The regular arrangement of collecting venules pattern evaluated by standard endoscope and the absence of antrum nodularity are highly indicative of Helicobacter pylori uninfected gastric mucosa.

AIM: To evaluate the accuracy of antrum nodularity and the regular arrangement of collecting venules for diagnosing Helicobacter pylori gastritis. METHODS: Ninety-nine consecutive children and adolescents (1.07 years-17.69 years, mean+/-S.D.=9.71+/-3.80 F:M 54:45) undergoing upper digestive endoscopy were assessed for the presence of antrum nodularity and regular arrangement of collecting venules pattern to determine the status of H. pylori infection. Antrum nodularity was observed by a tangential view of the greater curvature of the gastric antrum. Regular arrangement of collecting venules was visualized as being the regular pattern of red points evaluated with a standard endoscope. Two biopsies from the antrum were collected for histology and rapid urease test. The accuracy of diagnosis based on antrum nodularity and regular arrangement of collecting venules was evaluated considering the sensitivity, specificity and likelihood ratio. RESULTS: H. pylori was detected in 32/99 patients (32.3%). Antrum nodularity provided 59.4% sensitivity (95% confidence interval 50.7-68.1), 98.5% specificity (95% confidence interval: 97-100), likelihood ratio+ 39.78, and likelihood ratio- 0.41. A regular arrangement of collecting venules pattern provided 96.9% sensitivity (95% confidence interval: 93.8-100), 88.1% specificity (95% confidence interval: 84.1-92), likelihood ratio+ 8.11, and likelihood ratio- 0.04. CONCLUSION: Antrum nodularity is a specific finding, although its sensitivity is low. A regular arrangement of collecting venules pattern and the absence of antrum nodularity are highly indicative of normal gastric mucosa that is negative for Helicobacter pylori.

[Gastric vascular ectasia (GAVE) or watermelon stomach (WS): infrequent cause of anemia]. / Ectasia vascular del antro (EVA) ó Watermelon Stomach (WS). Poco frecuente causa de anemia.

The gastric vascular ectasia (GAVE) or watermelon stomach (WS) is an unfrequent cause of anemia or evident upper gastrointestinal bleeding in elderly patients. We presented five female patients, average age 79 years, 4 of them with a long evolution anemia and one with melena. Three of them showed a typical WS endoscopy, 2 of them with diffuse patent. All 5 cases with positive pathologic findings: vascular ectasia, fibrin thrombi and fibromuscular hyperplasia. The endoscopic biopsy is as accurate as the study of the antrectomy piece. None of them had portal hypertension although the GAVE would be different entity from the cirrhotic vascular gastropathy. The treatment consisted in monopolar electrocoagulation of the lesions after the failure with the medical treatment in one case, corticosteroid and ferrous therapies in the three cases and one of them didn't require treatment up to now.

Ectasia vascular del antro (EVA) o watermelon stomach (WS): poco frecuente causa de anemia / Gastric vascular ectasia (GAVE) or wartemelon stomach (WS): unfrequent cause of anemia

La ectasia vascular del antro (EVA) o watermelon stomach (WS) es una causa poco frecuente de anemia o hemorragia digestiva alta manifesta en pacientes de edad avanzada. Presentamos 5 apcientes, todas mujeres, edad promedio 79 años, 4 anémicas de larga evolución y 1 con melena. Tres tenían endoscopía típica de WS, 2 tenían patente difusa. Las 5 con anatomía patológica positiva: ectasias vasculares y/o microtrombos fíbrinosos y proliferación fibromuscular en la l mina propria. La biopesia esdoscópica es tan fiel como el estudio de la pieza de antrectomía. Ninguna tenía hipertensión portal, aunque la EVA sería una entidad diferente a la gastropatía vascular del cirrótico. El tratamiento conssitió en electrocoagulación monopolar de las lesiones tras fracaso del tratamiento médico en 1 caso, corticoterpia mas ferroterapia en 3, mientras que el restante no requiere tratamiento por el momento. Conclusiones: la EVA debe tenerse presente en pacientes anémicos crónicos sien diagnóstico, de edad avanzada. Las im genes endoscópicas no siempre son las típicas del estómago en sandía (WS). Se debe biopsiar el antro gastrico ante la duda. Si no responden al tratamiento con corticoides y/o hierro, el tratamiento de elección es el laser o el "heat electrocoagulación monopolar o la esclerosis. La cirurgía es el último recurso a aplicar. (AU)

Ectasia vascular del antro (EVA) o watermelon stomach (WS): poco frecuente causa de anemia / Gastric vascular ectasia (GAVE) or wartemelon stomach (WS): unfrequent cause of anemia

La ectasia vascular del antro (EVA) o watermelon stomach (WS) es una causa poco frecuente de anemia o hemorragia digestiva alta manifesta en pacientes de edad avanzada. Presentamos 5 apcientes, todas mujeres, edad promedio 79 años, 4 anémicas de larga evolución y 1 con melena. Tres tenían endoscopía típica de WS, 2 tenían patente difusa. Las 5 con anatomía patológica positiva: ectasias vasculares y/o microtrombos fíbrinosos y proliferación fibromuscular en la l mina propria. La biopesia esdoscópica es tan fiel como el estudio de la pieza de antrectomía. Ninguna tenía hipertensión portal, aunque la EVA sería una entidad diferente a la gastropatía vascular del cirrótico. El tratamiento conssitió en electrocoagulación monopolar de las lesiones tras fracaso del tratamiento médico en 1 caso, corticoterpia mas ferroterapia en 3, mientras que el restante no requiere tratamiento por el momento. Conclusiones: la EVA debe tenerse presente en pacientes anémicos crónicos sien diagnóstico, de edad avanzada. Las im genes endoscópicas no siempre son las típicas del estómago en sandía (WS). Se debe biopsiar el antro gastrico ante la duda. Si no responden al tratamiento con corticoides y/o hierro, el tratamiento de elección es el laser o el "heat electrocoagulación monopolar o la esclerosis. La cirurgía es el último recurso a aplicar.

Duodenal and antral varices

Oesophageal and gastric fundal varices can be demonstrated by barium examination in over 50 per cent of cases with portal hypertension. It is not generally recognised that varices may occur also in the duodenal bulb, pyloric antrum and in other parts of the alimentary tract. The author reports 18 cases of portal hypertension shown to have oesophageal varices who had lobulated filling defects of the pyloric antrum were also found. In three, these defects were shown by spleno-portography to be caused by dilated portal venous radicles and evidence is presented to suggest a similar cause in the remaining cases. Varices in this situation are due to anastomoses between branches of the superior mesenteric vein and retro-peritoneal veins. The differential diagnosis and significance of duodenal and antral varices is discussed. (AU)