| Gastrointestinal Involvement (Main Menu) | ||
| Gastric Antral Vascular Ectasia (Watermelon Stomach) | ||
| This page was written by Shelley Ensz, and has not yet been medically edited. Scleroderma (SD) affects everyone differently. See Disclaimer. | ||
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| What is Watermelon Stomach? | ||
| These symptoms may occur in systemic scleroderma but not in localized scleroderma, such as Linear and Morphea. See Types of Scleroderma. Just because something is listed here does not mean an individual patient will ever experience it. | ||
Watermelon Stomach can occur in patients with Diffuse Systemic Scleroderma. |
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| 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. | ||
| Gastric Antral Vascular Ectasia (GAVE): An Update on Clinical Presentation, Pathophysiology and Treatment.Gastric antral vascular ectasia (GAVE), though a rare disorder, causes up to 4% of non-variceal upper GI bleeding. This paper gives an overview of studies examining clinical presentation and pathophysiology, and reviews the current evidence for invasive and non-invasive treatments. Christian P. Selinger. Digestion 2008;77:131-137. | ||
| Watermelon stomach in systemic sclerosis: its incidence and management. Our series indicates that watermelon stomach should be considered when unexplained iron-deficiency anaemia occurs in SSc patients. Moreover, because watermelon stomach may be the first manifestation of SSc, patients with unexplained watermelon stomach should systematically undergo physical examination and autoantibody testing to detect the underlying SSc. Marie I. (PubMed) Aliment Pharmacol Ther. 2008 Aug 15;28(4):412-21. | ||
| Watermelon stomach: Clinical Images. Watermelon stomach is believed to be one of the manifestations of the widespread vasculopathy associated with scleroderma. Histology results show dilated, thrombosed capillaries in the lamina propria and reactive fibromuscular hyperplasia. Conventional therapies for acid-peptic disease are not effective; however, argon plasma coagulation is often successful and is the treatment of choice. Soumya Chatterjee, MD MS. CMAJ • July 15, 2008; 179 (2). | ||
| Diagnosis | ||
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. (At left, Watermelon Stomach as seen by Endoscopy, property of the ISN Photo Repository.) |
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| Gastric Antral Vascular Ectasia (GAVE) in Systemic Sclerosis (SSc): Demographics and Disease Predictors. Diffuse cutaneous SSc (dcSSc) is associated with earlier development of GAVE, as well as more severe anemia requiring more therapeutic interventions. Rapid progression of cutaneous disease may suggest earlier development of GAVE. Absence of antitopoisomerase I antibodies and presence of antibodies to RNAP III/speckled antinuclear antibody pattern may be useful to identify the subset of patients with SSc with increased risk for GAVE. Kristin M. Ingraham. J Rheum. Jan. 21, 2010. | ||
| Treatment | ||
| Watermelon stomach (GAVE) is treated very successfully with endoscopic laser surgery. | ||
| Improvement of Severe Systemic Sclerosis-associated Gastric Antral Vascular Ectasia (GAVE) Following Immunosuppressive Treatment with Intravenous Cyclophosphamide. A description of 3 patients with systemic sclerosis (SSc) with severe, transfusion-dependent GAVE refractory to laser ablation who showed remarkable clinical and endoscopic improvement following intravenous pulse cyclophosphamide (CYC) treatment. Steffan W. Schulz. (PubMed) J Rheumatol. 2009 Aug;36(8):1653-6. | ||
| Endoscopic cryotherapy for the management of gastric antral vascular ectasia (G.A.V.E.). Endoscopic cryotherapy is a safe and effective treatment for GAVE. It appears to be effective, even for GAVE refractory to argon plasma coagulation therapy. Cho S. (PubMed) Gastrointest Endosc. 2008 Nov;68(5):895-902. Epub 2008 Jul 21. | ||
| Successful Treatment of Watermelon Stomach / GAVE Syndrome by Using Argon Plasma Coagulation. After 3 sessions, the lesions disappeared and the hemoglobin increased by 2.4 gm/dl without any need of transfusion. Bhatti MA. (PubMed) J Coll Physicians Surg Pak. 2008 Oct;18(10):641-3. | ||
| Gastric antral vascular ectasia (GAVE) associated with systemic sclerosis: relapse after endoscopic treatment by argon plasma coagulation. This case showed resistance to endoscopic treatment using argon plasma coagulation (APC). In spite of GAVE eradication by APC, a third recurrence of GAVE was observed after 32 months. PubMed. Intern Med. 2007;46(6):279-83. | ||
| Clinical Applications of Argon Plasma Coagulation in Endoscopy. This article reviews the principles and components of the argon plasma coagulator, and provides a summary of the various clinical applications, patient safety practices, and potential complications of argon plasma coagulation therapy. Gastroenterology Nursing September/October 2006 Volume 29 Number 5 Pages 386 - 391. | ||
| A Patient's Perspective | ||
| 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. | ||
| Research | ||
| Gastric Antral Vascular Ectasia (Watermelon Stomach) in a Patient with Sjögren's Syndrome. Gastric antral vascular ectasia (GAVE), a rare yet treatable cause of upper gastrointestinal bleeding, has been described in a variety of autoimmune diseases. After several fulguration therapies with argon-plasma coagulator, the mucosal lesions improved and her hemoglobin levels returned to normal. J Rheumatol NO. 5 MAY 2003;30:1090-2 (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? |
| Go to Liver Involvement | ||||||||||||
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Diagnosis of Watermelon Stomach (GAVE) is most often made by Endoscopy. Often, AVMs aren't seen during selective angiography, endoscopic biopsy, or during surgery.