Samuel N. Marcus M.D., Ph.D.



GAVE (Gastric Antral Vascular Ectasia)

Gastric Antral Vascular Ectasia (GAVE) is a condition where the stomach lining bleeds in multiple locations. It is also referred to as “watermelon stomach” because when we view it with an endoscope, the stomach lining has visible stripes that make it look similar to the striped skin of a watermelon. These bleeds do not typically cause any pain, but they do cause a continuous drain on the body’s blood supply, which can cause extreme anemia.

Gave is most common in women, ages 70-years and older and the elderly population in general. While there is no known direct cause of GAVE, the condition is most common in those who have suffered from certain chronic conditions such as cirrhosis (poor liver function, or scarring of the liver), systemic sclerosis, CREST syndrome, atrophic gastritis and autoimmune disease.

You  may also be more prone to watermelon stomach if you suffer from vascular disease, diabetes mellitus, portal hypertension, metabolic syndrome and chronic renal failure.

Symptoms of GAVE

The most common and recognizable symptoms of GAVE include:

  • Blood in the stool
  • Vomiting blood (hematemesis)
  • Anemia (iron deficiency)
  • General abdominal pain or discomfort

None of these symptoms should ever be ignored. In most cases, you would report them to your general physician, who will then make a referral to a gastroenterologist for endoscopic diagnosis.

How is GAVE diagnosed and treated?

The least invasive – and clearest – way to diagnose GAVE is to have upper endoscopy. Using a gentle, flexible scope, we send it down through the throat, the esophagus and finally into the stomach. This gives us an excellent, real-time view of those soft, GI tissues that don’t show up as well or as clearly as on X-rays or ultrasounds. CT scans, endoscopic ultrasound, biopsy of the stomach lining and/or tagged red blood cell scans may also be used as diagnostic tools.

If you are referred to Dr. Marcus’s office, he will use an upper endoscopy to identify areas of the stomach that are bleeding. After your diagnosis, you’ll be able to discuss the available treatment options. It is important to choose a gastroenterologist who is experienced in accurately diagnosing GAVE because it can be confused with portal hypertensive gastropathy (PHG) or antral gastritis, and these require different treatment methods.

Treatment options vary according to your symptoms and the extent of the bleeding. Here in our office, we typically use Argon Plasma Coagulation (APC), which is becoming a preferred method of treatment over endoscopic laser therapy, although the latter may be required as well. Recent medical studies have also shown success treating GAVE with corticosteroids, hormone therapy and tranexamic acids.

If the bleeding has been severe and/or have existed untreated for some time, patients may require a blood transfusion, and blood transfusions are also used when the GAVE doesn’t respond to treatment in order to replace lost blood and reduce the effects of anemia.

Everybody is different so the prognosis for GAVE is difficult to predict. Some patients do quite well, without any recurring bleeds after their initial treatment protocol. Others may find their stomach bleeding starts back up over a certain period of time. In cases where gastrointestinal bleeding is difficult to eliminate completely, blood transfusion therapy may be necessary at set intervals to compensate for the chronic loss of blood.

Please contact the office of Dr. Marcus to schedule a consultation or to learn more about potential diagnosis and treatment of GAVE.