antral vasodilation
Introduction
Introduction to antral vasodilation Gastric antral vasodilatation (GAVE) endoscopically shows that the dilated blood vessels are red-striped along the top of the mucosal fold to the pylorus, which is stripped gastric sinus vasodilatation (S-GAVE), because its appearance resembles watermelon rind. The streaks on it are also called watermelonstomach (WS). basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: iron deficiency anemia
Cause
Cause of antral vasodilation
(1) Causes of the disease
The etiology of this disease has not been known so far, and the pathogenesis is not clear. Whether it is an independent disease or a concomitant disease of a certain disease remains to be further studied. The following is a more concentrated view.
1. Associated with portal hypertension: Some patients are accompanied by cirrhosis at the same time. Therefore, it is suggested that this disease is a special type of portal hypertensive gastropathy. It is suggested that antral erythema erythema is a manifestation of similar vascular spider mites on gastric mucosa, 6 males. Bone marrow transplantation patients with WS, all patients with gastrointestinal bleeding within 3 months after transplantation, and venous obstructive liver disease and platelets below 30 × 109 / L during bleeding, and another 5 cases of bone marrow transplantation after diagnosis Patients with GAVE also have venous obstructive liver disease, suggesting that liver disease is associated with the disease, but no similar lesions are found in gastroscopy in patients with cirrhosis, and angiographic and pathological examinations do not provide definitive evidence.
2. Relationship with gastric mucosal prolapse: Some scholars believe that when gastric motility causes prolapse of gastric antrum mucosa, the loose mucosa is stretched and pressed by the pylorus to form multiple longitudinal folds, and the blood vessels in the mucosa also follow Growth, curling and dilatation, accompanied by mucosal reactive hyperplasia and lamina propria fibrosis, the unique gastroscopic findings and pathological manifestations of this disease, due to the strong contraction of the antrum and pyloric muscles, can lead to chronic intravascular mucosa Intermittent insufficiency of obstruction and dilatation, as most GAVE is not accompanied by gastric mucosal prolapse, so there are many dissidents.
3. Mesenteric vascular occlusion: It is speculated that this disease may be a secondary lesion of mesenteric vascular occlusion. Morphological and pathological studies of colonic vasodilatation in the elderly indicate that the disease is caused by long-term intermittent insufficiency of intestinal mucosal vessels. It is a degenerative change that occurs with age. Some people think that this mechanism can also be used to explain the disease.
4. Relationship with other concomitant diseases: Many patients are accompanied by atrophic gastritis, Helicobacter pylori infection, hypertension, arteriosclerosis, ischemic heart disease, pernicious anemia, diabetes, connective tissue disease, intestinal diverticulum, esophageal hiatus Hemorrhoids, chronic obstructive pulmonary disease and pulmonary fibrosis, etc., whether these diseases have a certain relationship with the incidence of this disease remains to be studied.
(two) pathogenesis
Microscopic lesions showed mucosal hyperplasia, edema, mucosal and submucosal large number of capillaries and venules were significantly dilated, distorted and congested, and diffuse or focal reticular distribution, characteristic pathological manifestations of the disease, visible fibers in the blood vessels Protein column and small thrombus, sometimes accompanied by small artery and lymphatic vessel dilatation, but no evidence of vascular malformation or dysplasia, visible fibromuscular hyperplasia in the lamina propria, associated with connective tissue hyperplasia and fibrosis, and neuroendocrine The proliferation of cells, the lesions are concentrated in the antrum of the stomach, but the mucosa has no obvious inflammation, or only mild non-specific chronic inflammation. After the excised specimen of the stomach is drained out of the blood, the red stripe of the antrum can be seen to fade or disappear.
Prevention
Gastric sinus vasodilation prevention
Since the cause of this disease has not been known so far, prevention of related diseases may cause GAVE (eg, portal hypertension, gastric mucosal prolapse, atrophic gastritis, hypertension, etc.).
Complication
Gastric sinus vasodilation complications Complications iron deficiency anemia
Due to long-term digestive tract blood loss, patients have severe iron deficiency anemia, hemoglobin is less than 70g / L is quite common.
Symptom
Symptoms of antral vasodilatation common symptoms repeated hematemesis and iron deficiency anemia
The main clinical manifestations are long-term digestive tract recessive hemorrhage. The fecal occult blood test is persistently positive. The blood loss can reach 100-200ml per day, which may be accompanied by melena and hematemesis. The course of disease can last for several years to several decades due to long-term digestion. Blood loss, patients have severe iron deficiency anemia, hemoglobin is less than 70g / L is quite common, most patients need repeated blood transfusion to improve the state of severe anemia, in addition to severe anemia, physical examination, no abnormal findings, medical history, family history Physical examination and laboratory tests also do not prompt congenital vascular disease, such as evidence and manifestations of hereditary telangiectasia, some patients with cirrhosis, chronic atrophic gastritis, systemic sclerosis.
Examine
Examination of antral vasodilation
Mainly for iron deficiency anemia, some patients may have thrombocytopenia.
1. Appearance of gastroscope: GAVE endoscopic findings are divided into two types: point and strip shape according to the characteristics of antral vasodilation described by Minak: point antral vasodilation (Fig. 2) shows that the dilated blood vessels are red and evenly diffuse. Sexual distribution in the antrum of the stomach; strip vasodilatation (Fig. 3) showed multiple long-shaped pale yellow ridges resembling mucosal folds, arranged radially from the pylorus to the antrum of the stomach along the long axis of the stomach, and the surface of the strip-like ridge Fully contiguous bright red or deep red round or oval erythema, forming a unique watermelon-like stripe appearance with clear boundaries, normal interstitial mucosa, intact, no erosion, no matter what type, visible to the naked eye The erythema consists of a large number of distorted, spirally or saclike vessels, ranging from needle tip to 5mm. The biopsy forceps compress the erythema, which can be seen to rapidly fade. The erythema is more bleeding after biopsy, and spontaneous bleeding can also be seen. Intermittent hemorrhage with contraction of the antrum of the stomach, and the lesion of individual patients extends to the abdomen of the duodenum or the bottom of the stomach.
2. Endoscopic ultrasonography: The antral mucosa is thickened, and the mucosa and mucosa are spongy.
Diagnosis
Diagnosis and differentiation of gastric sinus vasodilatation
Diagnostic points
Gastroscope can clearly identify the characteristic manifestations of red streaks or diffuse erythema in the antrum of the antrum. In addition, the pathological examination of the lamina propria is markedly dilated and bruised, with no or only mild inflammatory changes. This performance is not seen or Very rare in other types of stomach and stomach vascular diseases, it is considered to be unique to GAVE, so the diagnosis of this disease is not difficult, red sinus lesions or diffuse erythema lesions found in gastroscopy, even similar to bleeding The pathology of gastritis should take into account the possibility of GAVE and be diagnosed according to pathological examination.
It is mainly distinguished from various types of stomach diseases and gastric vascular diseases.
Differential diagnosis
1. Portal hypertensive gastropathy (PHG) PHG lesions occur mostly in the fundus. There are specific mosaic signs in the mucosa under the gastroscope. The scarlet fever rash and cherry red spots are more different in histology. In terms of treatment, the treatment of PHG is Drugs and other measures to reduce portal pressure are the mainstay, while GAVE uses endoscopic laser coagulation for good results.
2. Others: Helicobacter pylori (Hp)-associated gastritis, alcoholic gastritis, gastric mucosal erosion, drug-related gastritis, biliary gastritis, gastric vascular dysplasia, etc. must be excluded, and none of the GAVE-specific watermelon skin samples Endoscopic features have no unique histopathological diagnosis and are easy to identify.
