Gastric varices are less prevalent than esophageal varices and are present in 5–33% of patients with portal hypertension with a reported incidence of bleeding of about 25% in 2 years, with a higher bleeding incidence for fundal varices (38). Risk factors for gastric variceal hemorrhage include the size of fundal varices (large>medium>small, defined as >10 mm, 5– 10 mm, and <5 mm, respectively), Child class (C>B>A), and endoscopic presence of variceal red spots (defined as localized reddish mucosal area or spots on the mucosal surface of a varix) (39). Gastric varices are commonly classified based on their relationship with esophageal varices as well as their location in the stomach (38). Gastroesophageal varices (GOV) are an extension of esophageal varices and are categorized into 2 types. The most common are Type 1 (GOV1) varices, which extend along the lesser curvature. They are considered extensions of esophageal varices and should be managed similarly. Type 2 (GOV2) gastric varices extend along the fundus and tend to be longer and more tortuous. Isolated gastric varices (IGV) occur in the absence of esophageal varices and are also classified into 2 types. Type 1 (IGV1) are located in the fundus and tend to be tortuous and complex, and type 2 (IVG2) are located in the body, antrum, or around the pylorus. The presence of IGV1 fundal varices requires excluding the presence of splenic vein thrombosis.
LGIB in patients with Crohn disease is not as common as in patients with ulcerative colitis; 1-2% of patients with Crohn disease may experience massive bleeding. The frequency of bleeding in patients with Crohn disease is significantly more common with colonic involvement than with small bowel involvement alone. The mucosal pattern of injury is similar to that found in patients with infectious and ischemic colitis, with the mucosa appearing friable, erythematous, edematous, and ulcerated. In severe Crohn disease, the inflammatory process may extend into the serosa, leading to colonic perforation.