Gastric Antral Vascular Ectasia

Definition

Distinctive pattern of gastric antral vascular changes with an associate distinctive endoscopic appearance

Mucosal vascular capillary ectasia
- No vascular malformations
- Submucosa may have tortuous vessels
Fibrin thrombi in capillaries
- CD61 may be useful to highlight thrombi
Edema and hemorrhage
Fibromuscular hyperplasia of lamina propria
- May hyalinize
Mild chronic inflammation in lamina propria
- Atrophic gastritis with intestinal metaplasia frequently present
  - Endocrine cell hyperplasia may be present
Microscopic changes may be less spectacular than the endoscopic findings
Does not respond to lowering of portal pressure, even if associated with cirrhosis
- Ablation of vessels may help

Predominantly affects adult women
- Age 40 and older
- Mean age about 79
Presents with iron deficiency anemia
Frequently associated with autoimmune disorders and connective tissue diseases
- Autoimmune atrophic gastritis
- Hypothyroidism
- Primary biliary cirrhosis
- Reynaud phenomenon, sclerodactyly and CREST syndrome
Frequently associated with cirrhosis
Endoscopic appearance
- Parallel longitudinal red stripes in antrum converging on pylorus
  - “Watermelon stomach”

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting/updates : 9/9/09, 4/16/10