Navigating Diagnostic Challenges: Chronic Anemia Leading to the Diagnosis of Gastric Antral Vascular Ectasia (GAVE) in the Absence of Typical Symptoms

Abstract

Gastric antral vascular ectasia (GAVE) is a rare acquired vascular dysplasia usually associated with portal hypertension or CREST syndrome. Here we present a case of a 62-year-old female with no significant related comorbidities who presented to our clinic due to severe acute on chronic anemia. On initial review of systems, the only complaint the patient had was fatigue, shortness of breath and being lightheaded. Patient denied hematochezia or melena, no hematemesis or other gastrointestinal complaints, no history of NSAIDs or aspirin use. Initial labs were significant for iron-deficiency anemia with hemoglobin of 8.5 g/ dL. Recent colonoscopy was non diagnostic for the cause of anemia as well. Due to unrevealing previous workup patient was referred to gastroenterologist
and undergone esophagogastroduodenoscopy (EGD) with findings of ecstatic vessels in stomach antrum suggestive of GAVE, successfully treated with argon plasma coagulation. Total in a span of 4 years due to recurrence of anemia patient required 3 EGDs, while GAVE was successfully treated each time with argon plasma coagulation. Due to absence of gastrointestinal (GI) complaints patient was recommended to have regular laboratory workup to monitor for silent blood loss. This atypical presentation of upper GI bleeding warrants physicians to refer patients to gastroenterologists to perform EGD for further evaluation and treatment in cases of unknown etiology of iron deficiency anemia even in the absence of gastrointestinal (GI) complaints and non-revealing previous GI workup with colonoscopy