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2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Gastric antral vascular ectasia &#40;GAVE&#41; is a rare&#44; but serious&#44; cause of upper gastrointestinal bleeding &#40;4&#37; of all gastric hemorrhages&#41;&#46; The endoscopic findings are characteristic&#58; linear images&#44; oriented radially and converging on the pylorus &#40;watermelon stomach<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;4</span></a>&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This condition is associated with underlying chronic diseases&#44; mostly with liver cirrhosis&#46; In autoimmune diseases&#44; it is related to the presence of Raynaud&#39;s phenomenon&#44; and is the form most widely reported of the limited subtype of scleroderma &#40;calcinosis&#44; Raynaud&#39;s phenomenon&#44; esophageal dysmotility&#44; sclerodactyly&#44; telangiectasia &#91;CREST syndrome&#93;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;6</span></a> The largest series of patients with GAVE includes 45 individuals&#44; 62&#37; of whom also had a connective tissue disease&#44; predominantly with Raynaud&#39;s phenomenon &#40;31&#37;&#41; and sclerodactyly &#40;20&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The etiology and pathogenesis of GAVE are unknown&#59; one hypothesis is that the histological changes&#44; especially in the lamina propria&#44; are due to a fibromuscular proliferation&#44; vascular dilatation and thrombosis&#44; caused by the vascular disease associated with this condition&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> It can be suspected in patients with scleroderma and iron deficiency anemia who do not respond to iron supplements&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">At the present time&#44; 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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Watermelon stomach following and preceding systemic sclerosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "O&#46; Elkayam"
                            1 => "M&#46; Oumanski"
                            2 => "M&#46; Yaron"
                            3 => "D&#46; Caspi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/sarh.2000.9623"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2000"
                        "volumen" => "30"
                        "paginaInicial" => "127"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11071584"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and management of gastric antral vascular ectasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Fuccio"
                            1 => "A&#46; Mussetto"
                            2 => "L&#46; Laterza"
                            3 => "L&#46;H&#46; Eusebi"
                            4 => "F&#46; Bazzoli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4253/wjge.v5.i1.6"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastrointest Endosc"
                        "fecha" => "2013"
                        "volumen" => "5"
                        "paginaInicial" => "6"
                        "paginaFinal" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23330048"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gastrointestinal complications&#58; the most frequent internal complications of systemic sclerosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Forbes"
                            1 => "I&#46; Marie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
                        "fecha" => "2009"
                        "volumen" => "48"
                        "numero" => "Suppl 3"
                        "paginaInicial" => "iii36"
                        "paginaFinal" => "iii39"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gastric antral vascular ectasia&#58; case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Kar"
                            1 => "S&#46; Mitra"
                            2 => "J&#46;M&#46; Resnick"
                            3 => "C&#46;F&#46; Torbey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3121/cmr.2012.1036"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Med Res"
                        "fecha" => "2013"
                        "volumen" => "11"
                        "paginaInicial" => "80"
                        "paginaFinal" => "85"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23262190"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence&#44; correlates and outcomes of gastric antral vascular ectasia in systemic sclerosis&#58; a EUSTAR case-control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Ghrenassia"
                            1 => "J&#46; Avouac"
                            2 => "D&#46; Khanna"
                            3 => "C&#46;T&#46; Derk"
                            4 => "O&#46; Distler"
                            5 => "Y&#46;A&#46; Suliman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3899/jrheum.130386"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2014"
                        "volumen" => "41"
                        "paginaInicial" => "99"
                        "paginaFinal" => "105"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24293584"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gastric antral vascular ectasia in systemic sclerosis&#58; current concepts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;H&#46; Parrado"
                            1 => "H&#46;N&#46; Lemus"
                            2 => "P&#46;X&#46; Coral-Alvarado"
                            3 => "G&#46; Quintana L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2015/762546"
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Rheumatol"
                        "fecha" => "2015"
                        "volumen" => "2015"
                        "paginaInicial" => "762546"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26633973"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The clinical and endoscopic spectrum of the watermelon stomach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;J&#46; Gostout"
                            1 => "T&#46;R&#46; Viggiano"
                            2 => "D&#46;A&#46; Ahlquist"
                            3 => "K&#46;K&#46; Wang"
                            4 => "M&#46;V&#46; Larson"
                            5 => "R&#46; Balm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol"
                        "fecha" => "1992"
                        "volumen" => "15"
                        "paginaInicial" => "256"
                        "paginaFinal" => "263"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1479175"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gastric antral vascular ectasia &#40;GAVE&#41;&#58; an update on clinical presentation&#44; pathophysiology and treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;P&#46; Selinger"
                            1 => "Y&#46;S&#46; Ang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000124339"
                      "Revista" => array:6 [
                        "tituloSerie" => "Digestion"
                        "fecha" => "2008"
                        "volumen" => "77"
                        "paginaInicial" => "131"
                        "paginaFinal" => "137"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18391491"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medical and endoscopic therapies for angiodysplasia and gastric antral vascular ectasia&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Swanson"
                            1 => "A&#46; Mahgoub"
                            2 => "R&#46; MacDonald"
                            3 => "A&#46; Shaukat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cgh.2013.08.038"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Gastroenterol Hepatol"
                        "fecha" => "2014"
                        "volumen" => "12"
                        "paginaInicial" => "571"
                        "paginaFinal" => "582"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24013107"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Refractory gastric antral vascular ectasia&#58; a new endoscopic approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Zulli"
                            1 => "A&#46; del Prete"
                            2 => "M&#46; Romano"
                            3 => "F&#46; Esposito"
                            4 => "M&#46;R&#46; Amato"
                            5 => "P&#46; Esposito"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Rev Med Pharmacol Sci"
                        "fecha" => "2015"
                        "volumen" => "19"
                        "paginaInicial" => "4119"
                        "paginaFinal" => "4122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26592837"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
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Journal Information
Vol. 13. Issue 6.
Pages 361-362 (November - December 2017)
Vol. 13. Issue 6.
Pages 361-362 (November - December 2017)
Images in Clinical Rheumatology
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Upper Gastrointestinal Bleeding (Watermelon Stomach) in a Patient With Limited Scleroderma (CREST Syndrome)
Hemorragia digestiva alta (estómago de sandía) en paciente con esclerodermia limitada (síndrome de CREST)
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8505
Ana Isabel Turrión Nievesa,b,
Corresponding author
anaturrion@hotmail.com

Corresponding author.
, Henry Moruno Cruza, M. Liz Romero Bogadoa, Ana Perez Gómeza
a Servicio de ESI-Reumatología, Departamento de Medicina Especialidades Médicas, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
b Unidad Docente de Anatomía y Embriología Humanas, Departamento de Cirugía y Ciencias Médico Sociales, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
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The patient was a 52-year-old man with a 20-year history of limited scleroderma, as well as antiphospholipid syndrome. He was positive for antinuclear antibodies (1:2560), with a centromere pattern, and for lupus anticoagulant, and was receiving oral anticoagulants due to thrombosis in a lower limb.

He was admitted to the hospital with an episode of blood in stool and evidence of anemia. Endoscopic study revealed vascular-like lesions in antrum converging as they neared the pylorus, compatible with watermelon stomach1,2 (Fig. 1). In the presence of active bleeding, he was treated with argon plasma coagulation3 (Fig. 2).

Fig. 1.

Endoscopic images of gastric antral vascular ectasia.

(0.09MB).
Fig. 2.

Endoscopic image of vascular ectasia treated with argon plasma coagulation.

(0.11MB).

Gastric antral vascular ectasia (GAVE) is a rare, but serious, cause of upper gastrointestinal bleeding (4% of all gastric hemorrhages). The endoscopic findings are characteristic: linear images, oriented radially and converging on the pylorus (watermelon stomach1,4).

This condition is associated with underlying chronic diseases, mostly with liver cirrhosis. In autoimmune diseases, it is related to the presence of Raynaud's phenomenon, and is the form most widely reported of the limited subtype of scleroderma (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia [CREST syndrome]).5,6 The largest series of patients with GAVE includes 45 individuals, 62% of whom also had a connective tissue disease, predominantly with Raynaud's phenomenon (31%) and sclerodactyly (20%).7

The etiology and pathogenesis of GAVE are unknown; one hypothesis is that the histological changes, especially in the lamina propria, are due to a fibromuscular proliferation, vascular dilatation and thrombosis, caused by the vascular disease associated with this condition.8 It can be suspected in patients with scleroderma and iron deficiency anemia who do not respond to iron supplements.

At the present time, we are unable to avoid its development and, given the presence of bleeding, the treatment with the best results is endoscopic, including the use of laser ablation, argon plasma coagulation or cold. With respect to the possible surgical solution, like antrectomy, it can be utilized if other therapies fail.9,10 There are medical treatments if endoscopy cannot be performed, but they are usually associated with more severe adverse effects.

Ethical DisclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflicts of Interest

The authors declare they have no conflicts of interest.

References
[1]
O. Elkayam, M. Oumanski, M. Yaron, D. Caspi.
Watermelon stomach following and preceding systemic sclerosis.
Semin Arthritis Rheum, 30 (2000), pp. 127-131
[2]
L. Fuccio, A. Mussetto, L. Laterza, L.H. Eusebi, F. Bazzoli.
Diagnosis and management of gastric antral vascular ectasia.
World J Gastrointest Endosc, 5 (2013), pp. 6-13
[3]
A. Forbes, I. Marie.
Gastrointestinal complications: the most frequent internal complications of systemic sclerosis.
Rheumatology (Oxford), 48 (2009), pp. iii36-iii39
[4]
P. Kar, S. Mitra, J.M. Resnick, C.F. Torbey.
Gastric antral vascular ectasia: case report and review of the literature.
Clin Med Res, 11 (2013), pp. 80-85
[5]
E. Ghrenassia, J. Avouac, D. Khanna, C.T. Derk, O. Distler, Y.A. Suliman, et al.
Prevalence, correlates and outcomes of gastric antral vascular ectasia in systemic sclerosis: a EUSTAR case-control study.
J Rheumatol, 41 (2014), pp. 99-105
[6]
R.H. Parrado, H.N. Lemus, P.X. Coral-Alvarado, G. Quintana López.
Gastric antral vascular ectasia in systemic sclerosis: current concepts.
Int J Rheumatol, 2015 (2015), pp. 762546
[7]
C.J. Gostout, T.R. Viggiano, D.A. Ahlquist, K.K. Wang, M.V. Larson, R. Balm.
The clinical and endoscopic spectrum of the watermelon stomach.
J Clin Gastroenterol, 15 (1992), pp. 256-263
[8]
C.P. Selinger, Y.S. Ang.
Gastric antral vascular ectasia (GAVE): an update on clinical presentation, pathophysiology and treatment.
Digestion, 77 (2008), pp. 131-137
[9]
E. Swanson, A. Mahgoub, R. MacDonald, A. Shaukat.
Medical and endoscopic therapies for angiodysplasia and gastric antral vascular ectasia: a systematic review.
Clin Gastroenterol Hepatol, 12 (2014), pp. 571-582
[10]
C. Zulli, A. del Prete, M. Romano, F. Esposito, M.R. Amato, P. Esposito.
Refractory gastric antral vascular ectasia: a new endoscopic approach.
Eur Rev Med Pharmacol Sci, 19 (2015), pp. 4119-4122

Please cite this article as: Turrión Nieves AI, Moruno Cruz H, Romero Bogado ML, Perez Gómez A. Hemorragia digestiva alta (estómago watermelon) en paciente con esclerodermia limitada (síndrome de CREST). Reumatol Clin. 2017;13:361–362.

Copyright © 2016. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
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