Can GAVE Occur in the Cardia?
Yes, gastric antral vascular ectasia (GAVE) can extend beyond the antrum to involve the cardia, though this is not universally recognized in the traditional nomenclature. 1
Evidence for Cardiac Involvement
The most direct evidence comes from a systematic endoscopic study that specifically examined patients with GAVE for concurrent lesions in the gastric cardia 1:
- When systematically examined after 1996,5 of 8 patients (62.5%) with GAVE had ectatic lesions in the cardia 1
- Before systematic examination protocols were implemented (pre-1996), only 2 of 9 patients were identified with cardiac involvement, suggesting this finding was previously underrecognized 1
- The study concluded that "ectatic lesions in the cardia are common in patients with GAVE" 1
Clinical Implications
Recognition and Diagnosis
- The traditional name "gastric antral vascular ectasia" is somewhat misleading, as the disease is not exclusively an antral process 1
- During endoscopic evaluation of patients with suspected or confirmed GAVE, systematic examination of the cardia should be performed to identify concurrent ectatic lesions 1
- The classic endoscopic patterns (watermelon stomach with radiating stripes or diffuse honeycomb pattern) are primarily described in the antrum, but similar vascular ectasia can occur in the cardia 2, 1
Pathophysiology Considerations
The histopathologic features of GAVE—including vascular ectasia of mucosal capillaries, focal thrombosis, fibromuscular hyperplasia, and fibrohyalinosis—are characteristic findings that can theoretically occur in any gastric location 3, 2
Treatment Approach
- Endoscopic band ligation remains the preferred first-line treatment and should address all areas of vascular ectasia, including cardiac lesions when present 4, 5
- The same endoscopic principles apply: EBL requires fewer sessions (mean 2.63 sessions) and achieves greater reduction in transfusion requirements compared to thermal methods 4
- Iron supplementation should be initiated in all patients regardless of lesion location 4
Important Caveat
Do not confuse GAVE involving the cardia with gastric varices in the cardia 6. These are entirely different entities:
- Gastric varices in the cardia (cardiofundal GV) are portal hypertensive lesions with distinct vascular supply requiring different management (cyanoacrylate injection or TIPS) 6
- GAVE can coexist with portal hypertension in approximately 30% of cases but represents a separate pathophysiologic process requiring endoscopic ablation rather than variceal therapy 7, 4, 2