The common nickname “watermelon stomach” refers to the rare gastrointestinal condition Gastric Antral Vascular Ectasia (GAVE). GAVE is an uncommon cause of chronic blood loss within the upper digestive tract. It involves fragile, dilated blood vessels in the stomach lining that bleed slowly over time. This chronic bleeding leads to iron deficiency anemia, making the condition a serious but manageable health concern requiring diagnosis and intervention.
What is Gastric Antral Vascular Ectasia
Gastric Antral Vascular Ectasia is an acquired disorder involving the lower section of the stomach, specifically the antrum. The name describes the core problem: the dilation (ectasia) of small blood vessels within the stomach’s mucosal lining. These abnormal vessels are prone to rupture, leading to chronic bleeding.
The striking visual appearance of the affected area gave GAVE its nickname. During an endoscopy, the engorged, red blood vessels form distinct, linear streaks parallel to the stomach folds. These bright red columns of ectatic vessels look similar to the stripes visible on a watermelon rind.
Microscopic examination confirms the presence of these dilated vessels, often accompanied by thickening of the underlying tissue (fibromuscular hyperplasia). The fragility of these surface blood vessels, combined with mechanical trauma from stomach movements and digestive acids, leads to persistent blood loss. GAVE is responsible for approximately four percent of all non-variceal upper gastrointestinal bleeding cases.
Associated Health Conditions and Risk Factors
GAVE is rarely a primary disease and is almost always associated with an underlying systemic health issue. The most frequent association is with chronic liver disease, particularly advanced cirrhosis and resulting portal hypertension. Approximately 30% of GAVE patients have liver cirrhosis, though the condition can occur without elevated portal vein pressure.
Another significant group of risk factors includes connective tissue and autoimmune disorders. Conditions such as systemic sclerosis (scleroderma) and CREST syndrome are commonly seen in GAVE patients. The proposed mechanism involves hormonal or chemical factors that encourage the abnormal proliferation and dilation of the stomach’s blood vessels.
Some theories suggest that imbalances in circulating hormones, specifically elevated gastrin levels, may contribute to the vascular changes observed in the antrum. Chronic kidney failure is also a recognized risk factor, illustrating the systemic nature of this disorder. The exact way these diverse conditions lead to the same gastric abnormality remains under study, but GAVE is a manifestation of broader physiological dysfunction.
Symptoms and Diagnostic Procedures
The symptoms of GAVE are primarily related to the chronic, slow bleeding in the stomach. Because the blood loss is gradual, it frequently manifests first as severe iron deficiency anemia. Patients commonly report persistent fatigue, weakness, and paleness, which are signs of a low red blood cell count.
While the bleeding is usually occult (not visibly apparent), some individuals may notice blood in the stool, appearing either black and tarry (melena) or bright red. This continuous blood loss often makes patients dependent on regular iron supplementation and, in advanced cases, blood transfusions.
The definitive diagnosis of GAVE is made using an upper endoscopy. During this procedure, a flexible tube with a camera is passed into the stomach. The physician looks for the pathognomonic sign: the characteristic pattern of longitudinal, red, stripe-like lesions converging on the pylorus. Blood tests are also performed to confirm the presence and severity of iron deficiency anemia.
Modern Treatment Options
The main goal of therapy is to stop the abnormal bleeding and manage the resulting anemia. Endoscopic intervention is the preferred first-line treatment for GAVE lesions. These procedures aim to cauterize and destroy the fragile, dilated blood vessels to prevent further hemorrhage.
Argon Plasma Coagulation (APC) is a widely used endoscopic technique. It employs a jet of ionized argon gas to deliver heat and coagulate the lesions with minimal depth. Laser photocoagulation is another thermal method using a focused laser to ablate the ectatic vessels. Patients often require multiple sessions of these therapies to fully obliterate the lesions and control the bleeding, as recurrence is possible.
Newer endoscopic techniques, such as Endoscopic Band Ligation (EBL) or Radiofrequency Ablation (RFA), are effective, particularly for cases that do not respond to APC. Supportive care complements endoscopic treatment, involving iron supplements to correct the deficiency and blood transfusions for severe anemia. In highly refractory cases, medications like octreotide have been tried. Surgical removal of the affected part of the stomach remains an option when all other treatments fail.