Watermelon Stomach: A Rare Condition That Causes Bleeding

Gastric Antral Vascular Ectasia (GAVE), also known as watermelon stomach, is a rare cause of bleeding from the stomach lining. GAVE is associated with chronic diseases such as liver cirrhosis, heart disease, poor kidney function, and autoimmune disease (such as rheumatoid arthritis, scleroderma, and lupus).

Symptoms include blood in the stool, vomiting blood, or anemia. GAVE can manifest in men and women but is most commonly found in women over 70 or in people with chronic health conditions.

GAVE signs and symptoms and diagnosis

GAVE is a rare cause of gastrointestinal bleeding found mostly in older women and people with chronic health conditions. GAVE is called “watermelon stomach” because the bleeding pattern looks like the distinctive watermelon stripes on endoscopy. It is so uncommon that GAVE is sometimes overlooked as a cause of bleeding.

While your healthcare provider may not immediately recognize your bleeding as GAVE, it is usually recognized once an endoscopy is performed and the characteristic bleeding pattern is seen.

The exact cause of GAVE is not known. It is usually found in people who have chronic (long-term) illnesses like liver cirrhosis (scarring and poor function of the liver), renal insufficiency (poor kidney function), and autoimmune diseases like scleroderma. These chronic illnesses appear to have some role in GAVE, but medical researchers have been unable to find the link.

Signs and symptoms are blood in the stool, vomiting blood, or anemia (lower than normal amount of red blood cells). Often, GAVE sufferers do not realize they are bleeding until they get a blood test showing anemia or see blood in their stools or vomit. People diagnosed with GAVE may require blood transfusions because of blood loss.

There are treatments available for GAVE, but there is not enough research to suggest a guideline for which treatments consistently work. The healthcare provider treating GAVE will recommend the best treatment based on case facts.

GAVE treatment options

Treatment options for GAVE have the goal of stopping the continuous bleeding from the stomach lining. Treatments include medication, endoscopy, and surgery.

Medications have been tried to stop the bleeding associated with GAVE, including corticosteroids and hormones. None of the medicines used have been proven consistently successful in controlling the bleeding caused by GAVE. For continuing medication use to treat GAVE, more research is needed into side effects, complications, and long-term effectiveness.

The first-line treatment option has emerged in recent years with endoscopy. Endoscopy treatment uses different tools to stop the bleeding by injecting medication directly into the bleeding vessel, spraying liquid nitrogen, using a heated probe, an electric current, laser, bands, or clips to seal off the bleeding vessels. A gastroenterologist is the specialty healthcare provider that will perform the endoscopy. The gastroenterologist will recommend a course of treatment for specific cases of GAVE.

According to Dr. Kenneth W. Shroeder, a Mayo Clinic gastroenterologist, “It often takes more than one treatment to seal off the blood vessels adequately. Blood transfusions may be needed in the interim to treat anemia until the bleeding can be controlled. Iron replacement by mouth or IV also can help improve the anemia.” While it may take more than one treatment, endoscopy may successfully stop the chronic bleeding caused by GAVE.

The treatment of last resort is surgery, used when endoscopic and medication therapies fail. The surgeon will remove the portion of the stomach that is bleeding. Surgery is the only treatment known to cure GAVE completely. However, because of the risks and complications of surgical treatment, the gastroenterologist and surgeon must carefully weigh the risks and benefits of surgery in each case.