Gave Syndrome - wi
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Transcript Gave Syndrome - wi
Why GIVE a Liver
Transplant to Patients
with GAVE Syndrome
GAVE
Gastric Antral Vascular Ectasia
Incidence and Etiology
More common in females (ratio reversed in
cirrhotic population)
Elderly-70’s
30% of patients diagnosed also have cirrhosis
Other 70% associated with autoimmune
diseases
5.7% of all sclerosis patients
Etiology commonly thought to be related to
abnormal antral motility and mucosal atrophy
GAVE vs PHG
Diagnosis and Symptoms
GAVE
lesions are restricted to antrum, diffuse or linear
chronic significant blood loss often resulting in transfusion dependency
Only 4% of acute GI bleeds are attributable to GAVE syndrome
Portal Hypertensive Gastropathy (PHG)
lesions throughout, lesions are diffuse
Treatment
PHG- responds to portal pressure reduction efforts
Beta-blocker
TIPS-Transjugular Intrahepatic Portosystemic Shunt
GAVE
Estrogen-Progesterone
Endoscopic Argon Plasma Coagulation (APC)
Antrectomy- high mortality in cirrhotic patients
Liver Transplant
Liver Transplant for GAVE
Study out of Mayo Clinic in Jacksonville FL
reviewed 597 patients transplanted from February
1998 to June 2003.
345 had EGD prior to OLT, 8 (2.3%) had GAVE
pre OLT
3 of 8 had post OLT EGD, GAVE absent in all 3,
other 5 had no post OLT gastrointestinal bleeding
J Clin Gatroenterol. 2004. Ward EM et al
Patient Demographics
49 y/o F
Cirrhosis secondary to NASH (Non-alcoholic
steatohepatitis
Portal hypertension
Hepatic Encephalopathy
GAVE syndrome
Clinical Data
Labs
Total Bilirubin 0.9-2.0
INR 1.4-1.8
Creatinine 1.2-2.4
Albumin 2.9
Sodium 130’s
Platelets 40’s
Hemoglobin 6.0-9.5
Interventions
H/H checks 2x/week,
scheduled outpatient
transfusions
PRBCs greater than 60
Units over 8 months
APC- 7 treatments
29 Hospitalizations in 1
years time-10 for
GIB/anemia
UNOS MELD exception request
MELD 15-25
Higher MELDs driven by AKI/HRS
MELD exception request denied for:
No increased mortality
Try APC
Recommend live liver donor
Not appropriate diagnosis for MELD exception
Patient Update
Patient recently transplanted
Post OLT course has been quite complicated
but no gastrointestinal bleeding
Has not had EGD post OLT to confirm
resolution
Nursing Implications
Correct diagnosis is key for treatment
Educating the patient and other care givers
about GAVE syndrome
Scheduling of serial H/H checks, transfusions,
Endoscopic APC
Resolves with Liver Transplantation though
exact mechanism is unknown