Iron deficiency anaemia, gastritis and antral vascular malformation

Endoscopic laser therapy for watermelon stomach

Eleven patients (nine females, two males) with anaemia due to acute and chronic gastrointestinal blood loss were found to have gastric antral vascular ectasia (watermelon stomach). Nine patients were transfusion-dependent, receiving a mean of 13.1 units over a mean period of 12.3 months. All patients received neodymium:yttrium-aluminium-garnet laser coagulation with a median of 3.0 treatment sessions. Post-treatment transfusion needs were abolished in six patients and minimal in two patients during a mean follow up of 27.3 months (range 12-60 months). Overall there was a mean reduction in transfusion requirement with treatment from 2.5 units per month to 0.4 units per month (P < 0.02). Mean pretreatment haemoglobin improved from 7.7 to 11.9 g/dL after treatment (P < 0.001). No complications occurred. Laser coagulation is safe and effective treatment for anaemia due to watermelon stomach and should be considered as first line therapy.

Two cases of gastric antral vascular ectasia--response to medical treatment

Two patients with severe iron deficiency anemia and gastric antral vascular ectasia (GAVE) are reported. The anemia caused by the chronic blood loss from the abnormally dilated mucosal and submucosal capillary veins in the gastric antrum was unresponsive to oral iron supplementation. However, one of the patients was successfully treated with intramuscular injection of (Asu1,7) eel calcitonin. The other one was treated by oral prednisolone with resulting improvement iron deficiency anemia. The possible mechanisms of successful calcitonin and prednisolone treatments on chronic blood loss from GAVE is discussed.

Watermelon stomach

The typical and atypical appearances of watermelon stomach (gastric antral vascular ectasia) during endoscopy, along with the treatments for it, are reviewed.

Gastric antral vascular ectasia (watermelon stomach)--therapeutic options

We have encountered five cases of chronic iron deficiency anaemia due to bleeding from gastric antral vascular ectasia (watermelon stomach). Two cases were associated with a lymphoma and in three cases there was evidence of portal hypertension. Two patients were treated conservatively by blood transfusions. The other patients required either surgery or tranexamic acid or endoscopic laser therapy to control the chronic haemorrhage.

Neuroendocrine cell proliferations in gastric antral vascular ectasia

Gastric antral vascular ectasia is a recently recognized cause of chronic gastrointestinal blood loss. Immunohistochemical and electron-microscopic studies were performed on the surgically resected antrum of a patient with antral vascular ectasia. These revealed extraepithelial and intraepithelial neuroendocrine cell proliferations. Staining for a wide range of neural and endocrine markers demonstrated that these cells contain large quantities of 5-hydroxytryptamine and vasoactive intestinal polypeptide. Gastric vascular ectasia is of unknown etiology but has been associated with achlorhydria and liver cirrhosis. The findings suggest that locally released neurotransmitters may be responsible for local vasodilation and hence a propensity to bleed.

Endoscopic laser therapy for watermelon stomach

Thirteen patients (9 women, 4 men) with anemia from acute and chronic gastrointestinal bleeding were found to have antral vascular disease consistent with watermelon stomach. The median age was 73 yr, with a range of 54-88 yr. Eight of the patients were transfusion-dependent, requiring a median of 5.5 U within the 12 mo before treatment. All were treated with endoscopic neodymium:yttrium-aluminum-garnet laser coagulation. Endoscopic and hematologic improvement were evident in 12 patients available for follow-up after a median period of 6 mo. There was a median increase of 4 g/dl in hemoglobin concentration; thus, the need for transfusion was eliminated. No major complications were encountered. Laser coagulation for watermelon stomach appears to be safe and efficacious and may be a therapeutic alternative for this disorder.

Causes of iron deficiency in adolescent athletes

Seventy-two high school cross-country runners were studied during the running session for possible etiologic factors associated with iron deficiency, which was defined as a serum ferritin level less than or equal to 12 ng/ml and a transferrin saturation of less than or equal to 16% occurring simultaneously. Iron deficiency was observed during the running season in 34% of female cross-country runners, compared with 8% of male runners. Increased iron losses through gastrointestinal bleeding occurred in 9 of 20 female runners; 7 of these 9 had iron deficiency. Dietary iron intake was low in both iron-deficient and iron-sufficient female runners, but dietary instruction did not increase iron intake significantly. Iron deficiency could not be prevented in 35% of the female runners treated with 60 mg of elemental iron daily, but adequate treatment was achieved with 180 mg. Iron losses in urine, sweat, and plasma were small and did not appear to be increased in iron-deficient runners. These findings indicate that female cross-country runners have a high incidence of iron deficiency that is associated with initially decreased iron stores and gastrointestinal bleeding.