Watermelon stomach resolved after stem cell transplant in five patients
GAVE was considered reason not to perform AHSCT because bleeding could worsen
Autologous hematopoietic stem cell transplant (AHSCT) helped resolve watermelon stomach in five people with systemic sclerosis (SSc), researchers in Israel report. Watermelon stomach occurs when the lining of the stomach bleeds.
Having watermelon stomach, or gastric antral vascular ectasia (GAVE), could be a reason for an SSc patient to not receive an AHSCT because it could worsen bleeding. The researchers “suggest that GAVE should be regarded as an indication rather than a contraindication for AHSCT in SSc,” based on their observation, however.
Their report, “Complete resolution of gastric antral vascular ectasia after autologous haematopoietic stem cell transplantation in systemic sclerosis,” was published as a letter in the Annals of the Rheumatic Diseases.
SSc occurs when the immune system goes awry and triggers a buildup of scar tissue in the skin and potentially in the heart, kidney, lungs, and gastrointestinal tract. Watermelon stomach causes the stomach to have what looks like the characteristic stripes of a watermelon when viewed by endoscopy, a visual scan of the upper gastrointestinal tract. Its exact cause isn’t clear, but it’s common with SSc.
People with watermelon stomach often have recurrent bleeding and may need regular blood transfusions and repeated argon plasma coagulation, which uses argon gas and electrical current to seal the bleeds.
Stem cell transplants are being studied as a way to reset the immune system with scleroderma, in particular in patients with diffuse disease who usually have early and rapid worsening of symptoms, “the population at risk for GAVE.”
Stem cell transplant and watermelon stomach
Conditioning — the step in the procedure that helps make room for the transplanted stem cells — causes the number of platelets to drop, however. Platelets help form blood clots to slow or stop bleeding and a lower than normal number of platelets, called thrombocytopenia, may worsen GAVE.
The researchers reviewed the clinical records of 14 adults with diffuse SSc who’d undergone AHSCT at a medical center in Haifa, Israel. Five received a diagnosis of GAVE up to four months before the procedure, nine had no evidence of GAVE.
There were no differences in age and sex between the two groups, but a greater proportion of those with watermelon stomach tested positive for self-reactive antibodies against RNA polymerase III, a risk factor for GAVE (80% vs. 22.2%).
During AHSCT, there were no differences in how long thrombocytopenia lasted, how low the mean number of platelets was, or how many blood transfusions were needed. During their time in the hospital, one person with GAVE and two without evidence of GAVE had gastrointestinal bleeding.
Treatment-related mortality was 0% in the GAVE group and 22% (two patients) in the non-GAVE group.
Endoscopy revealed GAVE had resolved completely in all patients at a mean 7.8 months after AHSCT, ranging from four to 12 months, “without safety concerns,” the researchers wrote. This was confirmed by histologic examination of tissue samples under a microscope. Over a follow-up of five years, GAVE didn’t return.