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Aldiabat M, Kilani Y, Alahmad M, Alhuneafat L, Aljabiri Y, Horoub A, Alabdallah K, Alrahamneh H, Manvar A. Inpatient Outcomes of Gastric Antral Vascular Ectasia in Those With Aortic Stenosis: A Retrospective Study of 85,000 Hospitalizations. J Clin Gastroenterol 2024; 58:769-775. [PMID: 37994146 DOI: 10.1097/mcg.0000000000001932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/31/2023] [Indexed: 11/24/2023]
Abstract
GOALS To investigate the outcomes of hospitalized patients with gastric antral vascular ectasia (GAVE) in the setting of aortic stenosis (AS). BACKGROUND Although AS is associated with gastrointestinal arteriovenous malformations, its association with GAVE, a rare cause of upper gastrointestinal bleeding, remains unknown. STUDY The National Inpatient Sample database from the years 2016 to 2019 was searched for patients admitted with a diagnosis of GAVE, with and without a history of AS. Univariate and multivariate logistic regression analysis was performed to determine the risk of mortality and in-hospital complications in the GAVE/AS group compared with the GAVE-only group. RESULTS Patients with AS had a 2-fold increase in the risk of GAVE [odds ratio (OR): 2.08, P < 0.001], with no statistically significant difference in inpatient mortality between the study groups (OR: 1.36, P = 0.268). Patients with GAVE-AS had a higher risk of hypovolemic shock (OR: 2.00, P = 0.001) and acute coronary syndromes (OR: 2.25, P < 0.001) with no difference in risk of cardiogenic shock ( P = 0.695), acute kidney injury ( P = 0.550), blood transfusion ( P = 0.270), sepsis ( P = 0.598), respiratory failure ( P = 0.200), or in-hospital cardiac arrest ( P = 0.638). The cost of care in patients with GAVE-AS was increased by a mean of $4729 ( P = 0.022), with no increase in length of stay ( P = 0.320) when compared with patients with GAVE-only. CONCLUSIONS Patients with AS have a 2-fold increase in the risk of development of GAVE. Patients with AS admitted for GAVE-related bleeding are at higher rates of hypovolemic shock, acute coronary syndrome, and higher resource utilization when compared with admitted patients with GAVE without AS.
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Affiliation(s)
- Mohammad Aldiabat
- Department of Medicine, Washington University in St. Louis, St. Louis
| | - Yassine Kilani
- Department of Medicine, Lincoln Medical Center/Weil Cornell Medicine
| | - Majd Alahmad
- Department of Medicine, University of Missouri-Columbia, Columbia, MO
| | - Laith Alhuneafat
- Department of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN
| | - Yazan Aljabiri
- Department of Medicine, Washington University in St. Louis, St. Louis
| | - Ali Horoub
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx
| | - Khaled Alabdallah
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Hebah Alrahamneh
- Department of Medicine, Mountainview Regional Medical Center, Las Cruces, NM
| | - Amar Manvar
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, Mineola, NY
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Cavallaro A, Zanghì A, Di Vita M, Catania VE, Longo G, Lo Menzo E, Granata R, Valenti MR, Cappellani A, Di Majo S. Recurrent gastric antral vascular ectasia: a single center experience. Front Surg 2024; 11:1356409. [PMID: 38633884 PMCID: PMC11021609 DOI: 10.3389/fsurg.2024.1356409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/02/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Gastric antral vascular ectasia (GAVE) is a rare cause of chronic or acute gastrointestinal bleeding. This condition accounts for ∼4% of upper gastrointestinal bleeding cases. This disease is often associated with systemic diseases, such as liver cirrhosis, chronic kidney failure, autoimmune conditions, diabetes mellitus, hypothyroidism, and cardiovascular diseases. However, its etiopathogenesis remains controversial. Materials and method We retrospectively reviewed the cases of GAVE treated at our digestive surgery unit. A total of nine patients were identified with a male/female ratio of 1.25:1 and an average age of 75.51 years (SD ± 9.85). All patients underwent endoscopic argon plasma coagulation (APC) treatment. At the time of the review, data on eight patients were available after 36 months of follow-up. Results APC appears to be safe and effective for hemostasis of bleeding vascular ectasia. Only one (11.1%) patient required surgical intervention due to hemodynamic instability after multiple unsuccessful endoscopic treatments. No intraoperative and postoperative complication or bleeding relapse was experienced. Discussion Based on our findings, we concluded that endoscopic APC is technically simple, but requires multiple re-interventions due to the incidence of relapses. Furthermore, larger randomized studies should be conducted to assess the role of elective surgery as the first intervention in stable patients with severe pathology and the timing of surgery after failed endoscopic treatment.
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Affiliation(s)
- Andrea Cavallaro
- General Surgery III, Department of Surgery, University of Catania, AOU Policlinico “G. Rodolico - San Marco,”Catania, Italy
| | - Antonio Zanghì
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Igrassia, Department of Catania, Chief ChiSMaCoTA Research Center, AOU Policlinico “G. Rodolico - San Marco,” Catania, Italy
| | - Maria Di Vita
- General Surgery III, Department of Surgery, University of Catania, AOU Policlinico “G. Rodolico - San Marco,”Catania, Italy
| | - Vito Emanuele Catania
- General Surgery III, Department of Surgery, University of Catania, AOU Policlinico “G. Rodolico - San Marco,”Catania, Italy
| | - Giovanni Longo
- General Surgery III, Department of Surgery, University of Catania, AOU Policlinico “G. Rodolico - San Marco,”Catania, Italy
| | - Emanuele Lo Menzo
- Department of General Surgery, Division of Minimally Invasive and Metabolic Surgery, Cleveland Clinic Florida, Weston, FL, United States
| | - Roberta Granata
- General Surgery III, Department of Surgery, University of Catania, AOU Policlinico “G. Rodolico - San Marco,”Catania, Italy
| | - Maria Rosaria Valenti
- General Surgery III, Department of Surgery, University of Catania, AOU Policlinico “G. Rodolico - San Marco,”Catania, Italy
| | - Alessandro Cappellani
- General Surgery III, Department of Surgery, University of Catania, AOU Policlinico “G. Rodolico - San Marco,”Catania, Italy
| | - Simone Di Majo
- General Surgery III, Department of Surgery, University of Catania, AOU Policlinico “G. Rodolico - San Marco,”Catania, Italy
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Maye JA, Baker O, Sheikh N. Resolution of gastric antral vascular ectasia following cessation of imatinib. BMJ Case Rep 2024; 17:e257620. [PMID: 38388203 PMCID: PMC10884209 DOI: 10.1136/bcr-2023-257620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
A female patient in her 80s presented with chronic iron-deficiency anaemia secondary to gastric antral vascular ectasia (GAVE), despite repeated endoscopic treatment. Her medical history was notable for chronic myeloid leukaemia, for which she took imatinib. Due to a possible association between imatinib and GAVE described in a small number of case reports, cessation of imatinib was trialled. This led to a significant improvement in the patient's anaemia and resolution of GAVE on repeat endoscopy. GAVE is an uncommon cause of gastrointestinal bleeding, the aetiology of which is uncertain. This report describes an approach to the differential diagnosis of chronic iron-deficiency anaemia and an overview of GAVE syndrome. It illustrates the benefit of broadening the differential when the diagnosis is uncertain and the utility of case reports in informing the differential diagnosis.
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Affiliation(s)
- James A Maye
- Medicine, West Suffolk Hospital, Bury Saint Edmunds, UK
| | - Olivia Baker
- Medicine, West Suffolk Hospital, Bury Saint Edmunds, UK
| | - Nadim Sheikh
- Gastroenterology, West Suffolk Hospital, Bury Saint Edmunds, UK
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Alsaeed BH, AlAbdulqader AA, Al-Qadhi AA, Alaswad HA, Foula MS, Alshomimi SJ. Successful Surgical Management of Gastric Antral Vascular Ectasia in a Patient with End-Stage Renal Disease: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e938543. [PMID: 36908039 PMCID: PMC10024934 DOI: 10.12659/ajcr.938543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Gastric antral vascular ectasia (GAVE) is a rare clinical entity that presents with acute upper-gastrointestinal bleeding or chronic anemia. It is characterized by endoscopic watermelon appearance of the stomach. It is usually associated with other comorbidities; however, few articles have previously described GAVE in patients with end-stage renal disease. Its management is controversial, and endoscopic management is considered the treatment of choice. CASE REPORT A middle-age female patient, on regular hemodialysis for ESRD, was referred to the surgical out-patient clinic as a refractory GAVE after failure of endoscopic management as she became blood transfusion-dependent. She underwent laparoscopic subtotal gastrectomy with a Billroth II reconstruction of gastrojejunostomy. She had a smooth postoperative course and was followed up in the clinic for 12 months with no complications. Her hemoglobin level was stable at 9.4 g/dL without further blood transfusion. CONCLUSIONS Gastric antral vascular ectasia is usually associated with other comorbidities; however, an association between GAVE and CKD is rare. Its management is controversial, and endoscopic management is considered the preferred method of treatment. Laparoscopic subtotal gastrectomy is an effective management modality for GAVE, with dramatic improvement and good outcomes in terms of bleeding, blood transfusion requirements, and nutritional status.
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Douglas AR, Holleran G, Smith SM, McNamara D. Shared changes in angiogenic factors across gastrointestinal vascular conditions: A pilot study. World J Gastrointest Pharmacol Ther 2020; 11:40-47. [PMID: 32844042 PMCID: PMC7416378 DOI: 10.4292/wjgpt.v11.i3.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/11/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neovascularisation is common to a variety of gastrointestinal (GI) disorders with differing aetiologies and presentations; usually affecting adults above 60 years. Shared angiogenic factors modulated by disease specific elements could be a common denominator and represent novel diagnostic and therapeutic targets. As yet, assessment of angiogenic factors across several GI vascular disorders associated with recurrent bleeding and anaemia has not been reported.
AIM To assess serum levels of angiogenic factors in several intestinal vascular disorders.
METHODS A case control study was performed in Tallaght University Hospital in patients with endoscopically proven small bowel angiodysplasia (SBA), portal hypertensive gastropathy (PHG), gastric antral vascular ectasia (GAVE) and non-bleeding, non-anaemic controls. Using enzyme-linked immunosorbent assay, concentrations of Angiopoietin 1 (Ang-1), Ang-2 and vascular endothelial growth factor (VEGF) were measured from 2 serum tubes of blood following informed consent. The relative expression of Ang-1 and Ang-2 and Ang-1/2 ratio was calculated and compared between groups. Statistical analysis was applied using a t-test, and a P value of < 0.05 was considered significant.
RESULTS To date 44 samples were tested: 10 SBA, 11 PHG, 8 GAVE and 15 controls. Mean age 60 (range 20-85) years and 20 (45%) were males. Controls were significantly younger (49 years vs 66 years, P = 0.0005). There was no difference in VEGF levels between the groups (P = 0.6). SBA, PHG and GAVE Ang-1 levels were similar and were significantly lower than controls, (P = 0.0002, 95%CI: 241 to 701). Ang-2 levels were statistically higher in PHG and GAVE groups compared to controls (P = 0.01, 95%CI: 77.8 to 668) and as a result, also had a lower Ang-1/2 ratios compared to controls. While SBA Ang-2 levels were higher than controls, this did not reach statistical significance. Neither age nor haemoglobin level, which was similar between disease groups, could explain the difference. In addition, the median Ang-1/Ang-2 ratio for all patients was found to be significantly lower compared to controls, 8 vs 28 respectively, P = 0.001, 95%CI: -27.55 to -7.12.
CONCLUSION Our novel pilot study suggests common alterations in Ang-1 and Ang-2 levels across several GI vascular disorders. Differences in Ang-1/Ang-2 ratios among vascular disorders compared to controls suggest disease-specific modulation.
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Affiliation(s)
| | - Grainne Holleran
- TAGG Research Centre, School of Medicine, Trinity College Dublin, Dublin D24, Ireland
| | - Sinead M Smith
- TAGG Research Centre, School of Medicine, Trinity College Dublin, Dublin D24, Ireland
| | - Deirdre McNamara
- TAGG Research Centre, School of Medicine, Trinity College Dublin, Dublin D24, Ireland
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Unnikrishnan R, Vijayakumar P, Senan S, Paul G. Gastric Antral Vascular Ectasia: An Uncommon Cause of Anemia in the Elderly. DUBAI MEDICAL JOURNAL 2019. [DOI: 10.1159/000501795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Gastric antral vascular ectasia (GAVE), also referred to as “watermelon stomach,” is an uncommon, under-reported, yet significant cause of acute or chronic gastrointestinal blood loss in the elderly. It accounts for about 4% of the nonvariceal upper GI bleeds, and diagnosis is established by the demonstration of characteristic watermelon stripes on upper GI endoscopy. The exact cause is unknown but is often associated with many systemic conditions and characterized by chronic anemia. With this case, we wish to emphasize the need to do upper GI endoscopy in all elderly patients undergoing anemia evaluation and to consider this possibility even in the very elderly individuals.
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Patel U, Desai R, Desai J, Damarlapally N, Zalavadia D, Yousef M, Coman R, Bansal P, Goyal H. Predictors of blood transfusion and in-hospital outcomes in patients with gastric antral vascular ectasia (GAVE): a nationwide population-based analysis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:46. [PMID: 30906750 DOI: 10.21037/atm.2019.01.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Gastric antral vascular ectasia (GAVE) is a rare cause of chronic non-variceal upper gastrointestinal (GI) bleeding and can turn into life-threatening bleed in some patients. Packed red blood cell (PRBC) transfusions are often required in these patients during hospitalization. We aimed to investigate the hospitalization outcomes and predictors of PRBC transfusions in patients with GAVE lesions. Methods Using the ICD-9-CM codes (537.82, 537.83), we queried the National Inpatient Sample (NIS) [2010-2014] to recognize hospitalized GAVE patients. A 1:2 random sample was obtained from the non-GAVE cohort and these groups were compared (GAVE vs. non-GAVE). The predictors of PRBC transfusion in GAVE cohort were analyzed with multivariate analysis by using SPSS Statistics 22.0. Results We included weighted 89,081 GAVE and 178,550 non-GAVE hospitalized patients. The GAVE patients were tended to be older, female and white. Significantly higher proportions of comorbidities such as congestive heart failure, diabetes, hypertension, hypothyroidism, liver disease, renal failure, Sjogren syndrome, systemic sclerosis and portal hypertension, etc. were present in these patients. The all-cause inpatient mortality was found to be 1.4%. The mean hospital charges and length of stay (LOS) per GAVE hospitalization were $36,059 and 4.63±5.3 days, respectively. A total of 6,276 (weighted 31,102) (34.9%) of these patients received at least one PRBC transfusion during hospitalization. Advanced age, multiple comorbidities, non-elective admissions, male gender, and African American race were the independent factors associated with higher chances of receiving PRBC transfusion. Conclusions Our analysis showed that hospitalized patients with GAVE lesions had lower overall mortality rate despite having multiple comorbidities. There was no difference in the LOS and hospital charges between the two cohorts. Nearly 35% of the GAVE patients received at least one PRBC transfusion.
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Affiliation(s)
- Upenkumar Patel
- Division of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | | | - Jiten Desai
- Division of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA
| | - Nanush Damarlapally
- Department of Health Sciences, Coleman College of Health Sciences, Houston, TX, USA
| | - Dipen Zalavadia
- Division of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Mohamad Yousef
- Division of Gastroenterology and Hepatology, University of Missouri at Columbia, Columbia, MO, USA
| | - Roxana Coman
- Division of Gastroenterology, Medical Center Navicent Health, Macon, GA, USA
| | - Pardeep Bansal
- Department of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
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Zulfiqar M, Shetty A, Shetty V, Menias C. Computed Tomography Imaging of Non-Neoplastic and Neoplastic Benign Gastric Disease. Curr Probl Diagn Radiol 2019; 48:75-96. [DOI: 10.1067/j.cpradiol.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/20/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022]
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Dridi I, Chaabane A, Ben-Cherif W, Aouam K, Haouas Z, Ben-Attia M, Boughattas NA. Circadian variation in intestine toxicity of Mycophenolate mofetil in rats: an experimental and histopathologic study. BIOL RHYTHM RES 2018. [DOI: 10.1080/09291016.2018.1533732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ichrak Dridi
- Laboratory of Pharmacology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Amel Chaabane
- Laboratory of Pharmacology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Wafa Ben-Cherif
- Laboratory of Pharmacology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Karim Aouam
- Laboratory of Pharmacology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Zohra Haouas
- Laboratory of Histology Embryology and Cytogenetic, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Mossadok Ben-Attia
- Laboratory of Biomonitoring of the Environment, Faculty of Sciences of Bizerte, Carthage University, Zarzouna, Tunisia
| | - Naceur A. Boughattas
- Laboratory of Pharmacology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Gastric Antral Vascular Ectasia in Systemic Sclerosis: Current Concepts. Int J Rheumatol 2015; 2015:762546. [PMID: 26633973 PMCID: PMC4655054 DOI: 10.1155/2015/762546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction. Gastric antral vascular ectasia (GAVE) is a rare entity with unique endoscopic appearance described as “watermelon stomach.” It has been associated with systemic sclerosis but the pathophysiological changes leading to GAVE have not been explained and still remain uncertain. Methods. Databases Medline, Scopus, Embase, PubMed, and Cochrane were searched for relevant papers. The main search words were “Gastric antral vascular ectasia,” “Watermelon Stomach,” “GAVE,” “Scleroderma,” and “Systemic Sclerosis.” Fifty-four papers were considered for this review. Results. GAVE is a rare entity in the spectrum of manifestations of systemic sclerosis with unknown pathogenesis. Most patients with systemic sclerosis and GAVE present with asymptomatic anemia, iron deficiency anemia, or heavy acute gastrointestinal bleeding. Symptomatic therapy and endoscopic ablation are the first-line of treatment. Surgical approach may be recommended for patients who do not respond to medical or endoscopic therapies. Conclusion. GAVE can be properly diagnosed and treated. Early diagnosis is key in the management of GAVE because it makes symptomatic therapies and endoscopic approaches feasible. A high index of suspicion is critical. Future studies and a critical review of the current findings about GAVE are needed to understand the role of this condition in systemic sclerosis.
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Assi H, Abdel-Samad N. Severe gastrointestinal hemorrhage during targeted therapy for advanced breast carcinoma. ACTA ACUST UNITED AC 2014; 21:e732-5. [PMID: 25302045 DOI: 10.3747/co.21.2038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The introduction of targeted agents has improved survival for patients with a number of types of cancer, including several breast cancer subtypes. However, these agents are not without toxicities, and the fact that many patients are now on targeted therapy for extended periods of time has presented new challenges for the management of adverse effects. Everolimus is an inhibitor of mtor (the mammalian target of rapamycin) that is used as targeted therapy for advanced, hormone receptor-positive, her2-negative breast cancer in postmenopausal women in combination with exemestane, after treatment failure with letrozole or anastrozole. Minor hemorrhagic events are relatively common with targeted agents, but life-threatening hemorrhages, although uncommon, can also occur. We report a case of life-threatening gastrointestinal bleeding in a 48-year-old woman being treated with everolimus for advanced infiltrating ductal carcinoma of the breast. The bleeding was successfully treated with 13 sessions of endoscopic hemostasis using argon plasma coagulation.
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Affiliation(s)
- H Assi
- Division of Medical Oncology/Hematology, The Moncton Hospital, Moncton, NB. ; Department of Medicine, Dalhousie University, Halifax, NS
| | - N Abdel-Samad
- Division of Medical Oncology/Hematology, The Moncton Hospital, Moncton, NB. ; Department of Medicine, Memorial University, St. John's, NL
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Lins L, Paraná R, Almeida Reis SR, Pereira Falcão AF. Primary Biliary Cirrhosis and Primary Sjögren's Syndrome: Insights for the Stomatologist. Case Rep Gastroenterol 2014; 8:251-6. [PMID: 25298762 PMCID: PMC4176406 DOI: 10.1159/000367595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Primary biliary cirrhosis (PBC) is a chronic progressive autoimmune disease characterized by portal inflammation and immune-mediated destruction of the intrahepatic bile ducts. Primary Sjögren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands, mainly the lachrymal and salivary glands, in the absence of other definitively diagnosed rheumatologic disease. We report a diagnosed case of primary Sjögren's syndrome associated with PBC. A 59-year-old Caucasian woman went to oral evaluation reporting dry mouth, difficulty in eating associated with burning mouth syndrome, dysgeusia and dysphagia. Intraoral examination revealed extensive cervical caries, gingivitis, gingival retraction, angular cheilitis and atrophic tongue. Hyposalivation was detected by salivary flow and Schirmer's test was positive. Antinuclear and antimitochondrial antibodies were both positive. Anti-Ro/SSA and anti-La/SSB antibodies were negative. A minor salivary gland biopsy of the lower lip was performed. Histopathologic analysis revealed lymphocytic infiltrate with destruction of salivary gland architecture in some areas and replacement of glandular tissues by mononuclear cells. Optimal management of PBC associated with Sjögren's syndrome requires a multidisciplinary approach as the key to optimal patient care. Dental practitioners should be able to recognize the clinical features of this associated condition. Appropriate dental care may prevent tooth decay, periodontal disease and oral infections as well as improve the patient's quality of life.
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Affiliation(s)
- Liliane Lins
- Faculty of Medicine, Federal University of Bahia, Salvador, Brazil ; Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Raymundo Paraná
- Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
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Montero A, Fernández-Lizarbe E, Rodríguez MÁ, Hernanz R, Polo A, Ramos A. External-beam radiotherapy: A realistic therapeutic option for the gastric antral vascular ectasia. Rep Pract Oncol Radiother 2012; 17:233-6. [PMID: 24377029 DOI: 10.1016/j.rpor.2012.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 01/16/2012] [Accepted: 03/10/2012] [Indexed: 11/29/2022] Open
Abstract
The gastric antral vascular ectasia (GAVE) is a well recognizable endoscopic entity characterized by the presence of multiple linear angioectatic vessels predominantly located in the antrum, with a typical appearance of "watermelon stomach". This condition typically affects elderly females presenting as iron-deficiency anaemia due to chronic gastric bleeding. Standard treatment is endoscopic ablation of the gastric mucosa. For non-responders, radical surgery is considered a curative treatment but with considerable morbidity and mortality. Radiation therapy is a well-known alternative for many benign diseases, including anomalous vascular hyperproliferative diseases, although its role has not been defined for GAVE. The present case illustrates the efficacy and tolerance of radiotherapy in the treatment of symptomatic gastric watermelon.
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Affiliation(s)
- Angel Montero
- Radiation Oncology Department, Universitary Hospital Ramón y Cajal, Madrid, Spain
| | | | | | - Raúl Hernanz
- Radiation Oncology Department, Universitary Hospital Ramón y Cajal, Madrid, Spain
| | - Alfredo Polo
- Radiation Oncology Department, Universitary Hospital Ramón y Cajal, Madrid, Spain
| | - Alfredo Ramos
- Radiation Oncology Department, Universitary Hospital Ramón y Cajal, Madrid, Spain
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