The vivid, descriptive name “watermelon stomach” refers to a specific gastrointestinal condition that causes chronic blood loss. Despite the unusual moniker, the disorder is not related to diet or the size of a person’s abdomen. The term describes the appearance of the stomach’s inner lining as seen during an endoscopic examination. Timely medical diagnosis and specialized treatment are required to manage this rare disease.
Defining the Condition
The formal medical designation for watermelon stomach is Gastric Antral Vascular Ectasia (GAVE). This condition involves the antrum, the lower portion of the stomach, where the lining develops fragile, dilated blood vessels. These enlarged vessels, called ectasias, are prone to rupture and chronic bleeding.
The nickname originates from the unique visual pattern observed during endoscopy. The ectasias typically align themselves in red, elongated stripes that radiate outward from the pylorus, the opening to the small intestine. This characteristic pattern of red, swollen vessels against the pale stomach lining resembles the stripes on a watermelon.
Underlying Mechanisms and Associated Risk Factors
While the exact cause of GAVE is not fully understood, the condition is linked to several systemic, chronic diseases. Mechanisms are thought to involve mechanical stress, humoral factors, and autoimmune factors. The primary clinical association is with liver cirrhosis, present in about 30% of diagnosed patients.
Another significant group of risk factors includes autoimmune and connective tissue disorders, such as scleroderma and Raynaud phenomenon, found in approximately 60% of patients without liver disease. Other chronic illnesses, including chronic kidney disease and heart failure, are also associated with GAVE development. Proposed theories suggest that increased hormone levels or localized mechanical trauma from stomach contractions contribute to the formation of the fragile, dilated vessels in the antrum.
Recognizable Signs and Diagnostic Procedures
The most common signs of watermelon stomach stem directly from the chronic bleeding of the ectatic vessels. Patients often experience symptoms related to chronic iron deficiency anemia, such as persistent fatigue, weakness, and shortness of breath. The blood loss is often occult (not visible), though some individuals may notice dark, tarry stools, known as melena.
Diagnosis typically begins with blood tests to check for low hemoglobin and hematocrit levels, confirming anemia. The definitive diagnostic procedure is an upper endoscopy, where a flexible tube with a camera is inserted through the mouth to view the stomach lining. Visual confirmation of the pathognomonic red, stripe-like lesions in the gastric antrum confirms GAVE. In some cases, a biopsy of the affected tissue may be taken to distinguish GAVE from similar conditions, such as portal hypertensive gastropathy.
Therapeutic Approaches
The primary goal of treatment is to control bleeding and resolve the resulting anemia. The most effective and widely used approach involves endoscopic therapy to cauterize the fragile blood vessels. Argon Plasma Coagulation (APC) is the first-line treatment, using a non-contact electrical current delivered through ionized argon gas to burn and seal the bleeding ectasias.
Multiple treatment sessions, often two or three, are required to completely ablate the lesions and achieve long-term control. Other endoscopic methods, such as laser photocoagulation, may also be used to seal the vessels. Supportive treatments are simultaneously administered and include oral iron supplementation and, for severe cases, blood transfusions to correct anemia. Drug therapies, such as octreotide or hormonal agents, are employed when endoscopic treatment is unavailable or ineffective, though success rates vary.