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vascular gastropathy

Thursday 10 November 2005

vascular gastropathies

Definition: Vascular gastropathies are anomalies of gastric mucosal vessels with little or no accompanying inflammation.

Congestion, dilatation of capillaries and focal hemorrhages are commonly found in many biopsy specimens with H. pylori gastritis.

It is therefore important for the pathologist to be able to distinguish these nonspecific changes of inflammation from primary vascular lesions that are not gastritides per se.

These conditions are known as vascular gastropathies and are defined as abnormalities of gastric mucosal vessels with little or no accompanying inflammation.

The most important of these conditions, and the only one that can be confidently diagnosed by histopathological examination of biopsy specimens is gastric antral vascular ectasia (“watermelon” stomach), a syndrome frequently associated with gastric atrophy and autoimmune and connective tissue disorders.

Histologically, gastric antral vascular ectasia is characterized by an expansion of the mucosa due to fibromuscular hyperplasia.

The lamina propria also contains markedly dilated mucosal capillaries, which are not increased in number but show a significant increase in cross-sectional area.

In most cases, fibrin thrombi are found within the dilated capillaries.

The presence of these thrombi is particularly important for the differentiation from other causes of mucosal congestion.

Portal hypertensive gastropathy

Another vascular gastropathy that may be suspected, but usually not diagnosed, by histopathological examination of biopsy specimens is portal hypertensive gastropathy, a significant cause of chronic upper gastrointestinal bleeding in patients with portal hypertension.

In contrast to watermelon stomach, the histological changes in portal hypertensive gastropathy are more prominent in the proximal stomach.

One can observe variable dilatation, irregularity, and tortuosity of the mucosal, and, if present in the specimen, submucosal veins and capillaries.

These changes, however, are not specific, and in patients with concurrent H. pylori gastritis it is virtually impossible to establish a histopathological diagnosis of portal hypertensive gastropathy.

Types

- gastric antral vascular ectasia (watermelon stomach)

  • frequently associated with gastric atrophy and autoimmune and connective tissue disorders
  • expansion of the mucosa due to fibromuscular hyperplasia
  • lamina propria also contains markedly dilated mucosal capillaries, which are not increased in number but show a significant increase in cross-sectional area
  • fibrin thrombi found within the dilated capillaries (particularly important for the differentiation from other causes of mucosal congestion)

- portal hypertensive gastropathy

  • variable dilatation, irregularity, and tortuosity of the mucosal, and submucosal veins and capillaries

Differential diagnosis

- Helicobacter pylori gastritis (congestion, dilatation of capillaries and focal hemorrhages)