented by red spots organized in stripes radially departing from pylorus, and also called watermelon stomach or honeycomb stomach. The histological pattern is characterised by four changes: vascular ectasia of mucosal capillaries, focal thrombosis, spindle cell proliferation, and fibro-hyalinosis. The main differential diagnosis is with portal hypertensive gastropathy, with which it can frequently co-exist (about 30% of patients with gastric antral vascular ectasia have liver cirrhosis). Autoimmune disorders, mainly represented by Reynaud's phenomenon and sclerodactyly, are present in about 60% of patients with gastric antral vascular ectasia. Autoimmune and connective tissue disorders such as Sjogren's syndrome, systemic lupus erythematosus, primary biliary cirrhosis, and systemic sclerosis have occasionally been reported. In a few cases, gastric antral vascular ectasia syndrome has been presented in patients with chronic renal failure, bone marrow transplantation, and cardiac diseases. The pathogenesis of gastric antral vascular ectasia is still not fully known, humoural, autoimmune factors and haemodynamic alterations, being the principal hypothesis. Many therapeutic options have been described. No satisfactory results have been observed with medical therapy, and surgery should only be considered for refractory severe cases. Endoscopic treatment, particularly with argon plasma coagulation, has shown to be as effective, and also safer, than surgery, and should be considered the first-line treatment for patients with gastric antral vascular ectasia related bleeding. A case report is presented, along with the diagnostic and therapeutic approach of this pathology.