Gastric Antral Vascular Ectasia and Underlying Microvascular or Vascular Disease: Is There an Association?

Abstract

Introduction: Gastric antral vascular ectasia (GAVE) is an important cause of chronic gastrointestinal (GI) bleeding accounting for 4% of non-variceal upper GI bleeding. It has been classically associated with cirrhosis, chronic kidney disease (CKD), hypothyroidism and autoimmune (AI) disorders. We aim to describe the clinical profile of patients with GAVE without known cirrhosis and to elucidate any associations with concomitant vascular or microvascular disorders. Methods: A retrospective study was conducted that included all patients diagnosed with GAVE without underlying cirrhosis (group 1). GAVE was diagnosed based on endoscopic appearance. An age and sex matched group of patients with cirrhosis and GAVE (group 2) was also included to serve as the control group. Information on demographics and co-morbid conditions like hypertension (HTN), diabetes mellitus I/II (DM), CKD, AI diseases, peripheral arterial disease requiring intervention (PAD), coronary artery disease (CAD), cerebrovascular disease (CVD) and smoking history was collected. Unpaired t-test was used to determine significance. Results: Seventeen patients were included in group 1 (mean age 65.3+15.1 years, women 70.6%) and group 2 (mean age 65.1+6.5 years, women 70.6%) each. Mean BMI was 29.8+6.5 (group 1) and 31.9+5.1 (group 2) respectively (p=0.300). Comparing group 1 vs. group 2, only CAD with a prevalence of 58.8% and 17.6%, respectively [p-value=0.0042] was statistically significant. PAD with a prevalence of was 17.6% (group 1) and 0% (group 2) [p-value=0.073] approached significance. Other conditions like HTN, DM, CVD, AI diseases, CKD and smoking history were not statistically significant (Table 1).Table 1Conclusion: In our small cohort of patients with GAVE, we found CAD was strongly associated with GAVE in patients without cirrhosis when compared to those with cirrhosis, while PAD approached statistical significance. We are limited by the small sample, which likely lowered the power of our study. Further large sample sized studies could help elucidate the association between underlying vascular disease and GAVE.