Grant Michael J, Horwitz Mitchell E
Adult Blood and Marrow Transplant Program, Duke University Medical Center, Durham, NC, USA.
Case Rep Transplant. 2018 Mar 12;2018:2376483. doi: 10.1155/2018/2376483. eCollection 2018.
Gastric antral vascular ectasia or "watermelon stomach" is a significant cause of nonvariceal upper GI bleeding and is characterized by red, tortuous ectatic vessels along longitudinal folds in the gastric antrum. The existing literature links GAVE to patients with cirrhosis, scleroderma, bone marrow transplantation, and chronic renal failure among other associations, but its pathophysiology remains ill-defined. Over 30 cases of hematopoietic stem cell transplant-related GAVE (HSCT-GAVE) have been reported in the literature to date and there are likely many more that go undiagnosed or are attributed to another cause of upper gastrointestinal bleeding. Interestingly, a busulfan-containing conditioning regimen has been the primary factor implicated in the etiology of HSCT-GAVE because this was common to all cases in the literature to date. Here, we present the first case of HSCT-GAVE in a patient that was treated with a non-busulfan-containing conditioning regimen. We propose a link between chronic GVHD and the development of HSCT-GAVE that is supported by a similar development of GAVE in patients with systemic sclerosis.
胃窦血管扩张症或“西瓜胃”是引起非静脉曲张性上消化道出血的一个重要原因，其特征是胃窦部纵行皱襞上出现红色、迂曲的扩张血管。现有文献将胃窦血管扩张症与肝硬化、硬皮病、骨髓移植和慢性肾衰竭等患者联系起来，但该病的病理生理学仍不明确。迄今为止，文献中已报道了30多例造血干细胞移植相关的胃窦血管扩张症（HSCT - GAVE），可能还有更多病例未被诊断出来或被归因于上消化道出血的其他原因。有趣的是，含白消安的预处理方案一直是HSCT - GAVE病因中的主要因素，因为这是迄今为止文献中所有病例的共同特征。在此，我们报告了首例接受不含白消安预处理方案治疗的患者发生HSCT - GAVE的病例。我们提出慢性移植物抗宿主病与HSCT - GAVE的发生之间存在联系，系统性硬化症患者中胃窦血管扩张症的类似发展情况支持了这一观点。
