Watermelon Stomach (Gastric Antral Vascular Ectasis)

What is watermelon stomach?

Watermelon stomach happens when the blood vessels in your stomach lining weaken and bleed, causing vertical stripes to form. These stripes make the inside of your stomach resemble the outside of a watermelon. Healthcare providers can see these stripes during endoscopy — a procedure that allows them to look inside your body using a thin tube with a tiny camera.

The medical name for watermelon stomach is gastric antral vascular ectasis (GAVE).

How common is watermelon stomach (gastric antral vascular ectasia)?

Watermelon stomach is rare overall. When bleeding of the stomach lining occurs, it’s often due to other conditions like stomach ulcers or enlarged blood vessels (varices).

Anyone can get watermelon stomach, but it’s most common in people assigned female at birth (AFAB) who are over 70.

What are the symptoms of gastric antral vascular ectasia (GAVE)?

Watermelon stomach symptoms and signs may include:

• Abdominal pain.
• Blood in stool (poop).
• Fatigue.
• Internal bleeding.
• Iron-deficiency anemia.
• Nausea.
• Vomiting blood.

In some cases, a person with watermelon stomach doesn’t experience any symptoms.

What causes watermelon stomach (gastric antral vascular ectasia)?

Scientists don’t know exactly why some people get watermelon stomach and others don’t. But according to current theories, watermelon stomach causes may include:

• Hypergastrinemia, a condition in which your levels of gastrin (a hormone that helps with digestion) are higher than normal.
• Achlorhydria, when your stomach doesn’t make hydrochloric acid (a substance that helps break down your food).
• Low levels of pepsinogen, an important digestive enzyme.
• Liver failure, which can cause dilated blood vessels.

Watermelon stomach risk factors

Watermelon stomach is more likely to occur in people with other health conditions like:

• Autoimmune diseases.
• Atrophic gastritis.
• Diabetes.
• Heart disease.
• Kidney failure.
• Cirrhosis of the liver.
• Metabolic syndrome.

How is watermelon stomach (gastric antral vascular ectasia) diagnosed?

A healthcare provider will meet with you to discuss your symptoms. If they suspect watermelon stomach, they’ll refer you to a gastroenterologist for further testing. These tests may include:

• Upper endoscopy to look inside your stomach, keeping an eye out for telltale stripe patterns.
• Biopsy, which involves taking a small sample of tissue for analysis under a microscope.
• Blood tests, which can detect anemia.

How is watermelon stomach (gastric antral vascular ectasia) treated?

Healthcare providers use a range of methods to treat watermelon stomach syndrome, from supplements to surgery. If you’ve lost a lot of blood, you may need an emergency blood transfusion. The option that’s right for you depends on the severity of your symptoms and whether you have any related conditions.

Iron supplements

When detected in its earliest stage, you might be able to manage watermelon stomach with iron supplements. But this approach doesn’t work for everyone — and people who take iron supplements may still need one or more blood transfusions to manage the bleeding.

Medications

Your healthcare provider might recommend certain medications to help slow the bleeding in your stomach lining. Though experts don’t yet know the long-term safety of these medications, they can work well during the short term:

• Corticosteroids.
• Octreotide.
• Hormone therapy.

Endoscopic treatments

Endoscopic surgery is the most common treatment for watermelon stomach. These procedures aim to close or destroy the affected blood vessels to stop bleeding:

• Argon plasma coagulation (APC). The most common watermelon stomach treatment, APC uses argon gas to cauterize (burn) and seal the affected blood vessels.
• Endoscopic band ligation (EBL). This involves placing a band around each affected vessel to close it. Sometimes, providers combine EBL with APC.
• Radiofrequency ablation (RFA). RFA uses heat from radio waves to destroy the affected blood vessels.
• Cryotherapy. This technique uses nitrous oxide to freeze the affected blood vessels.

People who have these procedures usually need a few treatments to achieve the desired result.

Blood transfusions

If you have severe bleeding, you’ll probably need one or more blood transfusions. But treatments like supplements, medications and endoscopic procedures can reduce your need for blood transfusions over time. Until your provider slows the bleeding enough, you might need occasional blood transfusions to replace what you’ve lost.

Surgery

People with watermelon stomach who don’t respond to supplements, medications or endoscopic procedures may need a partial gastrectomy. This surgery involves removing the affected parts of your stomach. Generally, people who have surgery for watermelon stomach don’t need blood transfusions.

While gastrectomy is more invasive than endoscopic procedures like APC, it’s the only way to effectively cure watermelon stomach.

Can watermelon stomach be prevented?

There’s nothing you can do to prevent watermelon stomach because experts don’t know exactly why it happens. The best thing to do is talk to your healthcare provider if you develop any worrisome symptoms. Early treatment may halt the bleeding before it worsens.

What’s the outlook for watermelon stomach (gastric antral vascular ectasia)?

It varies depending on the severity of your symptoms. While the goal is to stop the bleeding, some people have recurring (returning) issues even after treatment. In these cases, people with watermelon stomach may need routine blood transfusions. On the other hand, many people get better after they complete their initial treatment. Your healthcare provider can tell you what to expect in your situation.

Are there foods to avoid with watermelon stomach (gastric antral vascular ectasia)?

While there aren’t standardized nutritional recommendations for people with watermelon stomach, it’s a good idea to avoid these foods after you’ve had an upper endoscopic procedure:

• Spicy foods.
• Acidic foods.
• Caffeine.
• Alcohol.

Until your treatment is over, try blander foods like eggs, tofu, soups, smoothies and lean meats. Ask your healthcare provider for specific food recommendations.

When should I see my healthcare provider?

You should let your healthcare provider know any time you notice new symptoms, including nausea or fatigue. If something doesn’t seem right, don’t wait. Early diagnosis and treatment can reduce your need for invasive surgery.

If you have severe symptoms like vomiting blood, go to your nearest emergency room. It’s important to find a cause as soon as possible to prevent blood loss and other complications.

What questions should I ask my doctor?

If you have watermelon stomach, here are some things you may want to ask your healthcare provider:

• How severe is my condition?
• What type of treatment will I need?
• How many treatment sessions will it take?
• Will I need blood transfusions? If so, how often?

A note from Cleveland Clinic

Vomiting blood or seeing blood in your poop can be alarming. These things point to a stomach issue, but symptoms aren’t always that apparent. Maybe you’ve been exhausted for months. Or maybe you woke up this morning with an unfamiliar pain in your belly. Watermelon stomach is rare, and it shares symptoms with other stomach conditions. It might take time to come up with a proper diagnosis — and the uncertainty you experience in the meantime can take its toll. Talk to your healthcare provider about any symptoms you develop. They can find out what’s causing them and recommend appropriate treatment.