What is Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE)?

Watermelon Stomach, medically known as Gastric Antral Vascular Ectasia (GAVE), is a condition where a person suffers from chronic gastrointestinal bleeding leading to iron deficiency anemia. The person affected from water melon stomach has dilated small blood vessels in the last part of the stomach, which is the antrum. These dilated blood vessels lead to intestinal bleeding and causes appearance of red streaks internally and externally on the stomach giving it a appearance of watermelon; hence the name watermelon stomach. Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE) can become potentially fatal if the excessive bleeding is not controlled.

Anyone can suffer from this condition, however, women aged above 50 and who are suffering from irritable bowel syndrome, autoimmune disease, cirrhosis or any injury to the abdomen are at an increased to suffer from Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE).

Watermelon Stomach or Gastric Antral Vascular Ectasia

Causes of Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE)

The exact cause of Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE) is not clear, but patients who are suffering from chronic conditions, such as cirrhosis, systemic sclerosis, CREST syndrome and autoimmune disease more commonly diagnosed with Watermelon Stomach. Distension occurring as a result of vasculitis, diseases which hinder the function of the gastrointestinal system, abdominal injury, grave's disease or cirrhosis are some of the causes for the appearance of the dilated blood vessels in the lower or antral part of the stomach. Individuals who are at increased risk for developing Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE) often suffer from irritable bowel syndrome, large bowel obstruction and chronic constipation. If there is rupture of the dilated blood vessels, then patient can have bleeding/hemorrhaging leading to subsequent anemia.

Signs & Symptoms of Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE)

Gastrointestinal bleeding is the most obvious sign of Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE), which in turn leads to symptoms which include: Bloody stool, hematemesis (vomiting blood) and anemia. Patient also can experience other symptoms of Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE), such as shallow breathing, chronic headaches, fatigue/weakness, difficulty in concentration, palpitations, chest pain, lightheadedness and confusion. These symptoms occur from extreme blood loss in Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE). If the above symptoms are experienced, then patient should consult his/her doctor immediately so that proper treatment is started as soon as possible.

Diagnosis of Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE)

The symptoms of water melon stomach can be mistaken for other conditions, which have different types of treatment. For this reason it is important to arrive at proper differential diagnosis for Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE). Gastric/duodenal ulcer and portal hypertension are some of the common causes which should be considered for arriving at an adequate differential diagnosis. Other intermittent causes include hemobilia, Gastric antral vascular ectasia, Cameron lesions, aortoenteric fistulas, Dieulafoy lesions, hemosuccus pancreaticus, upper gastrointestinal tumors and portal hypertensive gastropathy, which should be included for an adequate differential diagnosis.

Endoscopic Biopsy: For arriving at a conclusive diagnosis, endoscopic biopsy is the only method. Doing an endoscopy, the characteristic watermelon stripes of watermelon stomach can be seen. The watermelon streaks appear as flat, erythematous stripes in longitudinal or vertical rows, which originate from the pylorus and radiate or spread into the antrum.

The presentation of the watermelon streaks is different in patients suffering from portal hypertension. These patients may have diffuse antral angiomas instead of the radiating patterns. For confirming the diagnosis in either case, the following such as tagged red blood cell scan, endoscopic ultrasound or CT scan can be done. Other than this, histopathological features of watermelon stomach or GAVE can also be characterized by vascular ectasia, spindle cell proliferation, and Hyaline arteriolosclerosis. Anti-RNA polymerase III auto-antibodies can be used as a risk indication in patients with watermelon stomach who have systemic sclerosis.

Treatment of Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE)

Medications for Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE): Medicines can be prescribed for some patients for stopping or controlling the gastrointestinal bleeding. Medications, such as hormone therapy (progesterone and estrogen), corticosteroids and tranexamic acid have been successfully used for treating watermelon stomach. Other than these, iron supplements and blood transfusions are also often needed, especially in case of severe bleeding. If there is persistent gastrointestinal bleeding, then additional transfusions are done.

Surgery for Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE): Endoscopic laser surgery or Argon plasma coagulation are the two surgical methods for treating watermelon stomach where endoscopy is used in both of these procedures. Electric current and argon gas are used in argon plasma coagulation for sealing of irregular tissue and bleeding; whereas laser light is used for treating bleeding blood vessels in endoscopic laser surgery.

Diet for Watermelon Stomach: Following a healthy diet helps a lot in management of watermelon stomach. Patients suffering from Watermelon Stomach or Gastric Antral Vascular Ectasia (GAVE) should avoid food and drinks which irritate the stomach such as greasy/spicy foods and alcohol. Healthy diet comprising of foods that are rich in fiber, such as fruits, whole grains and vegetables should be followed. Good eating habits should also be developed, such as patient should consume smaller and frequent meals instead of big meals. This helps with digestion.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: October 12, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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