Gastric Antral Vascular Ectasia and Its Clinical Correlates in Patients with Early Diffuse Systemic Sclerosis in the SCOT Trial

To describe the prevalence and clinical correlates of endoscopic gastric antral vascular ectasia (GAVE; "watermelon stomach") in early diffuse systemic sclerosis (SSc). Subjects with early, diffuse SSc and evidence of specific internal organ involvement were considered for the Scleroderma:...

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Published in:	Journal of rheumatology Vol. 40; no. 4; pp. 455 - 460
Main Authors:	HUNG, Emily W, MAYES, Maureen D, MINEISHI, Shin, PHILLIPS, Kristine, SEIBOLD, James R, BREDESON, Christopher, CSUKA, Mary Ellen, NASH, Richard A, WENER, Mark H, SIMMS, Robert, BALLEN, Karen, LECLERCQ, Sharon, SHARIF, Roozbeh, STOREK, Jan, GOLDMUNTZ, Ellen, WELCH, Beverly, KEYES-ELSTEIN, Lynette, CASTINA, Sharon, CROFFORD, Leslie J, MCSWEENEY, Peter, SULLIVAN, Keith M, ASSASSI, Shervin, MACHICAO, Victor I, HOSING, Chitra, CLAIR, E. William St, FURST, Daniel E, KHANNA, Dinesh, FORMAN, Stephen
Format:	Journal Article
Language:	English
Published:	Toronto, ON Journal of Rheumatology Publishing 01-04-2013
Subjects:	Adult Aged Biological and medical sciences Diseases of the osteoarticular system Female Gastric Antral Vascular Ectasia - complications Gastric Antral Vascular Ectasia - diagnosis Gastric Antral Vascular Ectasia - physiopathology Gastroenterology. Liver. Pancreas. Abdomen Gastroscopy Humans Male Medical sciences Middle Aged Other diseases. Semiology Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Scleroderma, Diffuse - complications Scleroderma, Diffuse - physiopathology Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Diffuse Human Immunopathology Connective tissue disease Skin disease SYSTEMIC SCLEROSIS Rheumatology GAVE Autoimmune disease Cardiovascular disease Vascular disease Gastric antral vascular ectasia Systemic disease Digestive diseases Endoscopy Scleroderma VASCULOPATHY Gastric disease
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Summary:	To describe the prevalence and clinical correlates of endoscopic gastric antral vascular ectasia (GAVE; "watermelon stomach") in early diffuse systemic sclerosis (SSc). Subjects with early, diffuse SSc and evidence of specific internal organ involvement were considered for the Scleroderma: Cyclophosphamide Or Transplant (SCOT) trial. In the screening procedures, all patients underwent upper gastrointestinal endoscopy. Patients were then categorized into those with or without endoscopic evidence of GAVE. Demographic data, clinical disease characteristics, and autoantibody data were compared using Pearson chi-square or Student t tests. Twenty-three of 103 (22.3%) individuals were found to have GAVE on endoscopy. Although not statistically significant, anti-topoisomerase I (anti-Scl70) was detected less frequently among those with GAVE (18.8% vs 44.7%; p = 0.071). Similarly, anti-RNP antibodies (anti-U1 RNP) showed a trend to a negative association with GAVE (0 vs 18.4%; p = 0.066). There was no association between anti-RNA polymerase III and GAVE. Patients with GAVE had significantly more erythema or vascular ectasias in other parts of the stomach (26.1% vs 5.0%; p = 0.003). Endoscopic GAVE was present on screening in almost one-fourth of these highly selected patients with early and severe diffuse SSc. While anti-Scl70 and anti-U1 RNP trended toward a negative association with GAVE, there was no correlation between anti-RNA Pol III and GAVE. Patients with GAVE had a higher frequency of other gastric vascular ectasias outside the antrum, suggesting that GAVE may represent part of the spectrum of the vasculopathy in SSc.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 E.W. Hung, MD, Rheumatology Associates of Houston; M.D. Mayes, MD, MPH; S. Assassi, MD, MS; V.I. Machicao, MD, University of Texas Health Science Center at Houston; R. Sharif, MD, University of Texas Medical Branch; C. Hosing, MD, MD Anderson Cancer Center; E.W. St. Clair, MD; K.M. Sullivan, MD, Duke University; D.E. Furst, MD, University of California at Los Angeles; D. Khanna, MD, MS; S. Mineishi, MD; K. Phillips, MD, PhD, University of Michigan; S. Forman, MD, City of Hope National Medical Center; J.R. Seibold, MD, Scleroderma Research Consultants, LLC; C. Bredeson, MD, Ottawa Hospital Research Institute; M.E. Csuka, MD, Medical College of Wisconsin; R.A. Nash, MD; P. McSweeney, MD, Colorado Blood Cancer Institute, Rocky Mountain Blood and Marrow Transplant Program; M.H. Wener, MD, University of Washington; R. Simms, MD, Boston University School of Medicine; K. Ballen, MD, Massachusetts General Hospital; S. LeClercq, MD; J. Storek, MD, PhD, University of Calgary; E. Goldmuntz, MD, PhD; B. Welch, RN, MSN, NIH/NIAID; L. Keyes-Elstein, DrPH; S. Castina, RN, MSN, Rho; L.J. Crofford, MD, University of Kentucky.
ISSN:	0315-162X 1499-2752
DOI:	10.3899/jrheum.121087