Scleroderma Types Systemic Symptoms GI

Gastric Antral Vascular Ectasia (Watermelon Stomach)

What is Watermelon Stomach?

Watermelon Stomach may occur in systemic scleroderma but not in localized scleroderma, such as Linear and Morphea.

Watermelon Stomach is the popular name for Gastric Antral Vascular Ectasia (GAVE) — a condition in which the lining of the stomach bleeds, causing it to look like the characteristic stripes of a watermelon when viewed by Endoscopy. (It is not a large, bloated or fat stomach as some people think it is.)

Watermelon Stomach can occur by itself, as a side effect of some medications, or in patients with Diffuse Systemic Scleroderma. (Also see Scleroderma Gastrointestinal Involvement, What is Scleroderma?, Types of Scleroderma, and Systemic Sclerosis)

Watermelon Stomach belongs to a group of gastrointestinal (GI) bleeding problems which are referred to as Arteriovenous Malformations  (AVMs.) Untreated, AVMs can cause chronic anemia or acute (sudden or severe) GI bleeding. AVMs can also cause vomiting of blood (hematemesis) or dark, tarry stools which contain blood (melena.) (Also see Anemia)

Vascular Disease and Systemic Scleroderma. The vascular system is our circulatory system. It consists of all the vessels that carry blood and lymph through the body, to and from organs. Vessels include arteries, veins, and capillaries. Any condition that affects the vascular system, all of in part, is considered a vascular disease. ISN.

Diagnosis

Photo of Watermelon Stomach
As seen by endoscopy.
© ISN Photo Repository.

Diagnosis of Watermelon Stomach (GAVE) is most often made by Endoscopy. Often, AVMs aren't seen during selective angiography, endoscopic biopsy, or during surgery.

They show up better during endoscopy because there's better blood flow to the stomach then than there is when a patient is under anesthesia and such.

Prevalence, Correlates and Outcomes of Gastric Antral Vascular Ectasia (GAVE) in Systemic Sclerosis. GAVE is rare and associated with a vascular phenotype, including anti-RNA-polymerase III antibodies, and a high risk of renal crisis. Anemia, usually requiring blood transfusions, is a common complication. Journal of Rheumatology. (Also see Anemia of Chronic Disease and Renal Involvement)

Treatment for Watermelon Stomach

Watermelon stomach (GAVE) is treated very successfully with endoscopic laser surgery.

Radiofrequency ablation for refractory gastric antral vascular ectasia (with video). Although upper endoscopy with argon plasma coagulation (APC) is an accepted therapy for GAVE, many patients continue to bleed and remain transfusion dependent after therapy. Radiofrequency ablation (RFA) may provide an alternative therapeutic option for GAVE. PubMed, Gastrointest Endosc.

A Patient's Perspective

Search for Watermelon Stomach (GAVE) discussions on Sclero Forums. ISN Sclero Forums.

I was told by my GI doc that he had seen a few other cases of watermelon stomach in Scleroderma patients. As it was explained to me, the blood vessels in the stomach come close to the surface and are bruised easily and leak blood. It's Telangiectasia — in the stomach. Endoscopy — with laser — does stop the bleeding. Sometimes it takes several treatments. Endoscopy is not at all painful. By Bonnie H., submitted for publication on ISN, 3/98.

Watermelon Stomach in Associated with Other Diseases

(Expired Article, Case Report) Gastric Antral Vascular Ectasia (Watermelon Stomach) in a Patient with Sjögren's Syndrome. J Rheumatol. (Also see Sjogren's Syndrome)

Patient/Caregiver Stories: Watermelon Stomach (GAVE)

D.M. Hoffe: Progressive Systemic Sclerosis (Scleroderma CREST) After an endoscopy it was discovered I had a Watermelon Stomach…

James S: Son of Watermelon Stomach Sufferer Last year, my mother was diagnosed as a celiac. Since then a number of other problems have risen to the surface…

Jeri-Lou: Watermelon Stomach Since then I have had nine laser surgeries, two units of blood and six iron injections, which have only managed to bring my blood count up to a 9 count…

Jill K: Lupus with GAVE (Watermelon Stomach) My hemotologist and GI specialists are very supportive but I am so frustrated at how little any one seems to know about GAVE disease…

Marian: Watermelon Stomach Now the doctors tell me I have 'watermelon stomach', a condition where the blood vessels burst and bleed and I become very anemic…

Nina: Fibromyalgia, Raynaud's, Limited Scleroderma/CREST That is when I found ISN! The volume of reliable, informative, trusted information that I found on this site completely overwhelmed me…

Ray N: Watermelon Stomach This past Friday I had two more pints of blood, making nineteen in all. I felt like King Kong from Saturday until Monday afternoon…

Sheena: Systemic Sclerosis with Watermelon Stomach None of my doctors could understand how all my other complaints went with the watermelon stomach, but I knew they did…

Sue D: Diffuse Scleroderma Pain developed in my hands, then I noticed pain in my knees, then my shoulders, down my back, elbows, hips, feet…

Suzy G: GAVE (Watermelon Stomach) and Primary Biliary Cirrhosis Just over six years ago I was diagnosed with primary biliary cirrhosis (PBC), a liver disease. Since then everything else seems to be happening to my body…

Tui: Limited Systemic Scleroderma I am wondering whether such treatments will be ongoing?

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