GAVE (gastric antral vascular ectasia) is a widening and prominence of the surface vessels in the stomach, particularly in the part near its outlet called the antrum.
At endoscopy, red stripes running outwards from the pylorus are usually seen. Because the appearance resembles the stripes on a watermelon rind, the name “watermelon stomach” is also used.
GAVE is not cancer. But because the widened vessels can bleed over time, it matters particularly for iron deficiency and anaemia.
What causes GAVE?
The exact mechanism by which GAVE forms is not fully known. In some patients no cause can be found, while it can be seen more often alongside:
- Cirrhosis of the liver
- Chronic kidney disease
- Some autoimmune conditions such as systemic sclerosis
- Some heart conditions
- Older age
Finding GAVE does not necessarily mean there is cirrhosis or portal hypertension.
What symptoms does it cause?
GAVE mostly causes no marked stomach pain. The most important problem is slow, recurring blood loss from the widened vessels.
As a result, blood loss → falling iron → falling ferritin → anaemia can develop.
The patient may have weakness, tiring easily, breathlessness, dizziness and pallor. Some patients may have black, tarry stools.
Is GAVE the same as portal hypertensive gastropathy?
No. Distinguishing between the two matters.
- GAVE Is mostly in the antrum of the stomach and produces red stripes or red spots spreading from the pylorus.
- Portal hypertensive gastropathy (PHG) Is seen more in the corpus and fundus of the stomach and typically produces a mosaic or "snakeskin" appearance.
And whereas PHG has portal hypertension underlying it, portal hypertension does not have to be present for GAVE.
Is GAVE a varix?
No.
Oesophageal and gastric varices are widened veins that develop because of portal hypertension.
GAVE is a different form of widening of the surface vessels in the stomach lining. Their appearance, their bleeding characteristics and their treatment all differ.
Does GAVE turn into cancer?
No.
GAVE is not cancer and is not considered pre-cancerous. The main problem in GAVE is not the development of cancer but chronic or recurring gastrointestinal bleeding.
How is it treated?
Treatment is determined by whether the patient has blood loss and anaemia.
Where there is iron deficiency, iron treatment may be given. Where there is continuing or recurring bleeding, endoscopic treatment may be needed. One of the most commonly used methods is argon plasma coagulation (APC).
During APC the widened surface vessels are coagulated in a controlled way through the endoscope. The aim is to reduce blood loss.
Some patients need more than one APC session. In selected cases endoscopic band ligation or other endoscopic methods may also be used.
Does it come back after treatment?
It can. So it is not only the endoscopic appearance that should be followed but haemoglobin, serum iron and ferritin as well.
Iron deficiency or anaemia developing again after treatment can suggest continuing or recurring blood loss.
Does every patient with GAVE need endoscopic treatment?
No.
A patient in whom GAVE is seen at endoscopy but who has no bleeding and no anaemia is not treated the same way as one needing iron or blood transfusion because of recurring bleeding.
The decision to treat is made according to the degree of bleeding, the anaemia, the patient’s other conditions and the endoscopic findings.
When is it urgent?
Urgent assessment for gastrointestinal bleeding is needed if there is
Vomiting blood · black, tarry stools · fainting · marked dizziness · palpitations · breathlessness · sudden serious weakness.
In brief
- GAVE Means watermelon stomach.
- Its most common location Is the antrum of the stomach.
- The most important problem Is chronic blood loss and iron deficiency anaemia.
- GAVE Is not cancer.
- GAVE Is not the same thing as portal hypertensive gastropathy or gastric varices.
- Where needed It can be treated by endoscopic methods such as APC.
- In follow-up Haemoglobin, iron and ferritin matter.
This is not enough to make a diagnosis
When GAVE is found at endoscopy, the patient’s haemoglobin and iron values, whether there is active or chronic bleeding, the endoscopic appearance and any accompanying conditions all have to be weighed together in planning follow-up and treatment.
Sources
- Prof. Ali Tüzün İnce, MD