Watermelon stomach

(Gastric Antral Vascular Ectasia or GAVE)

Watermelon stomach, which is also known as gastric antral vascular ectasis or GAVE, is where the lining of the stomach bleeds, causing it to look like the characteristic stripes of a watermelon when viewed by endoscopy. Watermelon stomach occurs most commonly in older women (over age 70 years), although it can develop in men and women of any age. Signs and symptoms of watermelon stomach include blood in the stool, haematemesis (vomiting blood) and anaemia.

The exact cause of watermelon stomach is not known, however, it is often diagnosed in people with other chronic (long-term) conditions such as cirrhosis (scarring of the liver and poor liver function) and systemic sclerosis.

Diagnosis

Diagnosis can be challenging as gastric bleeding is more commonly caused by other conditions, such as stomach ulcers and abnormal, enlarged vessels in the throat and stomach (oesophageal varices) and some medications that can irritate the stomach lining such as aspirin or NSAIDs. Tests for watermelon stomach include:

  • an endoscopy
  • a biopsy of the stomach lining
  • an endoscopic ultrasound (ultrasound probe on the tip of an endoscope) computed tomography (CT) scan
  • a tagged red blood cell scan may be used to confirm the diagnosis.

Treatment

Treatment can be surgery and/or medications to stop or control the bleeding. Watermelon stomach is usually treated with endoscopic laser surgery or argon plasma coagulation. Both of these procedures are performed by endoscopy. Endoscopic laser surgery uses a laser light to treat bleeding blood vessels, while argon plasma coagulation uses argon gas and electrical current to seal irregular or bleeding tissue.

In some cases, people may be treated with certain medications that help stop or control the gastrointestinal bleeding. Corticosteriods, tranexamic acid and hormone therapy (with oestrogen and progesterone) have been used to treat watermelon stomach with some success.

If the bleeding is severe, blood transfusions may also be necessary at the time of diagnosis to control the bleeding. Additional transfusions may be recommended if gastrointestinal bleeding cannot be stopped or controlled.

Long-term outlook

The prognosis or long-term outlook for people with watermelon stomach varies. Some people have continued or recurring gastrointestinal bleeding, even with treatment. These cases are often considered "transfusion-dependent", since regular blood transfusions are usually necessary. Other affected people respond well to therapy and have no additional bleeding episodes.

References

National Institutes of Health, Watermelon stomach

Nguyen H, Le C, Nguyen H. (Watermelon Stomach)—An enigmatic and often-overlooked cause of gastrointestinal bleeding in the elderly. Perm J. 2009 Fall; 13(4): 46–49.

Dulai GS, Jensen DM. Treatment of watermelon stomach. Curr Treat Options Gastroenterol. 2006;9(2): 175-80.