Improvement of Severe Systemic Sclerosis-associated Gastric Antral Vascular Ectasia Following Immunosuppressive Treatment with Intravenous Cyclophosphamide

Objective. We describe 3 patients with systemic sclerosis (SSc) with severe, transfusion-dependent gastric antral vascular ectasia (GAVE) refractory to laser ablation who showed remarkable clinical and endoscopic improvement following intravenous (IV) pulse cyclophosphamide (CYC) treatment. Methods. Review of clinical records and upper gastrointestinal endoscopy images from 3 patients with SSc and severe GAVE before and after treatment with IV pulse CYC. Results. IV CYC was followed by improvement and stabilization of hemoglobin levels, and marked reduction in blood transfusion requirements and the number and frequency of endoscopic laser treatments. Conclusion. IV pulse CYC immunosuppression was followed by remarkable clinical and endoscopic improvement of SSc-associated GAVE. (First Release July 15 2009; J Rheumatol 2009; 36:1653-6; doi: 10.3899/jrheum.081247)