title: Patients with Gastric Antral Vascular Ectasia (GAVE) Are at a Higher Risk of Gastrointestinal Bleeding in the Absence of Cirrhosis.
abstract: OBJECTIVE
  Gastric antral vascular ectasia (GAVE) is commonly found in patients with cirrhosis, but it is also associated with other diseases in the absence of cirrhosis. Whether GAVE confers a different severity of gastrointestinal (GI) bleeding between patients with and without cirrhosis remains unknown. We aim to examine whether there is a difference in clinically significant GI bleeding due to GAVE in patients with or without cirrhosis.
  
  
  METHODS
  This is a retrospective case-control study of patients who were diagnosed with GAVE between January 2000 and June 2014. Patients were categorized into cirrhosis and noncirrhosis groups, and those with an additional GI bleeding source were excluded. Univariate comparisons and multivariable models were constructed using logistic regression.
  
  
  RESULTS
  In total, 110 patients diagnosed with GAVE on esophagogastroduodenoscopy (EGD) were included in our analysis; 84 patients had cirrhosis (76.4%) and 26 (23.6%) did not. Active GI bleeding was more prevalent in patients without cirrhosis (63.4% vs. 32.1%, p=0.003) despite similar indications for EGD, and endoscopic treatment with argon plasma coagulation (APC) was required more often in this group, approaching statistical significance (27% vs. 10.7%, p=0.056). There was no difference in bleeding severity, as evidenced by similar re-bleeding rates, surgery, or death attributed to uncontrolled bleeding. The strongest independent risk factor for GI bleeding was the absence of cirrhosis (odds ratio (OR): 5.151 (95% confidence interval (CI): 1.08-24.48, p=0.039).
  
  
  CONCLUSIONS
  Patients with GAVE in the absence of cirrhosis are at higher risk for active GI bleeding and require more frequent endoscopic treatment than similar patients with cirrhosis. It may be worthwhile to treat GAVE in this population even in the absence of active bleeding.
authors.affiliation: Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Stine
authors.affiliation: Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Cornella
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Curtis K
authors.initials: CK
authors.lastname: Argo
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Cohn
keywords: Endoscopy; Gastric antral vascular ectasia; Liver disease; Portal hypertension