I am interested on starting a project considering the topic of GAVE in cirrhotic patients and I am looking for some answers to questions and doubts I have.
Does anyone have an opinion on relationships between histological differences between areas where GAVE manifests /usually multiple flat, linear erythematous strips of ectatic vessles, radiating from the pylorus to the antrum/ and sorrounding tissue - which looks more or less normal in endoscopy examination.
I would like to compare bioptates using histopathology, immunoenzymatic tools and propably also genetic tests, however I have some doubts can we treat this area as "healthy" control (i.e. - in cirrhotic patient) vs bioptates taken from areas with GAVE.
I thought that presence of portal gastropathy should not be a problem, as those pathologies occur in different area /gastric fundus/, comparing to GAVE /mostly in antrum/. The histologic hallmark of vascular changes of GAVE is superficial fibromuscular hyperplasia of gastric antral mucosa with capillary ectasia and microvascular thrombosis in the lamina propria.
Do you think that comparing material took from "healthy" vs "GAVE" areas in the same patient as control vs tested group is a good option? If not, what are the main problems you see in this conception.
Regards,
Mike
Department of Gastroenterology and Hepatology
Medical University of Silesia; Poland
I think the biggest issue would be the likelihood of milder gastropathic changes in the antrum related to portal hypertension. It is true that the most prominent findings are often in the fundus, but they can also manifest as a reactive gastropathy microscopically in antral biopsies. Since the most significant difference between GAVE and other forms of gastropathy is the frequent finding of microvascular thrombi, you will be dealing with a considerable histologic overlap between the two histopathologic findings. Endoscopic appearance may be helpful.
This is an interesting question asked above. The GAVE has been a small enigma beyond interest of researchers for long (as well as other tiny lesions of the stomach like the chronic erosions, for example). Besides, I think, one should consider both the macroanatomic pattern of the venous outflow in the antrum and the pressure venous gradient in the region. So it seems that the further from a porto-systemic shunt the smaller the venous bloodflow (the lower the pressure gradient?) and, so, the fainter pathologic lesions to occur.
Endobiopsy specemens' study only may not be sufficient for the investigation to complete. Perhaps, autopsy studies are needed.
Good luck!
As the GAVE lesions and portal hypertension seem to have different pathological pathways:
1) portal gastropathy seems to be more "hemodynamic" when it comes to etiology as GAVE does not dissapear or heal when we cure portal hypertension for example by performing liver transplantation, TIPSS or treat patient with b-blockers
2) GAVE seems to be in some way connected with autoimmunology - as it appears more frequently connected with sclerodermia
That is why I do expect some differences (especially in genetic testing) when investigating material took with biopsy during endoscopy: from GAVE vs "healthy" areas (however I do accept as you wrote some "overlaping" or sings of portal-hypertension-related lesions in non-GAVE material).
Regards
Dr.Żorniak,
By the way, what is your experience as to is there any correlation between the GAVE and so-called 'spider angiomata' on the skin to occur in the CLD patients?
Michał Żorniak - Thank you for your question. I suggest that the control should be healthy control subjects rather than the same patient. Because the pathophysiological changes of cirrhosis cannot be limited to certain parts or certain organs.
See this study for example-
Scand J Gastroenterol. 2018 Dec;53(12):1503-1508. doi: 10.1080/00365521.2018.1547922. Epub 2019 Jan 8.
Mucosal miR-3677 is over-expressed in cirrhotic patients with gastric antral vascular ectasia (GAVE).
Żorniak M1, Garczorz W2, Wosiewicz P1, Marek T1, Błaszczyńska M3, Waluga M1, Kukla M1, Kimsa-Furdzik M2, Francuz T2, Hartleb M1.
Author information
Abstract
INTRODUCTION:
Gastric antral vascular ectasia (GAVE) is a rare vasculopathy that associates several diseases, most commonly liver cirrhosis. It usually presents as an occult gastrointestinal bleeding leading to profound iron deficiency anemia. We hypothesized that GAVE is local mucosal pathology dependent on genetic mechanisms, and the purpose of the study was to characterize miRNAs expression in gastric tissue of patients with cirrhosis and GAVE.
MATERIALS AND METHODS:
Thirteen patients with GAVE and cirrhosis and 35 healthy subjects were recruited. Microarray analysis and comparative microRNA study was done by quantitative polymerase chain reaction (qPCR). The microarray scores were grouped with use of the hierarchical clusterization analysis and miRNA target prediction was done with TargetScan 6.2 algorithm and Gene Ontology analysis (DIANA-miRPath).
RESULTS:
Concentration of miR-3677 in GAVE-affected mucosa was higher by 72% in comparison with GAVE-free mucosa of patientswith cirrhosis (33.7 vs. 35.6 PCR cycles; p
- Badges
- Science topic
- Similar topics
- Statistics
- Survey