Gastric antral vascular ectasia (GAVE), or watermelon stomach, is a rare condition that causes the stomach lining to bleed. The hallmark of the condition is red stripes on the stomach lining, which give the appearance of a watermelon.

Although some people will experience no symptoms, others will feel tired and notice blood in their stool.

Read on to learn more about watermelon stomach, including its symptoms, causes, and treatments.

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Watermelon stomach is a rare condition that affects a person’s stomach lining. It makes the blood vessels within the stomach lining fragile and likely to bleed.

Research from 2019 notes that watermelon stomach is responsible for about 4% of non-variceal upper gastrointestinal bleeding. Non-variceal means that it is not due to varices, which are abnormally enlarged veins.

When a person has watermelon stomach, vertical red stripes develop along the inside of their stomach. This makes the stomach lining look like the outside of a watermelon.

Watermelon stomach can sometimes cause no symptoms. If a person does have symptoms, they can include:

Watermelon stomach often results in iron deficiency anemia. When a person loses blood, they also lose the iron it contains. The body uses iron to make hemoglobin, the substance that enables the blood to carry oxygen. A lack of oxygen in the blood can result in a person feeling tired or short of breath.

It remains unclear exactly what causes watermelon stomach, but researchers have various theories. These include:

  • achlorhydria, a condition in which a person’s stomach does not produce hydrochloric acid, an acid that the body uses to break down food
  • hypergastrinemia, which is when a person has an increased level of the hormone gastrin in their stomach
  • low levels of the digestive enzyme pepsinogen
  • liver failure, which causes a buildup of hormones that dilate blood vessels

Risk factors

Watermelon stomach has certain risk factors. Research from 2018 notes that females are almost twice as likely to have watermelon stomach as males. It is also more likely to affect older adults.

Additionally, watermelon stomach often occurs alongside conditions such as:

Research from 2015 found that 62% of people with watermelon stomach also had an autoimmune connective tissue disorder.

A doctor can diagnose a person with watermelon stomach by using endoscopy, in which they insert a long, thin tube called an endoscope into a person’s throat. The endoscope has a small camera on the end, which allows the doctor to look at images of the person’s stomach.

A person with watermelon stomach will have visible vertical red stripes on their stomach lining.

Occasionally, a doctor may take a tissue sample, or biopsy, of a person’s stomach lining to confirm a watermelon stomach diagnosis. They might also take a blood sample to check for signs of anemia.

Learn more about endoscopy.

If doctors diagnose watermelon stomach early enough, it may be possible to treat it just with iron supplements.

Doctors can treat the associated iron deficiency anemia with regular blood transfusions or iron replacement tablets.

They may prescribe certain medications to control bleeding resulting from watermelon stomach. However, the long-term effectiveness and safety of these medications require further research.

Medications that can treat watermelon stomach include:

As an alternative, doctors can use various endoscopic treatments to stop the bleeding. These treatments include:

Argon plasma coagulation (APC)

APC is the gold standard for watermelon stomach treatment. It involves using ignited argon gas to burn and seal the bleeding blood vessels.

APC can remove 80⁠–100% of watermelon stomach lesions. It can also reduce the need for blood transfusions in 50–80% of people after two or three sessions.

Endoscopic band ligation (EBL)

EBL involves placing elastic bands around enlarged blood vessels to prevent bleeding. These elastic bands pinch a small loop of the blood vessel to cut off the blood flow. Over time, the pinched loop will drop off, and the blood vessel will repair itself.

Research from 2022 reports that EBL achieves a higher rate of bleeding control than APC with fewer treatments. It also reduces the need for blood transfusions.

Combining APC and EBL can also be an effective way to treat watermelon stomach.

Neodymium-doped yttrium aluminum garnet (Nd: YAG) laser coagulation

Nd: YAG treatment uses heat to burn and seal bleeding blood vessels. This treatment is effective in preventing bleeding and reducing the need for blood transfusions after between one and four sessions.

Cryotherapy

Cryotherapy uses nitrous oxide to freeze the blood vessels that watermelon stomach affects. In a small study, five of seven people with watermelon stomach had no bleeding after an average of 3.6 cryotherapy sessions. There is a need for larger studies to confirm these findings.

Radiofrequency ablation (RFA)

RFA uses the heat that radio waves produce to destroy affected blood vessels. Several small sample studies found that RFA was able to increase hemoglobin levels and reduce the need for blood transfusions.

Surgery may be necessary for people who do not respond to medicinal or endoscopic treatments. Surgery for watermelon stomach can involve removing affected parts of the stomach.

Having surgery is the only reliable way to cure watermelon stomach. It can also eliminate the need for blood transfusions.

A person can speak with a doctor about what treatment option is right for them.

A person should speak with a doctor if they have symptoms of watermelon stomach. A person with signs of iron deficiency anemia should also contact a doctor.

Symptoms of iron deficiency anemia include:

People can manage watermelon stomach with treatment. Without treatment, a person may develop iron deficiency anemia. This may require them to have frequent blood transfusions.

A person may also find that their watermelon stomach reoccurs after treatment. If this happens, a person will need to restart their treatment.

Watermelon stomach is a rare condition that causes bleeding in a person’s stomach lining. It causes characteristic red, vertical stripes to form on the stomach lining, giving the appearance of a watermelon.

Watermelon stomach can sometimes show no symptoms. If symptoms do occur, they can include fatigue or blood in the stool.

Doctors do not know the exact cause of watermelon stomach. However, it commonly occurs alongside conditions such as autoimmune diseases and chronic renal failure.

A doctor can diagnose watermelon stomach using endoscopy. They may also use blood tests or a biopsy of stomach tissue.

Treatment for watermelon stomach includes various medications and endoscopic treatments. If these treatments are not effective, a person may require surgery.

A person can manage watermelon stomach with treatments. However, they may find that it reoccurs following treatment.

Anyone who notices any signs of watermelon stomach or iron deficiency anemia should speak with a doctor.