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SSc-Associated GAVE — SCE Rheumatology MCQ

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HardSystemic SclerosisSSc-Associated GAVESCE Rheumatology

A 50-year-old woman with diffuse cutaneous systemic sclerosis has recurrent iron-deficiency anaemia despite intravenous iron replacement. Gastroscopy shows longitudinal columns of ectatic vessels radiating across the gastric antrum, confirming gastric antral vascular ectasia. There is no portal hypertension or active peptic ulceration. Which treatment is most appropriate to control the continuing blood loss?

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Correct answer: E — Endoscopic thermal ablation with argon plasma coagulation

The correct answer is E. Systemic sclerosis-associated gastric antral vascular ectasia causes chronic mucosal blood loss and requires lesion-directed endoscopic treatment. Argon plasma coagulation is an established treatment and commonly requires repeated sessions; endoscopic band ligation or radiofrequency ablation may be considered by specialist endoscopists, particularly for recurrent or APC-refractory disease. Iron replacement treats the resulting deficiency but not the vascular lesion. A proton pump inhibitor is appropriate for coexisting reflux or ulcer disease but does not eradicate GAVE. Cyclophosphamide is not standard treatment for established bleeding GAVE, despite isolated reports of improvement with immunosuppression. Angiographic embolisation is poorly suited to diffuse mucosal ectasia. Surgical resection is reserved for exceptional disease that remains uncontrolled despite endoscopic therapy.

Reference: Denton CP et al. The 2024 British Society for Rheumatology guideline for management of systemic sclerosis, gastrointestinal tract manifestations, 2024. https://pubmed.ncbi.nlm.nih.gov/18391491/