RESUMO
Gastric antral vascular ectasia (GAVE), commonly known as "watermelon stomach," is characterized by parallel red stripes resembling watermelon stripes on endoscopic examination and is an uncommon but significant cause of chronic gastrointestinal bleeding, often associated with systemic diseases such as autoimmune conditions, liver cirrhosis, chronic renal insufficiency, and cardiovascular disease. Various therapeutic approaches have been introduced for GAVE treatment, including medical, endoscopic, and surgical interventions. We report a case of a 60-year-old man with a prior history of GAVE who developed melena and symptomatic severe anemia. Initial esophagogastroduodenoscopy (EGD) demonstrated oozing antral GAVE. The patient required weekly blood transfusions. In this article, we explored the safety and efficacy of azathioprine treatment for GAVE. We administered 100 mg (oral) of azathioprine once daily and evaluated the patient monthly for four months. After two months, the endoscopy examination results showed visible macroscopic improvement, and after four months, the lesions were healed. The healing process was complete with normal mucosa restored. After two months, there wasn't any need for blood transfusions or iron therapy. We present for the first time the endoscopic healing process of GAVE under azathioprine treatment confirming that the cause of GAVE is autoimmune. Further research is needed to optimize therapeutic strategies and improve patient outcomes.
RESUMO
Cholinesterase is a serum enzyme synthesized mainly by the hepatocyte. Serum cholinesterase levels tend to decrease in time in patients with chronic liver failure and can indicate the intensity of liver failure. The lower the value of serum cholinesterase, the higher the possibility of liver failure. A reduction in liver function induced a drop in the level of serum cholinesterase. We present a patient with end-stage alcoholic cirrhosis and severe liver failure that received a liver transplant from a deceased donor. We compared blood tests and serum cholinesterase before and after the liver transplant. The hypothesis is that the value of serum cholinesterase increases after a liver transplant, and we noticed a significant increase in cholinesterase levels after the transplant. Serum cholinesterase activity increases after a liver transplant and it indicates that the liver function reserve will reach a higher level after the transplant, according to the new liver function reserve.