June 01, 2018

What is watermelon stomach?

Q: I was diagnosed with internal bleeding in my stomach, a condition that my doctor said is sometimes called watermelon stomach. Can you explain why it has this name, since my belly is fairly flat?

A: The term watermelon stomach is another name for a condition called gastric antral vascular ectasia (GAVE). With a name like watermelon stomach, it's not surprising that the image of a large, oval-shaped belly may be the first thing to pop into your mind.

Rather, the term comes from the internal appearance of your stomach lining. Engorged blood vessels in the lining of the lower part of the stomach often form as red stripes, and resemble the dark-green and light-green stripes on the outside of a watermelon. These blood vessels are prone to bleeding into the stomach.

GAVE is a fairly rare cause of internal bleeding. It's most commonly seen in older adults, especially older women. It can be associated with longterm, chronic diseases such as cirrhosis of the liver, autoimmune diseases such as hardening and scarring of the skin (scleroderma), or Raynaud's disease.

The key problem with GAVE is blood loss. While blood can be observed, such as blood in the stool or in vomit, it often isn't visible. Suspicion of internal bleeding may arise if a routine blood test shows depletion of red blood cells from iron deficiency (anemia) without an obvious explanation. GAVE is usually then detected when an endoscopic exam of the esophagus, stomach and duodenum is performed.

There are a number of treatment options for GAVE. The mainstay approach involves using an endoscope to apply targeted heat — such as from a laser or argon plasma coagulation — to cauterize and seal off the engorged blood vessels. Other...