Gastric antral vascular ectasia

Most patients who are eventually diagnosed with watermelon stomach come to a physician complaining of anemia and blood loss. Sometimes, a patient may come to the physician because he or she notices blood in the stools—either melena (black and tarry stools) and/or hematochezia (red bloody stools). ==Cause==

The literature, from 1953 through 2010, often cited that the cause of gastric antral vascular ectasia is unknown. as 25% of all sclerosis patients with antibodies to anti-RNA polymerase III have GAVE. Watermelon stomach also occurs particularly with scleroderma, and especially the subtype known as systemic sclerosis. 30% of all patients have cirrhosis associated with GAVE. The first case of ectopic pancreas associated with watermelon stomach was reported in 2010. and one separate study showed that over three-fourths of the patients in the study with GAVE had some kind of vitamin B12 deficiency including the associated condition pernicious anemia. ==Pathogenesis==

GAVE is characterized by dilated capillaries in the lamina propria with fibrin thrombi. The main histomorphologic differential diagnosis is portal hypertension, which is often apparent from clinical findings. Research in 2010 has shown that anti-RNA polymerase III antibodies may be used as a risk marker for GAVE in systemic sclerosis patients. ==Diagnosis==

showing gastric antral vascular ectasia. A large spherical, eosinophilic (i.e. pink) fibrin thrombus is seen off-center right. Stomach biopsy. H&E stain. GAVE is usually diagnosed definitively by means of an endoscopic biopsy. The tell-tale watermelon stripes show up during the endoscopy. In fact, cirrhosis and portal hypertension may be missing in a patient with GAVE. The differential diagnosis is important because treatments are different. ==Treatment==

Traditional treatments Treatment of GAVE can be categorized into endoscopic, surgical and pharmacologic therapies. GAVE is treated commonly by means of an endoscope, including argon plasma coagulation (APC) and electrocautery. TIPSS-related encephalopathy occurs in about 30% of cases, with the risk being higher in those with previous episodes of encephalopathy, higher age, female sex, and liver disease due to causes other than alcohol. The patient, with their physician and family, must balance out a reduction in bleeding caused by TIPS with the significant risk of encephalopathy. may be used to remove fluid from the peritoneal cavity in the abdomen for such cases. Laparoscopic surgery is possible in some cases, and as of 2003, was a "novel approach to treating watermelon stomach". A treatment used sometimes is endoscopic band ligation. In 2010, a team of Japanese surgeons performed a "novel endoscopic ablation of gastric antral vascular ectasia". The experimental procedure resulted in "no complications". Antrectomy or other surgery is used as a last resort for GAVE. ==Epidemiology==

The average age of diagnosis for GAVE is 73 years of age for females, and 68 for males. Women are about twice as often diagnosed with gastric antral vascular ectasia than men. 71% of all cases of GAVE are diagnosed in females. Patients in their thirties have been found to have GAVE. It becomes more common in women in their eighties, rising to 4% of all such gastrointestinal conditions. 5.7% of all sclerosis patients (and 25% of those who had a certain anti-RNA marker) have GAVE. ==References==