Gastric Antral Vascular Ectasia as a Cause of Anemia in Systemic Sclerosis

We describe a patient with systemic sclerosis (SSc) in whom chronic blood loss from gastric antral vascular ectasia (GAVE) presented a major problem. A 69-year-old man, with Raynaud's phenomenon, sclerodactyly, hyperpigmentation on the forehead and nailfold capillary dilatation, required repeated transfusions but still exhibited persistent anemia due to recurrent upper gastrointestinal bleeding. He did not have cutaneous telangiectasias; neither hereditary hemorrhagic telangiectasia of Osler–Weber–Rendu disease nor any collagen disease was reported in his family. Gastroendoscopy showed an array of intensely red stripes radiating to the pylorus, resembling the stripes of a watermelon, with oozing hemorrhages. Biopsy samples were taken from this region of the distal gastric antrum and showed foveolar hyperplasia and superficial vascular ectasia, consistent with GAVE. Endoscopic treatment with a heater probe unit was effective in controlling blood loss from GAVE. The patient tolerated the procedure well and there were no resultant complications. Five sessions of treatment resulted in an eradication of almost all the vascular lesions, as well as negative fecal occult blood test results and a marked improvement of anemia without further transfusions. GAVE should be a diagnostic consideration in patients with SSc who develop recurrent upper gastrointestinal bleeding and anemia.