Case series on multimodal endoscopic therapy for gastric antral vascular ectasia, a tertiary center experience

AIM To study and describe patients who underwent treatment for gastric antral vascular ectasia(GAVE) with different endoscopic treatment modalities.METHODS We reviewed patients with GAVE who underwent treatment at University of Alabama at Birmingham between March 1, 2012 and December 31, 2016. Included patients had an endoscopic diagnosis of GAVE with associated upper gastrointestinal bleeding or iron deficiency anemia.RESULTS Seven out of 15 patients had classic watermelon description for GAVE, 1/15 with diffuse/honeycomb pattern and 6/15 with nodular GAVE per EGD description. Seven out of 15 patients required multimodal treatment. Four out of six of patients with endoscopically nodular GAVE required multimodal therapy. Overall, mean pre-and post-treatment hemoglobin(Hb) values were 8.2 ± 0.8 g/dL and 9.7 ± 1.6 g/dL, respectively(P ≤ 0.05). Mean number of packed red blood cells transfusions before and after treatment was 3.8 ± 4.3 and 1.2 ± 1.7(P ≤ 0.05), respectively.CONCLUSION Patients with nodular variant GAVE required multimodal approach more frequently than non-nodular variants. Patients responded well to multimodal therapy and saw decrease in transfusion rates and increase in Hb concentrations. Our findings suggest a multimodal approach may be beneficial in nodular variant GAVE.

PNPLA3 as a Genetic Determinant of Risk for and Severity of Non-alcoholic Fatty Liver Disease Spectrum

Background and Aims:Patatin-like phospholipase domain protein 3 (PNPLA3) polymorphisms (rs738409 C>G) are associated with non-alcoholic fatty liver disease (NAFLD).We performed a systematic review and meta-analysis to examine the association of PNPLA3 polymorphisms with the spectrum and severity of this disease.Methods:Studies evaluating the association between the PNPLA3 polymorphism spectrum (fatty liver,steatohepatitis,cirrhosis,and hepatocellular carcinoma) and NAFLD were included.Pooled data are reported as odds ratios (ORs) with 95% confidence intervals.Results:Of 393 potentially relevant studies,35 on NAFLD were included in the analysis.Compared to healthy controls,the pooled ORs for rs738409 CG and GG compared to CC among patients with non-alcoholic fatty liver (NAFL)were 1.46 (1.16-1.85) and 2.76 (2.30-3.13),and were 1.75 (1.24-2.46) and 4.44 (2.92-6.76) among patients with non-alcoholic steatohepatitis respectively.The respective ORs for CG and GG compared to the CC genotype were 2.35 (0.90-6.13) and 5.05 (1.47-17.29) when comparing nonalcoholic hepatocellular carcinoma to NAFL patients.Among the NAFLD patients,the ORs for G allele frequency when comparing steatosis grade 2-3 to grade 0-1 NAFL,when comparing the NAFLD activity score of ≥ 4 to score ≤ 3,when comparing NASH to NAFLD,when comparing the presence of lobular inflammation to absence,and when comparing the presence of hepatocyte ballooning to absence were 2.33 (1.43-3.80),1.80 (1.36-2.37),1.66 (1.42-1.94),1.58 (1.19-2.10),and 2.63 (1.87-3.69) respectively.Subgroup analysis based on ethnicity showed similar results.Conclusions:PNPLA3 polymorphisms have strong association with the risk for and severity of NAFLDs.PNPLA3 polymorphism plays an evolving role in diagnosis and treatment decisions in patients with NAFLD.