GAVE

Gastric Antral Vascular Ectasia (GAVE) is a rare medical condition characterized by the formation of dilated blood vessels in the antrum, or the last part of the stomach. This condition is also colloquially known as watermelon stomach due to the characteristic stripe-like appearance of the stomach lining that resembles the pattern of a watermelon. GAVE is a significant cause of chronic gastrointestinal bleeding and iron deficiency anemia.

Etiology

The exact cause of GAVE is not fully understood, but it is believed to be related to conditions that increase pressure within the abdomen or affect blood flow to the gastric lining. Several factors have been associated with GAVE, including cirrhosis, systemic sclerosis, and chronic renal failure. It is also seen more frequently in older individuals, suggesting that age-related changes in the gastric vasculature may play a role.

Pathophysiology

GAVE is characterized by the proliferation of blood vessels (angiogenesis) in the antral region of the stomach, leading to the formation of fragile, tortuous vessels prone to rupture and bleeding. The pathogenesis of GAVE is thought to involve a combination of mechanical stress, hormonal factors, and immune-mediated damage leading to vascular ectasia and fibromuscular hyperplasia.

Clinical Presentation

Patients with GAVE typically present with symptoms of gastrointestinal bleeding, such as melena (black, tarry stools), hematemesis (vomiting blood), or iron deficiency anemia. Some patients may be asymptomatic, with the condition discovered incidentally during endoscopic examinations for other reasons.

Diagnosis

The diagnosis of GAVE is primarily made through endoscopy, which allows direct visualization of the characteristic red, striped pattern on the stomach lining. Histological examination of biopsy samples can confirm the diagnosis, showing evidence of vascular ectasia, fibromuscular hyperplasia, and thrombosis.

Treatment

Treatment options for GAVE include medical, endoscopic, and, rarely, surgical interventions. Medical therapy may involve the use of proton pump inhibitors to reduce gastric acid secretion and iron supplements to address anemia. Endoscopic treatments, such as argon plasma coagulation (APC), are the most effective, targeting and cauterizing the dilated vessels to reduce the risk of bleeding. Surgical intervention is considered a last resort and may involve partial gastrectomy in cases where endoscopic treatment is not successful.

Prognosis

The prognosis for patients with GAVE varies depending on the severity of the condition and the effectiveness of treatment. With appropriate management, most patients experience a significant reduction in bleeding episodes and an improvement in quality of life. However, some individuals may require ongoing treatment to manage recurrent bleeding.