Gastric Antral Vascular Ectasia (GAVE)

Gastric antral vascular ectasia (GAVE), or watermelon stomach, is a rare acquired vascular disorder, characterized by multiple longitudinal stripes of red vessels originating from the pylorus and involving the antrum. In recent years, GAVE emerged as a potential gastrointestinal complication in patients with systemic sclerosis, with an estimated prevalence that ranges between 1% and 22.3%. GAVE usually presents with a refractory iron-deficiency anemia, that may require repeated blood transfusions, due to recurring gastrointestinal bleeding. Given the close association between GAVE and anti-RNA polymerase III antibodies, screening these high risk patients with endoscopy should be considered even in absence of anemia or gastric-related symptoms. Endoscopic methods, including thermal and mechanical techniques, are the treatment of choice for GAVE-related bleeding. In patients with GAVE and systemic sclerosis that are refractory to endoscopic therapy, cyclophosphamide and autologous hematopoietic stem cell transplantation may be an effective treatment option.