A case of gastric antral vascular ectasia in the maintenance hemodialysis patient: Our case and summary of the relevant literature in Japan

We report, here, a case of gastric antral vascular ectasia with severe progressive anemia in a hemodialysis patient. The patient is a 60-year old man who has been receiving hemodialysis due to chronic glomerulonephritis. Six months ago, his hemoglobin level showed a fall to 4.0g/dl but his anemia did not improve by any systemic treatment at all and required repeated blood transfusions. From initial endoscopic findings, a tentative diagnosis of erosive and easily hemorrhagic gastritis had been made but careful observation revealed numerous telangiectatic lesions in the antrum. Biopsy specimens were obtained from their lesions. These were pathologically consistent with gastric antral vascular ectasia. On admission, we used a heater probe treatment. His anemia improved at the end of treatment. It was a useful and safe treatment even in hemodialysis patients with a hemorrhagic risk. Gastric antral vascular ectasia has recently been recognized as an uncommon cause of upper gastrointestinal bleeding. Despite higher frequency of angiodysplastic lesion among the many causes of bleeding in the gastrointestinal tract in uremic patients, only a few cases in hemodialysis patients have been reported in Japan. The strong resemblance of this condition to an antral gastritis may well lead to confusion on endoscopy. The possibility of an antral vascular ectasia needs to be borne in mind in uremic patients with persistent anemia. We must more carefully observe these endoscopic findings and must correctly diagnose by an adequate biopsy.