Patients with GAVE syndrome suffer from vascular dilatations in the area of the stomach. These ectasias cause gastric bleeding later in life, which causes iron deficiency anemia in addition to tarry and bloody stools. To stop the bleeding, patients have access to treatments such as argon plasma coagulation, which delivers radiofrequency current into the tissue.
What is GAVE syndrome?
Ectasias are dilatations on hollow organs or vessels that can carry a spindle or sac shape. The filling state of the ectasia determines whether the dilation appears bulging elastic. On vessels, different processes can cause ectasia. One possible cause of ectasia is GAVE syndrome. The name is an acronym that stands for G-astric A-ntral V-ascular E-ctasia. Accordingly, the disease is characterized by ectasias of the gastric mucosal vessels that may extend from the gastric corpus to the pylorus. GAVE syndrome affects the female sex twice as often as the male sex. GAVE syndrome most commonly affects people around the age of 70. The disease is also called watermelon stomach in the vernacular and German-language literature. This name refers to the derives red-streaked image that patients with GAVE syndrome give during gastroscopy.
Causes
The exact mechanisms by which GAVE syndrome develops have not yet been fully elucidated and remain a subject of speculation. Scientists are currently discussing various mechanisms of development. The cause could be an involvement of the bacterium Helicobacter pylori. Autoimmune diseases and collagenosis are also under discussion as causes. In addition, gastric torsion into the small intestine could explain the phenomenon. In addition, the phenomenon of GAVE syndrome is associated with conditions such as portal hypertension, renal insufficiency, and scleroderma. A putative link also appears to exist with liver cirrhosis. On gastroscopy, GAVE syndrome acts like hypertensive gastropathy but is considered an independent entity. Why women are affected twice as often as men remains unclear to date.
Symptoms, complaints, and signs
Patients with GAVE syndrome usually notice their disease relatively late. The radially seated ectasias of the gastric vessels do not necessarily cause symptoms in the early course. After a certain point, however, gastric bleeding usually occurs. These bleedings lead to chronic blood loss. The leaked blood is excreted by the patient in the stool, thus causing tarry stools or blood stools in the acute course. Because of the blood loss, anemia develops. As soon as this is the case, symptoms such as loss of performance, physical weakness and fatigue set in. In addition, patients often complain of headaches and nail changes. Brittle nails with groove formation are conceivable in this context. In the advanced clinical picture of anemia, cardiac arrhythmias may occur due to restrictions of cardiac functions. In addition, those affected complain of persistent concentration disorders, dizziness and balance disorders. At the latest when fainting attacks occur, those affected usually seek medical attention.
Diagnosis
Patients with GAVE syndrome usually present to the physician with symptoms of iron deficiency anemia. Iron deficiency anemia can have many causes. This fact greatly complicates the diagnosis for the physician. Tarry stools or blood in the stool mentioned in the medical history may be an important clue to watermelon stomach. The physician may take a stool sample for laboratory diagnostic analysis. The results of this analysis demonstrate larger amounts of blood. The tentative diagnosis of GAVE syndrome becomes more and more likely. In order to confirm the tentative diagnosis beyond doubt, gastroscopy can be performed. In gastroscopy, GAVE syndrome is recognized by long and streaky redness resembling the stripes of a watermelon. The prognosis for patients with GAVE syndrome depends on the time of diagnosis and the extent of chronic subacute and gastrointestinal bleeding.
Complications
In most cases, GAVE syndrome is diagnosed late, which is why late treatment is not possible. Without diagnosis and treatment, the syndrome usually causes bleeding in the stomach, which can have serious complications.Likewise, there is often blood in the stool, which can lead to anxiety and panic attacks in many patients. Likewise, the affected person suffers from a general feeling of illness and weakness. Headaches are also not uncommon and extremely restrict the patient’s daily life. Furthermore, there may be discomfort in the heart, so that physically strenuous activities can no longer be performed. There is often dizziness and disturbances of balance. Often the patient also suffers from movement disorders. Treatment of GAVE syndrome is not causal and therefore can only relieve the symptoms and discomfort. In most cases, the patient is also dependent on long-term treatment. This is especially the case if the affected person suffers from renal insufficiency and is dependent on dialysis. In some cases, organ transplantation may also be necessary.
When should you go to the doctor?
If blood is noticed in the stool or other signs of gastric bleeding occur, a doctor should be consulted promptly. Medical advice is needed if other symptoms of GAVE syndrome occur down the road, such as tarry or bloody stools. Symptoms such as fatigue, headache and loss of performance indicate anemia, which can lead to serious complications if left untreated. For this reason, the family doctor or a gastroenterologist should be consulted if the symptoms mentioned above occur. Brittle nails, pale skin and dizziness are clear warning signs that should be clarified immediately. If there is any disturbance of consciousness or even circulatory collapse, the affected person must be taken to a hospital. GAVE syndrome is associated with autoimmune diseases, collagenosis and bacterial infections. Patients with such a disease should talk to the doctor in charge if symptoms are mentioned. Children, elderly and physically weakened people as well as pregnant women should also consult a physician or pediatrician. Close medical monitoring is usually required during treatment.
Treatment and therapy
A causal therapeutic option is not yet available for patients with GAVE syndrome because the mechanisms of ectasia development remain unclear. For this reason, the primary cause of the ectasias cannot be resolved. However, a symptomatic treatment option is available with argon plasma coagulation. Argon plasma coagulation is a high-frequency thermal procedure used to coagulate various tissues. In surgery, coagulation is used to stop bleeding for various indications. In principle, the procedure consists of electric shocks delivered by a small-area electrode to the affected tissue. A neutral electrode rests on the thigh of the affected person and feeds the delivered current back into the high-frequency unit. In argon plasma coagulation, current transmission takes place by means of ionized argon gas jets used in the form of sparks. In this type of coagulation, the high heat generation initiates protein denaturation. The proteins change their structure in the process. The argon plasma jet used is directed by the surgeon to the mucous membranes, which have the highest conductivity. During the process, a highly flammable gas escapes if there is an oxygen-rich atmosphere. This connection should not be considered during the treatment in order to avoid complications. Patients with GAVE syndrome usually receive the coagulation treatment with time intervals several times until the bleeding is stopped. Symptoms of iron deficiency anemia resolve on their own after hemostasis. However, if GAVE syndrome occurs in the context of diseases such as renal insufficiency or liver cirrhosis, further treatment of the respective organ disease is given. Renal insufficiency can initially be treated with diuretics and dialysis. Patients with liver cirrhosis must avoid all substances toxic to the liver. In both cases, cure can only be achieved by organ transplantation.
Outlook and prognosis
GAVE syndrome has an unfavorable prognosis if the affected person does not seek treatment. The difficulty with the disease lies in timely diagnosis and thus treatment options. If, for various reasons, no diagnosis is made, the affected person suffers severe blood loss. Lack of strength and internal weakness are the consequences.Since the risk group for the disease includes people over 70 years of age, the organism is normally weakened overall. As a result, the body is often no longer able to compensate for the high blood loss sufficiently on its own. The affected person is thus threatened with premature death. With timely medical care, GAVE syndrome results in treatment of the existing symptoms. A causal therapy does not take place. This is due to the insufficiently researched cause of the disease. For this reason, there is no cure with the current medical possibilities and knowledge. Nevertheless, a long-term therapy can provide sufficient relief of the symptoms. This minimizes the risk of shortening the patient’s life. The patient must undergo regular check-ups so that changes or abnormalities are documented and treated as quickly as possible. If this takes place to a sufficient degree, patients with GAVE syndrome receive a good prognosis.
Prevention
The etiology of GAVE syndrome is largely unknown to date. For this reason, no preventive measures are available.
Follow-up
In GAVE syndrome, the options for follow-up are severely limited in most cases. To prevent further complications, the affected person is primarily dependent on direct and, above all, rapid treatment by a physician. The earlier GAVE syndrome is recognized and treated, the better the outlook and prognosis. As a rule, GAVE syndrome is treated by surgical intervention, although self-healing is not possible. After such an operation, the affected person should always rest and take care of his body. Strenuous activities or other sporting activities should be avoided in any case. Often, an examination is still necessary after the procedure in order to detect further damage. If GAVE syndrome leads to kidney insufficiency, the patient is usually dependent on dialysis. During dialysis, most sufferers also need support from their friends and family, and a complete cure can only be achieved through transplantation of the organ. For this reason, the life expectancy of the affected person is relatively limited or reduced by GAVE syndrome.
What you can do yourself
In any case, the affected persons are dependent on medical treatment to avoid further complaints and complications, since the syndrome cannot be prevented. Since the syndrome very often leads to permanent fatigue and exhaustion of the patient, the affected person should take it easy and not perform any strenuous activities. The anemia should be compensated. Blood transfusions are primarily suitable for this purpose, although blood formation can also be stimulated by various foods and trace elements. If the affected person suffers from an acute fainting spell, an emergency doctor must be called. Until the arrival of the emergency physician, the patient’s breathing and a stable lateral position must be ensured. In case of balance disorders, the use of walking aids may be useful to avoid further accidents and thus complications. If the patient is dependent on dialysis due to GAVE syndrome, friends and family can accompany them during the session. This can help resolve any potential psychological discomfort. In general, the support of family and friends has a very positive effect on the course of GAVE syndrome.
