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Published in: Advances in Therapy 10/2021

01-10-2021 | Endoscopy | Review

Pharmacotherapy for the Treatment of Gastric Antral Vascular Ectasia: A Narrative Review

Authors: Mengyuan Peng, Xiaozhong Guo, Fangfang Yi, Fernando Gomes Romeiro, Andrea Mancuso, Xingshun Qi

Published in: Advances in Therapy | Issue 10/2021

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Abstract

Gastric antral vascular ectasia (GAVE) is an uncommon clinical entity leading to recurrent gastrointestinal bleeding. There is no consensus regarding treatment of GAVE. Endoscopic therapy is the preferred treatment option, but has a fairly high recurrence rate. Surgical resection can completely resolve GAVE, but is invasive with a relatively high risk of postoperative complications. Recently, the role of pharmacotherapy for GAVE has been recognized. However, the evidence is limited to scattered case reports or small case series. This review comprehensively summarizes the efficacy and side effects of drugs commonly used for the treatment of GAVE, including octreotide, cyproheptadine, cyclophosphamide, prednisolone, estrogen-progesterone, thalidomide, bevacizumab, and tranexamic acid.
Literature
1.
Rider JA, Klotz AP, Kirsner JB. Gastritis with veno-capillary ectasia as a source of massive gastric hemorrhage. Gastroenterology. 1953;24(1):118–23.PubMedCrossRef
2.
Thomas A, Koch D, Marsteller W, Lewin D, Reuben A. An analysis of the clinical, laboratory, and histological features of striped, punctate, and nodular gastric antral vascular ectasia. Dig Dis Sci. 2018;63(4):966–73.PubMedCrossRef
3.
Hsu WH, Wang YK, Hsieh MS, et al. Insights into the management of gastric antral vascular ectasia (watermelon stomach). Ther Adv Gastroenterol. 2018;11:1756283x17747471.CrossRef
4.
Liberski SM, McGarrity TJ, Hartle RJ, Varano V, Reynolds D. The watermelon stomach: long-term outcome in patients treated with Nd:YAG laser therapy. Gastrointest Endosc. 1994;40(5):584–7.PubMedCrossRef
5.
Garg S, Aslam B, Nickl N. Endoscopic resolution and recurrence of gastric antral vascular ectasia after serial treatment with argon plasma coagulation. World J Gastrointest Endosc. 2017;9(6):263–6.PubMedPubMedCentralCrossRef
6.
Magee C, Lipman G, Alzoubaidi D, et al. Radiofrequency ablation for patients with refractory symptomatic anaemia secondary to gastric antral vascular ectasia. United Eur Gastroenterol J. 2019;7(2):217–24.CrossRef
7.
Eccles J, Falk V, Montano-Loza AJ, Zepeda-Gomez S. Long-term follow-up in patients with gastric antral vascular ectasia (GAVE) after treatment with endoscopic band ligation (EBL). Endosc Int Open. 2019;7(12):E1624-e1629.PubMedPubMedCentralCrossRef
8.
Peng M, Guo X, Yi F, et al. Endoscopic treatment for gastric antral vascular ectasia. Therap Adv Chronic Dis. 2021;12:20406223211039696.
9.
Jin T, Fei BY, Zheng WH, Wang YX. Successful treatment of refractory gastric antral vascular ectasia by distal gastrectomy: a case report. World J Gastroenterol. 2014;20(38):14073–5.PubMedPubMedCentralCrossRef
10.
Quintero E, Pique JM, Bombi JA, et al. Gastric mucosal vascular ectasias causing bleeding in cirrhosis. A distinct entity associated with hypergastrinemia and low serum levels of pepsinogen I. Gastroenterology. 1987;93(5):1054–61.PubMedCrossRef
11.
Saperas E, Perez Ayuso RM, Poca E, et al. Increased gastric PGE2 biosynthesis in cirrhotic patients with gastric vascular ectasia. Am J Gastroenterol. 1990;85(2):138–44.PubMed
12.
Lowes JR, Rode J. Neuroendocrine cell proliferations in gastric antral vascular ectasia. Gastroenterology. 1989;97(1):207–12.PubMedCrossRef
13.
Yamaoka Y, Konishi H, Kodama T, et al. A case of gastric antral vascular ectasia–increase of neuroendocrine cells in the antrum. J Gastroenterol. 1995;30(3):387–92.PubMedCrossRef
14.
15.
Novitsky YW, Kercher KW, Czerniach DR, Litwin DE. Watermelon stomach: pathophysiology, diagnosis, and management. J Gastrointest Surg. 2003;7(5):652–61.PubMedCrossRef
16.
Nardone G, Rocco A, Balzano T, Budillon G. The efficacy of octreotide therapy in chronic bleeding due to vascular abnormalities of the gastrointestinal tract. Aliment Pharmacol Ther. 1999;13(11):1429–36.PubMedCrossRef
17.
Reubi JC, Schaer JC, Laissue JA, Waser B. Somatostatin receptors and their subtypes in human tumors and in peritumoral vessels. Metabolism. 1996;45(8 Suppl 1):39–41.PubMedCrossRef
18.
Clarke DL, McKune A, Thomson SR. Octreotide lowers gastric mucosal blood flow in normal and portal hypertensive stomachs. Surg Endosc. 2003;17(10):1570–2.PubMedCrossRef
19.
Barbara G, De Giorgio R, Salvioli B, Stanghellini V, Corinaldesi R. Unsuccessful octreotide treatment of the watermelon stomach. J Clin Gastroenterol. 1998;26(4):345–6.PubMedCrossRef
20.
Lam A, Lam SSH, Chang DWH, Badov D. Octreotide use in gastric antral vascular ectasia. J Pharm Pract Res. 2013;43(4):297–9.CrossRef
21.
Michopoulos S, Zampeli E, Giannopoulos C, et al. Effective pharmacological management of gastrointestinal vascular lesions with long acting octreotide: a case series. Gastroenterology. 2011;140(5):S388.CrossRef
22.
Krasaelap A, Madani S. Cyproheptadine: a potentially effective treatment for functional gastrointestinal disorders in children. Pediatr Ann. 2017;46(3):e120–5.PubMedCrossRef
23.
Cabral JE, Pontes JM, Toste M, et al. Watermelon stomach: treatment with a serotonin antagonist. Am J Gastroenterol. 1991;86(7):927–8.PubMed
24.
Soykan I, Toruner M, Idilman R, Ozden A. Reversal of iron deficiency anemia in a patient with gastric antral vascular ectasia treated with cyproheptadine. J Clin Gastroenterol. 2003;36(2):183–4.PubMedCrossRef
25.
Kishi K, Kinoshita Y, Kitajima N, et al. Two cases of gastric antral vascular ectasia–response to medical treatment. Gastroenterol Jpn. 1991;26(6):757–62.PubMedCrossRef
26.
Yamamoto M, Takahashi H, Akaike J, et al. Gastric antral vascular ectasia (GAVE) associated with systemic sclerosis. Scand J Rheumatol. 2008;37(4):315–6.PubMedCrossRef
27.
Ceribelli A, Cavazzana I, Airo P, Franceschini F. Anti-RNA polymerase III antibodies as a risk marker for early gastric antral vascular ectasia (GAVE) in systemic sclerosis. J Rheumatol. 2010;37(7):1544.PubMedCrossRef
28.
Ghrenassia E, Avouac J, Khanna D, et al. Prevalence, correlates and outcomes of gastric antral vascular ectasia in systemic sclerosis: a EUSTAR case-control study. J Rheumatol. 2014;41(1):99–105.PubMedCrossRef
29.
Serling-Boyd N, Chung MP, Li S, et al. Gastric antral vascular ectasia in systemic sclerosis: association with anti-RNA polymerase III and negative anti-nuclear antibodies. Semin Arthritis Rheum. 2020;50(5):938–42.PubMedCrossRef
30.
Hung EW, Mayes MD, Sharif R, et al. Gastric antral vascular ectasia and its clinical correlates in patients with early diffuse systemic sclerosis in the SCOT trial. J Rheumatol. 2013;40(4):455–60.PubMedPubMedCentralCrossRef
31.
Schulz SW, O’Brien M, Maqsood M, et al. Improvement of severe systemic sclerosis-associated gastric antral vascular ectasia following immunosuppressive treatment with intravenous cyclophosphamide. J Rheumatol. 2009;36(8):1653–6.PubMedPubMedCentralCrossRef
32.
Papachristos DA, Nikpour M, Hair C, Stevens WM. Intravenous cyclophosphamide as a therapeutic option for severe refractory gastric antral vascular ectasia in systemic sclerosis. Intern Med J. 2015;45(10):1077–81.PubMedCrossRef
33.
Lorenzi AR, Johnson AH, Davies G, Gough A. Gastric antral vascular ectasia in systemic sclerosis: complete resolution with methylprednisolone and cyclophosphamide. Ann Rheum Dis. 2001;60(8):796–8.PubMedPubMedCentralCrossRef
34.
Peterson A, Varga J. Cyclophosphamide: a novel treatment of gastric antral vascular ectasia associated with systemic sclerosis? Curr Rheumatol Rep. 2010;12(1):4–7.PubMedCrossRef
35.
Matsumoto Y, Hayashi H, Tahara K, et al. Intravenous cyclophosphamide for gastric antral vascular ectasia associated with systemic sclerosis refractory to endoscopic treatment: a case report and review of the pertinent literature. Intern Med. 2019;58(1):135–9.PubMedCrossRef
36.
37.
Calam J, Walker RJ. Antral vascular lesion, achlorhydria, and chronic gastrointestinal blood loss: response to steroids. Dig Dis Sci. 1980;25(3):236–9.PubMedCrossRef
38.
Moss SF, Ghosh P, Thomas DM, Jackson JE, Calam J. Gastric antral vascular ectasia: maintenance treatment with oestrogen-progesterone. Gut. 1992;33(5):715–7.PubMedPubMedCentralCrossRef
39.
Marks R, Barlow JW, Funder JW. Steroid-induced vasoconstriction: glucocorticoid antagonist studies. J Clin Endocrinol Metab. 1982;54(5):1075–7.PubMedCrossRef
40.
41.
42.
Suzuki T, Hirano M, Oka H. Long-term corticosteroid therapy for gastric antral vascular ectasia. Am J Gastroenterol. 1996;91(9):1873–4.PubMed
43.
Schäcke H, Döcke WD, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther. 2002;96(1):23–43.PubMedCrossRef
44.
van Cutsem E, Rutgeerts P, Vantrappen G. Treatment of bleeding gastrointestinal vascular malformations with oestrogen-progesterone. Lancet. 1990;335(8695):953–5.PubMedCrossRef
45.
Panés J, Casadevall M, Fernández M, et al. Gastric microcirculatory changes of portal-hypertensive rats can be attenuated by long-term estrogen-progestagen treatment. Hepatology. 1994;20(5):1261–70.PubMed
46.
Manning RJ. Estrogen/progesterone treatment of diffuse antral vascular ectasia. Am J Gastroenterol. 1995;90(1):154–6.PubMed
47.
Hermans C, Goffin E, Horsmans Y, Laterre E, Van Ypersele de Strihou C. Watermelon stomach. An unusual cause of recurrent upper GI tract bleeding in the uraemic patient: efficient treatment with oestrogen-progesterone therapy. Nephrol Dial Transplant. 1996;11(5):871–4.PubMedCrossRef
48.
Chien CC, Fang JT, Huang CC. Watermelon stomach—an unusual cause of recurrent upper gastrointestinal bleeding in a uremic patient receiving estrogen-progesterone therapy: case report. Changgeng Yi Xue Za Zhi. 1998;21(4):458–62.PubMed
49.
Tran A, Villeneuve JP, Bilodeau M, et al. Treatment of chronic bleeding from gastric antral vascular ectasia (GAVE) with estrogen-progesterone in cirrhotic patients: an open pilot study. Am J Gastroenterol. 1999;94(10):2909–11.PubMedCrossRef
50.
Sinha SK, Udawat HP, Varma S, et al. Watermelon stomach treated with endoscopic band ligation. Gastrointest Endosc. 2006;64(6):1028–31.PubMedCrossRef
51.
Bauditz J, Lochs H. Angiogenesis and vascular malformations: antiangiogenic drugs for treatment of gastrointestinal bleeding. World J Gastroenterol. 2007;13(45):5979–84.PubMedPubMedCentralCrossRef
52.
53.
Dunne KA, Hill J, Dillon JF. Treatment of chronic transfusion-dependent gastric antral vascular ectasia (watermelon stomach) with thalidomide. Eur J Gastroenterol Hepatol. 2006;18(4):455–6.PubMedCrossRef
54.
Moser S, Tischer A, Karpi A, et al. Evidence that thalidomide is effective in recurrent bleeding from watermelon stomach associated with liver cirrhosis. Endoscopy. 2014;46(Suppl 1 UCTN):E384.PubMed
55.
Aveiro M, Rodrigues T, Rabadão T, et al. The use of thalidomide in severe refractory anaemia due to gastric antral vascular ectasia (GAVE) in Cirrhosis? Eur J Case Rep Intern Med. 2020;7(12):002099.PubMedPubMedCentral
56.
Bayudan AM, Chen CH. Thalidomide for refractory gastrointestinal bleeding from vascular malformations in patients with significant comorbidities. World J Clin Cases. 2020;8(15):3218–29.PubMedPubMedCentralCrossRef
57.
58.
Kamalaporn P, Saravanan R, Cirocco M, et al. Thalidomide for the treatment of chronic gastrointestinal bleeding from angiodysplasias: a case series. Eur J Gastroenterol Hepatol. 2009;21(12):1347–50.PubMedCrossRef
59.
Santos S, Bernardes C, Borges V, Ramos G. Gastric antral vascular ectasia (GAVE) and hereditary hemorrhagic telangiectasia (HHT): two different conditions, one treatment. Ann Hematol. 2020;99(2):367–9.PubMedCrossRef
60.
Al-Bawardy B, Kamath PS, Simonetto D, et al. Intravenous bevacizumab for the treatment of refractory bleeding from small bowel angioectasia and gastric antral vascular ectasia (Gave): initial experience of a tertiary center. Gastroenterology. 2018;154(6):S-662-S-663.CrossRef
61.
Albitar HAH, Almodallal Y, Papadakis KA, et al. Intravenous bevacizumab reduces transfusion requirements and endoscopic interventions in patients with gastric antral vascular ectasia and small bowel angioectasia. Therap Adv Gastroenterol. 2020;158(4):1162-1163.e4.
62.
Hunt BJ. The current place of tranexamic acid in the management of bleeding. Anaesthesia. 2015;70(Suppl 1):50-3e18.PubMedCrossRef
63.
64.
Gluud LL, Klingenberg SL, Langholz E. Tranexamic acid for upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2012;1:Cd006640.PubMed
65.
66.
Amarapurkar DN, Patel ND. Gastric antral vascular ectasia (GAVE) syndrome. J Assoc Phys India. 2004;52:756–8.
67.
Khan S, Vaishnavi A. Pharmacotherapy for gastric antral vascular ectasia: dramatic response to tranexamic acid. Gastrointest Endosc. 2009;70(1):191 (author reply 191-2).PubMedCrossRef
68.
Ng W, Jerath A, Wąsowicz M. Tranexamic acid: a clinical review. Anaesthesiol Intensive Ther. 2015;47(4):339–50.PubMedCrossRef
Metadata
Title
Pharmacotherapy for the Treatment of Gastric Antral Vascular Ectasia: A Narrative Review
Authors
Mengyuan Peng
Xiaozhong Guo
Fangfang Yi
Fernando Gomes Romeiro
Andrea Mancuso
Xingshun Qi
Publication date
01-10-2021
Publisher
Springer Healthcare
Published in
Advances in Therapy / Issue 10/2021
Print ISSN: 0741-238X
Electronic ISSN: 1865-8652
DOI
https://doi.org/10.1007/s12325-021-01912-6

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