Gastric antral vascular ectasia medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Traditional treatments
GAVE is treated commonly by means of an endoscope, including argon plasma coagulation[1] and electrocautery. Since endoscopy with argon photo coagulation is usually effective, surgery is usually not required. Endoscopy with thermal ablation is favored medical treatment because of its low side effects and low mortality, but is rarely curative.
Complications of coagulation therapy include
- Oozing
- Bleeding
- Relapse
Other treatments
Other medical treatments have been tried and include estrogen and progesterone therapy, and anti-fibrinolytic drugs such as tranexamic acid. Corticosteroids are effective, but are limited by their side effects.
Treatment of co-morbid conditions
A transjugular intrahepatic portosystemic shunt (TIPS or TIPSS) procedure is used to treat portal hypertension when that is present as an associated condition. Unfortunately, the TIPSS, which has been used for similar conditions, may cause or exacerbate hepatic encephalopathy.[2][3] TIPSS-related encephalopathy occurs in about 30% of cases, with the risk being higher in those with previous episodes of encephalopathy, higher age, female sex, and liver disease due to causes other than alcohol.[4] The patient, with his or her physician and family, must balance out a reduction in bleeding caused by TIPS with the significant risk of encephalopathy. Various shunts have been shown in a meta-study of 22 studies to be effective treatment to reduce bleeding, yet none have any demonstrated survival advantage.
If there is cirrhosis of the liver that has progressed to liver failure, then lactulose may be prescribed for hepatic encephalopathy, especially for Type C encephalopathy with diabetes. Also, antibiotics such as neomycin, metronidazole, and rifaximin may be used effectively to treat the encephalopathy by removing nitrogen-producing bacteria from the gut.
Paracentesis, a medical procedure involving needle drainage of fluid from a body cavity,[5] may be used to remove fluid from the peritoneal cavity in the abdomen for such cases. This procedure uses a large needle, similar to the better-known amniocentesis.
References
- ↑ Rosenfeld, G; Enns, R (2009). "Argon photocoagulation in the treatment of gastric antral vascular ectasia and radiation proctitis". Canadian Journal of Gastroenterology. 23 (12): 801–4. PMC 2805515. PMID 20011731.
- ↑ Khan S, Tudur Smith C, Williamson P, Sutton R (2006). Khan, Saboor A, ed. "Cochrane Database of Systematic Reviews". Cochrane Database Syst Rev (4): CD000553. doi:10.1002/14651858.CD000553.pub2. PMID 17054131.
|chapter=ignored (help) - ↑ Saab S, Nieto JM, Lewis SK, Runyon BA (2006). Saab, Sammy, ed. "TIPSS versus paracentesis for cirrhotic patients with refractory ascites". Cochrane Database Syst Rev (4): CD004889. doi:10.1002/14651858.CD004889.pub2. PMID 17054221.
|chapter=ignored (help) - ↑ Sundaram V, Shaikh OS (2009). "Hepatic encephalopathy: pathophysiology and emerging therapies". Med. Clin. North Am. 93 (4): 819–36, vii. doi:10.1016/j.mcna.2009.03.009. PMID 19577116. Unknown parameter
|month=ignored (help) - ↑ Template:DorlandsDict