Gastric Antral Vascular Ectasia, commonly known by the acronym GAVE, is an uncommon cause of gastrointestinal bleeding. It represents a vascular disorder affecting the stomach lining, leading to chronic blood loss. GAVE is a condition that gastroenterologists diagnose and manage.
Defining Gastric Antral Vascular Ectasia
The full medical name describes the condition’s pathology and location. The “gastric antrum” is the lower, narrow part of the stomach connecting to the small intestine. “Vascular ectasia” denotes blood vessels that have become abnormally widened and fragile. This dilation of small blood vessels in the stomach’s inner layer (mucosa) makes them prone to rupture and bleeding.
This condition is often nicknamed “watermelon stomach” because of its distinctive appearance during an endoscopic procedure. The dilated vessels arrange themselves into red, longitudinal stripes that run down the antrum, visually resembling the stripes on the exterior of a watermelon. The fragility of these ectatic vessels results in chronic blood loss that can persist over a long period.
Recognizing the Signs
Chronic blood loss from GAVE often leads to signs related to diminishing red blood cell count and iron stores. The most frequently observed sign is iron deficiency anemia, which manifests as persistent fatigue and generalized weakness.
Patients may also notice shortness of breath, particularly during physical activity, as the anemic blood struggles to deliver sufficient oxygen. Other signs of bleeding are found in the stool, which may appear black and tarry (melena) or contain visible red blood. While many cases involve slow, occult (hidden) blood loss, GAVE can occasionally result in more significant, acute bleeding episodes.
Associated Conditions and Risk Factors
GAVE is frequently not an isolated disease but occurs alongside other systemic health issues, though the exact cause remains unknown. The syndrome is strongly associated with underlying conditions that may contribute to its development. A significant number of patients with GAVE also have liver cirrhosis, a condition characterized by scarring of the liver tissue.
In these patients, high blood pressure in the liver’s circulatory system (portal hypertension) may contribute to the formation of the ectatic vessels. GAVE is also linked to autoimmune conditions, such as systemic sclerosis and CREST syndrome. Chronic kidney failure, heart disease, and certain hormonal imbalances have also been identified as risk factors.
Diagnosis and Treatment Approaches
Diagnosis involves an upper endoscopy, where a flexible tube with a camera is passed into the stomach. This allows the gastroenterologist to visually confirm the characteristic red, stripe-like lesions in the gastric antrum. Biopsies are frequently taken during the procedure to examine the vessels and rule out other potential causes of bleeding.
Once GAVE is confirmed, treatment focuses on stopping the bleeding and managing the resulting anemia. Endoscopic therapy is the primary treatment approach, typically administered during subsequent procedures. Argon Plasma Coagulation (APC) is the most common and effective endoscopic modality used for GAVE.
APC is a non-contact technique that uses a jet of argon gas ionized into plasma, which carries an electrical current to the bleeding sites. This energy coagulates, or seals, the fragile blood vessels on the stomach lining, stopping the blood loss. Patients often require multiple APC sessions to fully treat the affected area.
Managing the consequences of chronic blood loss is a significant part of the treatment plan. Patients with anemia often require iron supplementation to replenish depleted stores. For severe or ongoing bleeding, blood transfusions may be necessary to quickly restore red blood cell levels and alleviate symptoms. If endoscopic treatment fails, certain medications, such as octreotide, may be tried. Surgery to remove the affected part of the antrum is reserved for refractory cases, though Endoscopic Band Ligation (EBL) is also an alternative endoscopic option.