Gastric antral vascular ectasia (GAVE) syndrome, commonly known as watermelon stomach, is a rare but significant cause of acute or chronic gastrointestinal blood loss, particularly in the elderly. This condition, characterized by fragile and bleeding blood vessels in the stomach lining, can lead to various symptoms, ranging from fatigue to severe anemia.
What is Watermelon Stomach?
Watermelon stomach, or GAVE, is a condition affecting the stomach lining, causing the blood vessels to become weak and prone to bleeding. The term "watermelon stomach" comes from the endoscopic appearance of the stomach lining, where vertical red stripes develop, resembling the stripes on a watermelon.
Prevalence and Significance
Although GAVE is rare, it accounts for up to 4% of non-variceal upper gastrointestinal bleeding. It is a relevant possibility in older patients with severe acute or chronic gastrointestinal blood loss.
Symptoms of Watermelon Stomach
Some individuals with watermelon stomach may not experience any symptoms. However, when symptoms do occur, they can include:
- Iron deficiency anemia (a lack of iron in the blood)
- Fatigue
- Vomiting blood
- Blood in stools (which may appear dark or tarry)
- Abdominal pain
- Nausea
- Chronic blood loss
- Internal bleeding
- Weakness
- Pale skin
- Shortness of breath
- Unexplained weight loss
The chronic blood loss associated with watermelon stomach often leads to iron deficiency anemia. Because the body uses iron to make hemoglobin, the substance that enables blood to carry oxygen, a lack of iron can result in fatigue and shortness of breath.
Read also: Risks of Watermelon Diet
Causes and Risk Factors
The exact cause of watermelon stomach remains unclear, but several theories exist. Some potential causes and risk factors include:
- Achlorhydria: A condition in which the stomach does not produce hydrochloric acid, which is necessary for breaking down food.
- Hypergastrinemia: An increased level of the hormone gastrin in the stomach.
- Low levels of the digestive enzyme pepsinogen.
- Liver failure: Which can cause a buildup of hormones that dilate blood vessels.
- Autoimmune conditions
- Chronic renal failure
- Cardiac disease
- Diabetes
- Atrophic gastritis: A chronic condition that causes inflammation of the stomach lining.
- Cirrhosis: Scarring of the liver.
- Scleroderma: A condition that causes thickening of the skin.
- Pernicious anemia: A reduction in red blood cells resulting from a lack of vitamin B12.
- CREST syndrome: A connective tissue disorder.
- High blood pressure (hypertension)
- Vascular disease
- Metabolic syndrome: A combination of diabetes, hypertension, and obesity.
Research suggests that females are almost twice as likely to develop watermelon stomach as males and that it is more likely to affect older adults. Additionally, it is often associated with autoimmune connective tissue disorders, with one study finding that 62% of people with watermelon stomach also had such a disorder.
Diagnosis of Watermelon Stomach
Diagnosing watermelon stomach typically involves the following steps:
- Medical History and Physical Exam: The doctor will review the patient's medical history and symptoms, asking about instances of blood in the stool, fatigue, or other related symptoms. A physical exam will be performed to check for signs of anemia or related conditions.
- Blood Tests: Blood tests are conducted to evaluate hemoglobin levels and check for anemia caused by chronic blood loss.
- Upper Endoscopy: This is the primary method for diagnosing GAVE. The patient is given a sedative to relax, and a thin, flexible tube with a light and camera (endoscope) is passed down the throat into the stomach. The doctor examines the lining of the stomach for red, stripe-like lesions resembling watermelon stripes.
- Biopsy: During the endoscopy, the doctor may take small tissue samples (biopsies) from the stomach lining for further examination under a microscope to confirm the diagnosis and rule out other conditions.
- Imaging Tests: In some cases, additional imaging tests, such as a CT scan or MRI, may be recommended to provide a more detailed view of the stomach and surrounding organs.
Differential Diagnosis
It is crucial to differentiate GAVE syndrome from other conditions with similar symptoms, such as:
- Portal hypertensive gastropathy (PHG)
- Antral gastritis
- Esophageal or gastric varices
- Peptic ulcer disease
Treatment Options for Watermelon Stomach
Treatment for watermelon stomach focuses on managing the condition and preventing further bleeding. Options range from supplements and medications to endoscopic procedures and surgery.
Read also: Risks of Watermelon Diet
Initial Management
In the earliest stages, watermelon stomach might be managed with iron supplements to address the iron deficiency anemia caused by blood loss. Blood transfusions may also be necessary to restore normal blood levels in cases of significant blood loss.
Medications
Healthcare providers might recommend medications to help slow the bleeding in the stomach lining. These may include:
- Corticosteroids
- Hormone therapy (estrogen and/or progesterone)
- Octreotide (Mycapssa)
- Tranexamic acid
- Thalidomide (which is unsuitable for people who are pregnant or may become pregnant)
- Proton Pump Inhibitors (PPIs): Medications to reduce stomach acid and help heal the stomach lining.
Endoscopic Treatments
Endoscopic surgery is the most common treatment for watermelon stomach. These procedures aim to close or destroy the affected blood vessels to stop bleeding.
- Argon Plasma Coagulation (APC): The gold standard for watermelon stomach treatment, APC uses argon gas to cauterize (burn) and seal the affected blood vessels. It can remove 80-100% of watermelon stomach lesions and reduce the need for blood transfusions in 50-80% of people after two or three sessions.
- Endoscopic Band Ligation (EBL): This involves placing elastic bands around enlarged blood vessels to prevent bleeding. The bands pinch a small loop of the blood vessel to cut off the blood flow. EBL achieves a higher rate of bleeding control than APC with fewer treatments and reduces the need for blood transfusions. Combining APC and EBL can also be effective.
- Neodymium-doped Yttrium Aluminum Garnet (Nd: YAG) Laser Coagulation: Nd: YAG treatment uses heat to burn and seal bleeding blood vessels. It is effective in preventing bleeding and reducing the need for blood transfusions after one to four sessions.
- Cryotherapy: Cryotherapy uses nitrous oxide to freeze the blood vessels affected by watermelon stomach.
- Radiofrequency Ablation (RFA): RFA uses heat from radio waves to destroy affected blood vessels. Studies have found that RFA can increase hemoglobin levels and reduce the need for blood transfusions.
- HALO 90 Ablation Technique: The HALO 90 catheter allows quick treatment of large areas of affected tissue with extreme accuracy. Each application provides a uniform treatment to a rectangular area of 20 mm X 13 mm, which is larger than alternative treatment methods.
People who undergo these procedures usually need a few treatments to achieve the desired result.
Surgical Intervention
Surgery may be necessary for people who do not respond to medicinal or endoscopic treatments. The surgical procedure typically involves removing the affected parts of the stomach (partial gastrectomy). Surgery is considered the only reliable way to cure watermelon stomach and can eliminate the need for blood transfusions. However, primary surgical therapy is not generally advocated due to reports of high morbidity and mortality in patients with multiple comorbidities.
Read also: Healthy Diet Tea Option
Lifestyle Modifications
Dietary modifications, such as avoiding foods and medications that irritate the stomach lining and worsen bleeding, can help manage symptoms. Managing underlying conditions, such as liver disease or autoimmune disorders, can also help reduce symptoms of GAVE.
Potential Complications
Without treatment, watermelon stomach can lead to iron deficiency anemia, requiring frequent blood transfusions. The condition may also recur after treatment, necessitating the restart of treatment.
Importance of Early Diagnosis and Management
GAVE syndrome can be inadvertently overlooked as a remediable cause of gastrointestinal bleeding because more frequent causes of gastrointestinal bleeding (esophageal or gastric varices, PHG, and peptic ulcer disease) are common among patients with renal or hepatic diseases, which are the same medical conditions in which GAVE syndrome occurs. Therefore, it is essential to consider GAVE syndrome in older patients with severe anemia and occult or profuse gastrointestinal bleeding, especially in the setting of heart, liver, or kidney diseases.
tags: #watermelon #stomach #causes #and #treatment