Summary about Disease
Gastric antral vascular ectasia (GAVE) is a rare condition characterized by abnormal, dilated blood vessels in the antrum (lower part) of the stomach. These blood vessels can bleed, leading to chronic blood loss and anemia. GAVE is sometimes called "watermelon stomach" because the striped appearance of the dilated blood vessels resembles the markings on a watermelon.
Symptoms
The most common symptom is chronic iron deficiency anemia, which can cause:
Fatigue
Weakness
Shortness of breath
Pale skin
Dizziness
Black, tarry stools (melena)
Blood in vomit (hematemesis) (less common)
Causes
The exact cause of GAVE is unknown, but several factors are believed to be associated with its development:
Autoimmune diseases (e.g., systemic sclerosis, also known as scleroderma)
Chronic kidney disease
Liver cirrhosis
Bone marrow transplantation
Heart and Lung transplants. It is thought that these conditions may contribute to the development of abnormal blood vessels in the stomach.
Medicine Used
Treatment options primarily focus on stopping the bleeding and addressing the anemia. Medicines include:
Iron supplements: To treat iron deficiency anemia.
Blood transfusions: In severe cases of anemia to rapidly increase red blood cell count.
Hormonal therapy: In some cases, progestins (synthetic forms of progesterone) or estrogen/progesterone combinations have been used to reduce bleeding, but their effectiveness is variable.
Endoscopic therapies are the primary treatments.
Is Communicable
GAVE is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent GAVE because the underlying cause is unknown and multifactorial. However, managing associated conditions, such as autoimmune diseases, chronic kidney disease, and liver disease, may potentially reduce the risk.
How long does an outbreak last?
GAVE is not characterized by outbreaks. It is a chronic condition, meaning it persists over a long period. The bleeding can be intermittent, leading to a fluctuating pattern of anemia symptoms. Without treatment, the bleeding and anemia will likely continue indefinitely.
How is it diagnosed?
Diagnosis typically involves:
Endoscopy: A procedure where a thin, flexible tube with a camera is inserted into the esophagus, stomach, and duodenum to visualize the lining of the stomach and identify the characteristic watermelon-like appearance of GAVE.
Biopsy: During endoscopy, a small tissue sample (biopsy) may be taken from the affected area to confirm the diagnosis under a microscope.
Blood tests: To check for anemia (low red blood cell count) and iron deficiency.
Timeline of Symptoms
The timeline of symptoms varies from person to person.
Initial phase: Often starts with mild fatigue and weakness, which may be attributed to other causes.
Progressive phase: As bleeding continues, symptoms worsen, including increased fatigue, shortness of breath, dizziness, and pale skin. Black, tarry stools may appear.
Advanced phase: Severe anemia can lead to more significant symptoms, such as chest pain, rapid heartbeat, and even heart failure in rare cases. Blood transfusions may be required.
Important Considerations
GAVE can be difficult to diagnose initially due to its rarity and the non-specific nature of the early symptoms.
Endoscopic treatments, such as argon plasma coagulation (APC), radiofrequency ablation (RFA), or endoscopic band ligation (EBL), are often the primary treatment options to stop the bleeding.
The underlying cause of GAVE should be investigated and addressed if possible.
Long-term monitoring is necessary to manage the condition and prevent complications.