Understanding Hemostasis for Gastric Antral Vascular Ectasia (GAVE) and Radiation Proctitis (RP)
The purpose of this module is to create awareness of the bleeding disorders GAVE and Radiation Proctitis, discuss why they occur and explore the treatment options available to patients. We will review the basic definition of each disorder, followed by an in depth discussion of the clinical implications and therapeutic options available for patients.
GAVE: Gastric Antral Vascular Ectasia
Exactly what is GAVE? The technical name for this condition is gastric (stomach) antral (the end part of the stomach) vascular (blood vessel) ectasia (dilated blood vessels), otherwise known as GAVE and first described in the literature by Rider et al. in 1953. These dilated blood vessels may leak or rupture, causing intestinal bleeding.
As the name implies, the disease generally manifests itself in the distal portion of the stomach, the antrum. The typical appearance of GAVE consists of visible columns of red, dilated vessels which course along the longitudinal folds of the antrum. This appearance has been likened to the stripes on a watermelon rind, hence the term “watermelon stomach”, another name for the condition, coined by Jabbari et al. in 1984.
Overall, GAVE is found more frequently in females. The majority of non-cirrhotic GAVE patients are females (71%), with a mean age of 73 years, whereas cirrhotic GAVE patients tend to be younger (mean age 65 years) and male (75%).
In non-cirrhotic patients with GAVE, autoimmune diseases are most common, with incidences of 62% for autoimmune connective tissue disorders, 31% for Raynaud's phenomenon and 20% for sclerodactyly. Other conditions described in GAVE patients include scleroderma, chronic renal failure, ischemic heart disease, hypertension, valvular heart disease, familial Mediterranean fever and acute myeloid leukemia.