Elsevier

The American Journal of Medicine

Volume 129, Issue 12, December 2016, Pages 1329.e19-1329.e23
The American Journal of Medicine

AJM online
Clinical research study
Clinical Characterization of Gastric Antral Vascular Ectasia: A Potential Manifestation of the Metabolic Syndrome

https://doi.org/10.1016/j.amjmed.2016.07.007Get rights and content

Abstract

Background and Objectives

Gastric antral vascular ectasia is a relatively common endoscopic finding. Past studies have shown an association of gastric antral vascular ectasia with cirrhosis and autoimmune disorders. We aimed to re-examine these associations and to investigate a possible association of gastric antral vascular ectasia with features of the metabolic syndrome.

Methods

There were 135 patients with a diagnosis of gastric antral vascular ectasia from years 1995-2013 seen at the University of Virginia who were identified from a clinical data repository and age and sex matched to a cohort of patients without gastric antral vascular ectasia undergoing endoscopy within the same time frame as the index cases. The groups were compared for comorbidities including autoimmune disease, cirrhosis, vascular disease, body mass index (BMI), diabetes mellitus, and cirrhosis due to nonalcoholic steatohepatitis.

Results

Sixty-four percent of gastric antral vascular ectasia patients were cirrhotic, compared with 14% of controls (P <.001). Vascular disease was more common in the gastric antral vascular ectasia cohort (57% vs 36%; P <.001). The mean BMI was also higher in the gastric antral vascular ectasia cohort (33.7 kg/m2 vs 28.8 kg/m2; P <.001). Diabetes mellitus and nonalcoholic steatohepatitis cirrhosis were more frequently observed in gastric antral vascular ectasia subjects (64% vs 29% in controls [P <.001] and 28% vs 2% [P <.001], respectively). There was not an increased prevalence of autoimmune disease in gastric antral vascular ectasia patients vs controls (15% vs 13%; P = .861).

Conclusion

These results confirm the association of gastric antral vascular ectasia with underlying cirrhosis and revealed a significant correlation of gastric antral vascular ectasia with features of metabolic syndrome such as diabetes, BMI, vascular disease, and nonalcoholic steatohepatitis cirrhosis. The pathophysiology of gastric antral vascular ectasia remains uncertain, but we speculate that it may be a manifestation of the metabolic syndrome.

Section snippets

Methods

Institutional Review Board approval was obtained at the University of Virginia prior to initiating the study. One hundred forty patients with a diagnosis of gastric antral vascular ectasia examined between 1995 and 2013 were identified through clinic records and an institutional Clinical Data Repository database based on International Classification of Diseases, Ninth Revision coding. Five patients were excluded for incomplete records. The remaining 135 case patients were matched in a 1:1 ratio

Patient Population

A total of 140 patients were identified with endoscopic findings diagnostic of gastric antral vascular ectasia. Five of these patients were excluded for incomplete records. Thus, a total of 135 patients with a diagnosis of gastric antral vascular ectasia were matched to 135 patients without gastric antral vascular ectasia. As in past studies, our institutional practice has been to rely on the endoscopic appearance to diagnose gastric antral vascular ectasia, although 10 of the cases had a

Discussion

Gastric antral vascular ectasia is a well-described gastric disorder that can lead to acute and chronic gastrointestinal bleeding.5, 22 We present a modern cohort of 135 gastric antral vascular ectasia patients matched with 135 patients without gastric antral vascular ectasia. To our knowledge, this is the largest cohort of patients with gastric antral vascular ectasia reported in the literature to date and the first clinical characterization since 1992.14 Our univariate analysis confirms the

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Funding: None.

Conflict of Interest: No conflicts of interest to report.

Authorship: ES – Design, acquisition of data, and drafting of the manuscript; BT – Design, acquisition of data, and critical revision of the manuscript; JP – Analysis and interpretation, drafting of the manuscript and statistical analysis; S Cornella – acquisition of data and drafting of the manuscript; S Caldwell – Study concept, design, drafting, and critical revision of the manuscript for important intellectual content.

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