Gastric antrum angiectasia

　　How is antral vascular ectasia caused? Briefly described as follows:

　　The etiology of the disease is not yet clear, and it is usually accompanied by systemic diseases, such as liver cirrhosis, chronic renal insufficiency, hypertension, heart valve disease, autoimmune diseases, etc.

　　The pathogenesis of the disease is also not clear, and it may be caused by the combined action of mechanical and humoral factors, leading to abnormal vascular development. Gastric acid and gastric food damage the submucosal congested blood vessels, leading to obvious bleeding in clinical practice.

　　Due to long-term gastrointestinal bleeding, patients with antral vascular ectasia all have severe iron deficiency anemia, and a considerable number of patients have hemoglobin below 70g/L. The disease seriously affects the daily life of patients and must be treated in a timely manner.

　　What are the symptoms of antral vascular ectasia? Briefly described as follows:

　　The disease is commonly manifested as chronic gastrointestinal bleeding, with symptoms such as melena and vomiting, and can have明显的 refractory iron deficiency anemia, which may require regular blood transfusions. Oral iron supplements usually cannot improve the symptoms of iron deficiency anemia. Some patients may have decreased or absent gastric acid, and more than 90% of patients have chronic atrophic gastritis, and some may have hypergastrinemia.

　　How to prevent antral vascular ectasia? Briefly described as follows:

　　Since the etiology of the disease has not been clarified yet, prevention of related diseases that may trigger the disease, such as portal hypertension, pyloric mucosal prolapse, atrophic gastritis, hypertension, etc., is recommended. Avoid all factors that can promote and worsen bleeding, and avoid using drugs that can increase blood volume, raise blood pressure, dilate blood vessels, and promote bleeding. Daily precautions: avoid smoking and alcohol stimulation, eat a balanced diet, avoid spicy and刺激性 food. Prevent constipation, and supplement a variety of vitamins and trace elements. Maintain sufficient sleep and pay attention to the combination of work and rest.

　　What examinations should be done for antral vascular ectasia? Briefly described as follows:

　　一、Blood routine examination

　　Some patients may have thrombocytopenia.

　　二、Gastroscopy

　　1. The typical antral mucosa, which is a coiled, spiny dilated vascular tissue emanating from the pylorus;

　　2. Radial flat strip-like mucosal injuries;

　　3. Scattered multiple mucosal injuries;

　　4. It can present with a rare condition called 'honeycomb stomach', which is a giant, red, combined vascular malformation focus;

　　5. In addition to the antrum, the lesion can also affect the gastric mucosa of other parts, with extensive vascular dilation in the duodenum and jejunum;

　　6. Under gastroscopy, the disease often combines with pyloric mucosal prolapse, where dilated blood vessels and ecchymotic hemorrhage can be seen at the top of the prolapsed mucosa;

　　7. The characteristic manifestation of the disease is the watermelon-like stripes found under gastroscopy;

　　8. Gastric endoscopic biopsy is of great significance for diagnosis.

　　Three. Upper Gastrointestinal Contrast

　　It can show mucosal folds extending from the pylorus, without specificity.

　　Four. CT

　　It can show thickening of the gastric antrum wall.

　　Five. Angiography

　　It can show increased vessels in the gastric antrum.

　　Six. Endoscopic Ultrasound

　　It can clearly distinguish the layers of the gastric mucosa, locate the mucosal and submucosal dilated vessels, and the dilated vessels show weak echo vascular structures in the mucosal layer.

　　Patients with gastric antrum varices should have a light diet, reasonable structure, and be nutritious. They should eat more liquid foods such as milk, congee, and oatmeal. They should avoid spicy, greasy, salty, and cold foods.

　　What are the treatment methods for gastric antrum varices (GAVE)? Briefly described as follows:

　　Endoscopic treatment is the most widely used conservative treatment method at present, which can completely control symptoms and reduce or avoid blood transfusion dependence. The efficacy of drug treatment for this disease is not clear. Currently, most people believe that surgical operations such as gastric antrum resection are the only methods that can treat the disease.

　　1. Endoscopic Treatment

　　Endoscopic sclerotherapy, thermal probe, and laser coagulation are all effective for GAVE. Currently, a series of contact or non-contact thermal burn methods for abnormal vascular development are widely used. Endoscopic laser treatment is usually ineffective for patients with portal hypertension and can cause a variety of complications. Repeated coagulation therapy can damage the gastric antrum mucosa, leading to polypoid hyperplasia or gastric antrum ulceration, which can further lead to significant rebleeding.

　　2. Argon Plasma Coagulation (APC)

　　Apply ionized gas coagulation to lesions 2-3mm deep, but do not directly contact the lesions. After widespread application, it has been confirmed that APC is more superior to other thermal treatment methods.

　　3. Drug Treatment

　　Corticosteroid hormone therapy is effective for some patients, but the side effects of hormones limit its application. Other treatments such as tranexamic acid, serotonin, etc., are limited to case reports. At present, there is no effective drug treatment for the disease.

　　4. Surgical Treatment

　　After endoscopic and drug therapy are ineffective, surgical treatment may be the only reliable method for treating the disease. Laparoscopic or laparoscopic-assisted gastric antrum resection has the advantages of short hospital stay, rapid functional recovery, and few postoperative complications.