Gastric antral vascular ectasia is more frequent in patients with non-alcoholic steatohepatitis-induced cirrhosis

Abstract

Background: Gastric antral vascular ectasia (GAVE) is an uncommon cause of occult gastrointestinal (GI) bleeding. Based on clinical observations, we hypothesized that GAVE was more common in patients with non-alcoholic steatohepatitis (NASH) cirrhosis. Methods: We performed this retrospective study at Centre Hospitalier de l’Université de Montréal (CHUM). We included all cirrhotic patients who had undergone an esophagogastroduodenoscopy (EGD) between 2009 and 2011. GAVE was diagnosed based on a typical endoscopic appearance. NASH cirrhosis was diagnosed in patients with a metabolic syndrome after excluding other causes of liver disease. GAVE was considered symptomatic if it required treatment. Results: We included 855 cirrhotic patients in the study. The median age was 58 (range 19–88) years. The etiology of cirrhosis was as follows: NASH in 18% ( n = 154), autoimmune diseases in 15.1% ( n = 129), hepatitis B virus (HBV) in 6.3% ( n = 54), hepatitis C virus (HCV) in 19.4% ( n = 166), alcohol in 25.7% ( n = 220), alcohol plus HCV in 7.8% ( n = 67), cryptogenic in 2.8% ( n = 24), and other etiologies in 4.8% ( n = 41). GAVE was more frequently observed among patients with NASH cirrhosis than in cirrhosis of other etiologies (29.2% vs. 9.4%, respectively; p < 0.001). In multivariate analysis, NASH was strongly associated with GAVE with an odds ratio (OR) of 3.73 (95% CI 2.36 to 5.90, p < 0.001), and the association was stronger with symptomatic GAVE (OR 5.77, 95% CI 2.93 to 11.38). Conclusions: NASH cirrhosis is a major risk factor for GAVE and symptomatic GAVE.