“Watermelon stomach” is a common term for Gastric Antral Vascular Ectasia (GAVE), a medical condition affecting the stomach lining. It involves abnormal dilation and fragility of blood vessels, leading to a distinctive appearance. This condition can result in various symptoms, primarily related to blood loss. Understanding GAVE involves recognizing its characteristics, symptoms, causes, diagnosis, and treatment.
Understanding Watermelon Stomach
Gastric Antral Vascular Ectasia (GAVE) is a rare condition where blood vessels in the stomach lining become enlarged and prone to bleeding. The name “watermelon stomach” comes from the characteristic appearance during an endoscopic examination, where dilated blood vessels form longitudinal red stripes resembling a watermelon. GAVE primarily affects the antrum, the lower part of the stomach, where these fragile vessels are concentrated. This abnormal vessel formation can lead to chronic gastrointestinal blood loss.
Recognizing the Symptoms
Individuals with watermelon stomach often experience symptoms related to chronic blood loss. Iron-deficiency anemia is common, manifesting as fatigue, weakness, and pale skin. Shortness of breath can also occur due to reduced oxygen-carrying capacity.
Gastrointestinal bleeding is a primary symptom, which may be acute or chronic. This bleeding can appear as dark, tarry stools (melena) or bright red blood in the stool (hematochezia). Some individuals may also vomit blood, appearing fresh or like coffee grounds. Abdominal pain and nausea are reported in some cases.
Identifying the Causes
The exact cause of watermelon stomach is not fully understood, but it is frequently associated with other underlying systemic medical conditions. Liver cirrhosis is a common association, accounting for about 30% of GAVE cases. Other linked conditions include chronic kidney disease, heart conditions, and various autoimmune diseases such as systemic sclerosis, lupus, and CREST syndrome. Some theories suggest that hormonal factors or imbalances in digestive enzymes might contribute to its development. While the condition is not congenital, it is considered an acquired disease that often occurs as a secondary manifestation of these broader health issues. GAVE is more common in older adults, particularly women over 70 years of age.
Diagnosing the Condition
Diagnosis of watermelon stomach primarily relies on an upper endoscopy, which allows direct visualization of the stomach lining. During this procedure, the characteristic red, longitudinal stripes or a diffuse “honeycomb” pattern resembling a watermelon are observed. The endoscopy helps distinguish GAVE from other causes of gastrointestinal bleeding.
A biopsy, which involves taking a small tissue sample from the affected area, is often performed to confirm the diagnosis. Microscopic examination of the biopsy can reveal dilated capillaries with fibrin thrombi and fibromuscular hyperplasia, which are hallmarks of GAVE. Blood tests are also conducted to assess for anemia and iron deficiency, providing supportive evidence for the bleeding associated with the condition.
Treatment Options
Treatment for watermelon stomach focuses on controlling bleeding and managing associated symptoms. Endoscopic therapies are often the primary approach, aiming to cauterize or obliterate the fragile blood vessels. Argon plasma coagulation (APC) is a widely used endoscopic technique that employs argon gas and an electrical current to seal bleeding vessels. Laser photocoagulation is another endoscopic option that effectively controls blood loss by coagulating the lesions. Other endoscopic methods include endoscopic band ligation (EBL) and radiofrequency ablation (RFA).
Anemia resulting from chronic blood loss is managed with iron supplementation and, when necessary, blood transfusions. While endoscopic treatments are effective, recurrence of bleeding can occur, sometimes requiring multiple sessions. Medications like hormonal therapy, tranexamic acid, or corticosteroids have been explored, though their effectiveness varies and evidence is limited. Surgical removal of the affected part of the stomach, known as antrectomy, is reserved for severe cases that do not respond to endoscopic therapies, particularly given its associated risks. Managing any underlying medical conditions can also contribute to the long-term control of GAVE.