Patients with GAVE syndrome suffer from vasodilatation in the area of the stomach. Later on, these ectasias cause gastric bleeding which, in addition to tar and blood stools, causes iron deficiency anemia. In order to stop the bleeding, treatments such as argon plasma coagulation are available for patients, in which high-frequency current is released into the tissue.
What is GAVE Syndrome?
According to SPORTINGOLOGY, ectasias are widening of hollow organs or vessels that can have the shape of a spindle or a sac. The filling state of the ectasia determines whether the expansion appears to be bulging and elastic. Various processes in vessels can cause ectasia. One possible reason for ectasia is GAVE syndrome.
The name is an acronym that stands for G -astric A -ntral V -ascular E -ctasia. The disease is therefore characterized by ectasia of the gastric mucosal vessels, which can extend from the stomach to the pylorus. GAVE syndrome affects women twice as often as men.
GAVE syndrome most commonly affects people around the age of 70. The disease is also called watermelon stomach in the vernacular and in German-language specialist literature. This designation refers to the red-streaked picture that patients with GAVE syndrome give during gastroscopy.
Causes
The exact mechanisms underlying GAVE syndrome have not yet been fully clarified and remain the subject of speculation. Scientists are currently discussing various mechanisms of origin. The cause could be an involvement of the Helicobacter pylori bacterium. In addition, autoimmune diseases and collagenosis are discussed as causes.
A twisting of the stomach in the small intestine may also explain the phenomenon. In addition, the phenomenon of GAVE syndrome is associated with diseases such as portal hypertension, renal insufficiency and scleroderma. There also seems to be a connection to cirrhosis of the liver.
In gastroscopy, GAVE syndrome acts like hypertensive gastropathy, but is viewed as an independent entity. How often women are affected twice as often as men remains unclear.
Symptoms, ailments & signs
Patients with GAVE syndrome usually notice their illness relatively late. The radial ectasias of the gastric vessels do not necessarily have to cause symptoms in the early course. After a certain point in time, however, gastric bleeding usually occurs.
This bleeding leads to chronic blood loss. The leaked blood is excreted by the patient in the stool and thus causes 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 decreased performance, physical weakness and fatigue set in.
In addition, patients often complain of headaches and changes in their nails. Brittle nails with grooves are conceivable in this context. In advanced anemia, cardiac arrhythmias can occur due to impaired cardiac functions.
In addition, those affected complain of persistent concentration problems, dizziness and disorders of balance. At the latest when fainting attacks occur, those affected usually see a doctor.
Diagnosis
Patients with GAVE syndrome usually present the symptoms of iron deficiency anemia to the doctor. Iron deficiency anemia can have many causes. This fact makes the diagnosis much more difficult for the doctor. A history of tarry stools or blood in the stool may be important clues about the watermelon stomach.
The doctor may take a stool sample for laboratory diagnostic analysis. The results of this analysis reveal larger amounts of blood. The suspected diagnosis of GAVE syndrome is becoming more and more likely. A gastroscopy can be performed to unequivocally confirm the suspected diagnosis.
In a gastroscopy, the GAVE syndrome can be recognized by the long, streaky reddening that resembles the stripes on 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 treatment is not possible until late. Without diagnosis and treatment, the syndrome usually causes bleeding in the stomach, which can have serious complications. There is also often blood in stool, which can lead to anxiety and panic attacks in many patients.
The person concerned also suffers from a general feeling of illness and weakness. Headaches are also not uncommon and limit the patient’s everyday life extremely. Furthermore, it can lead to heart problems, so that physically strenuous activities can no longer be carried out. Dizziness and imbalance are common. Often the patient also suffers from movement disorders.
The treatment of GAVE syndrome is not causal and can therefore only alleviate the symptoms and discomfort. In most cases, the patient is also dependent on long-term treatment. This is especially the case if the person concerned suffers from kidney failure and is dependent on dialysis. In some cases, an organ transplant 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 required if other symptoms of GAVE syndrome occur later, such as tar or blood stools. Symptoms such as tiredness, headaches and poor performance indicate anemia, which, if left untreated, can lead to serious complications. Therefore, if the symptoms mentioned, the family doctor or a gastroenterologist should be consulted.
Brittle nails, pale skin and dizziness are clear warning signs that should be clarified immediately. If disturbances of consciousness up to and including a circulatory collapse occur, the person concerned must be taken to a hospital. GAVE syndrome is associated with autoimmune diseases, collagenosis, and bacterial infections.
Patients with such a disease should speak to their doctor if they have mentioned symptoms. Children, elderly and physically weakened people as well as pregnant women should also see a doctor or pediatrician. Close medical supervision is usually required during treatment.
Treatment & Therapy
A causal therapy option is not yet available for patients with GAVE syndrome, as the mechanisms underlying the ectasias have not yet been clarified. Because of this, the primary cause of the ectasias cannot be resolved. However, with argon plasma coagulation, a symptomatic treatment option is available.
Argon plasma coagulation is a high-frequency thermal process for coagulating different types of tissue. In surgery, coagulation is used to stop bleeding for various indications. In principle, the procedure consists of electric pulses that are emitted into the affected tissue by a small-area electrode.
A neutral electrode rests on the patient’s thigh and feeds the current back into the high-frequency device. In argon plasma coagulation, electricity is transmitted by means of ionized argon gas jets, which are used in the form of sparks. With this type of coagulation, the high heat generation initiates protein denaturation.
The proteins change their structure. The argon plasma jet used is directed by the surgeon onto the mucous membranes, which have the highest conductivity. During the process, a highly flammable gas escapes if there is an oxygen-rich atmosphere. This relationship should not be considered during treatment in order to avoid complications.
Patients with GAVE syndrome usually receive the coagulation treatment several times at intervals until the bleeding has stopped. The symptoms of iron deficiency anemia subside after hemostasis. However, if the GAVE syndrome occurs in the context of diseases such as kidney failure or liver cirrhosis, further treatment of the respective organ disease is carried out.
Renal insufficiency can initially be countered with diuretics and dialysis. Patients with liver cirrhosis should avoid all substances that are toxic to the liver. In both cases, healing can only be achieved through organ transplantation.
Outlook & forecast
GAVE syndrome has an unfavorable prognosis if the person does not seek treatment. The difficulty with the disease lies in the timely diagnosis and thus the possibility of therapy. If, for various reasons, no diagnosis is made, the affected person will lose a lot of blood.
Powerlessness and an inner weakness are the consequences. Since people over 70 years of age belong to the risk group for the disease, there is usually an overall weakening of the organism. As a result, the body can often no longer adequately compensate for the high blood loss on its own. The person concerned is threatened with premature death.
With timely medical care, the symptoms of GAVE syndrome are treated. There is no causal therapy. This is due to the insufficiently researched cause of the disease. For this reason there is no cure given with the current medical possibilities and knowledge.
Nevertheless, long-term therapy can provide sufficient relief from the symptoms. This minimizes the risk of shortening the service 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 extent, patients with GAVE syndrome have a good prognosis.
Prevention
The etiology of GAVE syndrome is largely unknown. For this reason, no preventive measures are available.
Aftercare
With GAVE syndrome, the options for follow-up care are very limited in most cases. In order to prevent further complications, the person affected is primarily dependent on direct and, above all, rapid treatment by a doctor. The earlier GAVE syndrome is recognized and treated, the better the future prospect and prognosis.
As a rule, GAVE syndrome is treated with a surgical procedure, whereby self-healing is not possible. After such an operation, the person affected should always rest and take care of their body. In any case, strenuous activities or other sporting activities are to be avoided.
An examination is often necessary after the procedure in order to detect further damage. If the GAVE syndrome has resulted in kidney insufficiency, the affected person is usually dependent on dialysis.
With dialysis, most people also need support from their friends and family, although complete healing can only be achieved by transplanting the organ. For this reason, the life expectancy of those affected by GAVE syndrome is relatively severely restricted or reduced.
You can do that yourself
In any case, those affected are dependent on medical treatment in order to avoid further complaints and complications, as the syndrome cannot be prevented.
Since the syndrome very often leads to permanent fatigue and exhaustion in the patient, the person affected should take it easy and not do strenuous activities. The anemia should be compensated for. Blood transfusions are primarily suitable, although blood formation can also be stimulated by various foods and trace elements.
If the person concerned suffers from an acute fainting attack, an emergency doctor must be called. Until the emergency doctor arrives, the patient’s breathing and a stable side position must be ensured. If the balance is disturbed, the use of walking aids can be useful in order 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 resolve possible psychological complaints. In general, the support of family and friends has a very positive effect on the course of GAVE syndrome.
