Incidence Of Helicobacter Pylori In Patients Undergoing Upper Endoscopy Living In A Long Term Care Facility For Individuals With Intellectual Disabilities And Developmental Disabilities (Iddd) Compared To A Reference General Population

transfusions. Generally these patients are treated by invasive endoscopic methods or surgery. We evaluated the literature about pharmacologic management of GAVE and performed qualitative meta-analysis (QMA) on these cases. Methods: A PubMed search using the terms GAVE, watermelon stomach, recurrent bleeding pharmacotherapy without time or language barrier was carried out. Additional papers were manually added from the reference list of key articles. GAVE patients treated surgically or endoscopically were excluded. To facilitate QMA, summary sheets of all the papers were created. QMA was performed using the well-established methods of Qualitative Research, e.g., Diagramming, Th eme Repetition Without Serious Contradiction, Th eme Saturation and Investigator Refl exivity. (Eval Rev 1985;9:627-643. Th e Lancet 2001;358:483-488). Quantitative data can be used to perform QMA. Results: GAVE causes up to 4% of non-variceal upper GI bleeding. Endoscopically GAVE is seen as longitudinal, red edematous folds converging on the pylorus or as coalescence of angiodysplastic lesions (honey-comb) or as a localized lesion formed by a tuft of ectatic blood vessels. Histologically, it shows fi bromuscular hyperplasia of lamina propria, intravascular fi brin thrombi and ectatic mucosal vessels. It must be diff erentiated from hemorrhagic gastritis and portal hypertensive gastropathy (PHG). GAVE patients, unlike PHG patients, do not benefi t from beta-blockers or TIPS. Aft er excluding GAVE patients treated endoscopically or surgically, only 49 GAVE patients in the world literature were available to evaluate the eff ect of pharmacotherapy. Th ere are no large randomized studies. Th ere are isolated case reports or small series of 3-6 patients. Th ere were 16 men (32%); there were 33 women (68%). Th e mean age was 60.5 (range 27-90) years. Th e medications used were corticosteroids, octreotide, thalidomide, tranexamic acid (antifi brinolytic agent), estrogen-progestrone, calcitonin, alpha-Interferon, cyproheptadine, I/V cyclophosphamide (only in cases of GAVE associated with progressive systemic sclerosis) GAVE was associated with cirrhosis, systemic sclerosis, autoimmune connective tissue diseases, chronic renal failure, ischemic or valvular heart disease, acute myeloid leukemia and bone-marrow transplantation. Conclusion: Th e role of pharmacotherapy in GAVE is not yet established. Large randomized studies are needed. Th e promising agents are octreotide, thalidomide and tranexamic acid. Some new anti-angiogenesis agents are being considered for evaluation.