Gastric antral vascular ectasia (GAVE), or watermelon stomach, is a rare condition that causes the stomach lining to bleed. The hallmark of the condition is red streaks on the gastric mucosa, giving the appearance of a watermelon.
While some people will experience no symptoms, others will feel tired and notice blood in their stools.
Read on to learn more about watermelon stomach, including its symptoms, causes, and treatments.
Watermelon stomach is a rare condition that affects a person’s stomach lining. It makes the blood vessels in the stomach wall fragile and can bleed.
Research from 2019 shows that watermelon stomach is responsible for about 4% of non-variceal bleeding in the upper gastrointestinal tract. Non-variceal means it is not due to varices, which are abnormally enlarged veins.
When a person has a watermelon stomach, vertical red stripes develop along the inside of their stomach. This makes the gastric mucosa resemble the outside of a watermelon.
Watermelon stomach can sometimes cause no symptoms. If a person has symptoms, they may include:
Watermelon stomach often results in iron deficiency anemia. When a person loses blood, he also loses the iron it contains. The body uses iron to make hemoglobin, the substance that allows the blood to carry oxygen. A lack of oxygen in the blood can cause a person to feel tired or short of breath.
It remains unclear what exactly causes the watermelon stomach, but researchers have found
- achlorhydria, a condition in which a person’s stomach does not produce hydrochloric acid, an acid the body uses to break down food
- hypergastrinemia, which is when a person has an elevated level of the hormone gastrin in their stomach
- low levels of the digestive enzyme pepsinogen
- liver failure, which causes a build-up of hormones that widen blood vessels
Watermelon stomach has certain risk factors. Research from 2018 shows that women are
In addition, watermelon stomach often occurs alongside conditions such as:
Research from 2015 found that:
A doctor can diagnose a person with a watermelon stomach using endoscopy, in which they insert a long, thin tube called an endoscope into a person’s throat. The endoscope has a small camera on the end that allows the doctor to view images of the person’s stomach.
A person with a watermelon stomach will have visible vertical red streaks on their stomach lining.
Occasionally, a doctor may take a tissue sample or biopsy from a person’s stomach lining to confirm the diagnosis of watermelon stomach. They may also take a blood sample to check for signs of anemia.
Read more about endoscopy.
When doctors diagnose watermelon stomach
Doctors can treat associated iron deficiency anemia with regular blood transfusions or iron replacement tablets.
They may prescribe certain medications to control bleeding due to watermelon stomach. However, the long-term effectiveness and safety of these drugs require further research.
Medications That Can Treat Watermelon Stomach
Alternatively, doctors can use a variety of endoscopic treatments to stop the bleeding. These treatments include:
Argon Plasma Coagulation (APC)
APC is the gold standard for treating watermelon stomach. It involves using inflamed argon gas to burn and seal the bleeding blood vessels.
APC can remove 80–100% of watermelon gastric lesions. It can also reduce the need for blood transfusions in 50-80% of people after two or three sessions.
Endoscopic Band Ligation (EBL)
EBL involves placing elastic bands around enlarged blood vessels to prevent bleeding. These elastic bands squeeze a small loop of the blood vessel to close off blood flow. Over time, the pinched loop will fall off and the blood vessel will repair itself.
Research from 2022 reports that EBL achieves a higher degree of bleeding control than APC with fewer treatments. It also reduces the need for blood transfusions.
Combining APC and EBL can also be an effective way to treat watermelon stomach.
Neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser coagulation
Nd:YAG treatment uses heat to burn and seal bleeding blood vessels. This treatment is effective in preventing bleeding and reducing the need for intermittent blood transfusions
Cryotherapy uses nitrous oxide to freeze the blood vessels that affect watermelon’s stomach. In a
Radiofrequency Ablation (RFA)
RFA uses the heat produced by radio waves to destroy affected blood vessels. Several small sample studies have shown that RFA was able to:
Surgery may be necessary for people who do not respond to medicinal or endoscopic treatments. Surgery for watermelon stomach may involve removing affected parts of the stomach.
Having surgery is the only reliable way to cure watermelon stomach. It can also eliminate the need for blood transfusions.
A person can talk to a doctor about which treatment option is right for them.
A person should talk to a doctor if they have symptoms of watermelon stomach. A person with signs of iron deficiency anemia should also contact a doctor.
Symptoms of iron deficiency anemia include:
People can manage watermelon stomach with treatment. Without treatment, a person can develop iron deficiency anemia. This may require them to have regular blood transfusions.
A person may also notice that their watermelon stomach returns after treatment. If this happens, a person will have to restart treatment.
Watermelon stomach is a rare condition that causes bleeding in a person’s stomach lining. It causes characteristic red, vertical stripes on the gastric mucosa, making it resemble a watermelon.
Watermelon stomach may sometimes show no symptoms. If symptoms do occur, they may include tiredness or blood in the stool.
Doctors don’t know the exact cause of watermelon stomach. However, it often occurs alongside conditions such as autoimmune diseases and chronic renal failure.
A doctor can diagnose watermelon stomach using endoscopy. They may also use blood tests or a biopsy of stomach tissue.
Treatment for watermelon stomach involves various medications and endoscopic treatments. If these treatments are not effective, a person may need surgery.
A person can manage watermelon stomach with treatments. However, they may find that it reoccurs after treatment.
Anyone who notices signs of watermelon stomach or iron deficiency anemia should see a doctor.