Watermelon Stomach (GAVE): Symptoms, Causes, and Treatments
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Watermelon stomach, or GAVE, is a condition in which blood vessels in the lower stomach become dilated and prone to bleeding, creating a striped appearance on endoscopy. It is a significant cause of chronic gastrointestinal bleeding and iron-deficiency anemia, especially with liver or kidney disease. Treatment ranges from iron to argon plasma coagulation and, in severe cases, partial gastrectomy. [4]
What the research says
Endoscopic treatment works for most people, but recurrence is common. A review of endoscopic therapy reported success rates of 40–100% for argon plasma coagulation (recurrence 10–78.9%), 90–100% for radiofrequency ablation (recurrence 21.4–33.3%), and 77.8–100% for endoscopic band ligation (recurrence 8.3–48.1%) (Peng et al., Therapeutic Advances in Chronic Disease, 2021) [1].
Band ligation may outperform argon plasma coagulation. GAVE accounts for about 4% of nonvariceal upper GI bleeds. In a network meta-analysis comparing argon plasma coagulation, band ligation, and combined therapy, band ligation showed a significantly lower rate of bleeding recurrence than argon plasma coagulation, with no significant difference in adverse events or red blood cell transfusions across the three approaches (Gangwani et al., Journal of Clinical Gastroenterology, 2025) [2].
Early results favor band ligation as a first step for nodular GAVE. In a small retrospective study of 37 patients with nodular GAVE, clinical remission was reached in 90% of those treated first with band ligation versus 69% of those treated first with thermal therapy (p = 0.041), and hemoglobin rose from 8.7 to 11.4 in the band ligation group and from 8.6 to 10.4 in the thermal therapy group (Cooper et al., World Journal of Gastrointestinal Endoscopy, 2025) [3].
Emergency Medical Warning
Seek immediate emergency care if you experience:
Vomiting blood (which may look like coffee grounds).
Severe abdominal pain.
Significant rectal bleeding or black, tarry stools.
Extreme dizziness or fainting due to blood loss.
What is Watermelon Stomach (GAVE)?
Watermelon stomach is the descriptive name for Gastric Antral Vascular Ectasis (GAVE). The name comes from the characteristic appearance of the stomach lining: weakened and dilated blood vessels form vertical red stripes that resemble the pattern on the outside of a watermelon. [4]
These stripes are internal and cannot be seen without a medical procedure called an endoscopy. [4] While rare, GAVE is a serious condition because it causes persistent internal bleeding, which can lead to severe anemia and the need for frequent blood transfusions.
Symptoms and Warning Signs
Symptoms of watermelon stomach are primarily related to the loss of blood and the resulting anemia. In some cases, the condition may be "silent," showing no outward symptoms until a blood test reveals low iron levels.
Common Signs
Physical Fatigue: Feeling unusually tired or weak due to iron-deficiency anemia. [4]
Digestive Issues: Nausea, abdominal pain, and vomiting blood. [4]
Stool Changes: Blood in the stool or stools that appear black and tarry.
Internal Bleeding: Chronic, slow loss of blood that may not be immediately obvious.
Causes and Risk Factors
While the exact cause of GAVE is unknown [4], medical experts have identified several conditions and hormonal imbalances that frequently occur alongside it.
Risk Category | Associated Conditions & Details |
|---|---|
Chronic Diseases | Liver cirrhosis, kidney failure, heart disease, and diabetes. [4] |
Autoimmune | Atrophic gastritis and other autoimmune disorders. [4] |
Hormonal/Enzymatic | Hypergastrinemia (high gastrin levels), achlorhydria (lack of stomach acid), and low pepsinogen. [4] |
Demographics | Most commonly diagnosed in females over the age of 70. [4] |
Diagnosis and Clinical Testing
If a healthcare provider suspects GAVE based on symptoms like unexplained fatigue or anemia, they will typically refer the patient to a gastroenterologist for specialized testing. [4]
Upper Endoscopy: The primary diagnostic tool. A thin tube with a camera is used to look for the telltale watermelon-stripe pattern in the stomach. [4]
Biopsy: A small tissue sample may be taken during the endoscopy to be analyzed under a microscope. [4]
Blood Tests: Used to confirm iron-deficiency anemia and measure blood loss levels.
Treatment Options
Treatment for watermelon stomach focuses on stopping the bleeding and managing the resulting anemia. The choice of treatment depends on the severity of the condition.
Non-Invasive Management
Endoscopic Procedures
Endoscopy is the most common way to treat GAVE by sealing the leaking vessels:
Argon Plasma Coagulation (APC): The standard treatment, using argon gas to cauterize and seal blood vessels. [4]
Endoscopic Band Ligation (EBL): Placing small bands around vessels to close them off. [4]
Radiofrequency Ablation (RFA): Using heat from radio waves to destroy affected vessels. [4]
Cryotherapy: Freezing the vessels to stop the bleeding. [4]
Surgical Intervention
For patients who do not respond to other treatments, a partial gastrectomy (removing the affected portion of the stomach) is the only definitive cure. [4]
Living with Watermelon Stomach
While you cannot prevent GAVE [4], you can manage the symptoms and recovery process through careful monitoring and dietary adjustments, especially after procedures.
Dietary Adjustments: Following an endoscopy, avoid spicy foods, acidic foods, caffeine, and alcohol. Opt for bland foods like eggs, tofu, and lean meats. [4]
Regular Monitoring: See your doctor if you notice new fatigue or nausea. Early detection can prevent the need for more invasive surgery.
Frequently Asked Questions
1. Is watermelon stomach a type of cancer?
No, watermelon stomach (GAVE) is not cancer. It is a vascular condition involving the blood vessels in the stomach lining.
2. Can you see watermelon stomach from the outside?
No. The "watermelon" appearance is only visible on the inside of the stomach lining during an endoscopy.
3. Why is it called watermelon stomach?
Watermelon stomach is named for the vertical red stripes that form in the stomach, which look like the stripes on the rind of a watermelon.
4. Who is most at risk for GAVE?
GAVE is most common in women over 70, particularly those with liver cirrhosis or autoimmune diseases.
5. Can watermelon stomach be cured?
A partial gastrectomy is currently the only way to effectively cure the condition, though endoscopic treatments can manage it successfully for many people.
6. What is APC treatment?
Argon Plasma Coagulation (APC) is a procedure where a doctor uses argon gas and electrical current to seal bleeding blood vessels without direct contact.
7. Does watermelon stomach cause pain?
Some people experience abdominal pain, but many others have no pain and only discover the condition due to symptoms of anemia like fatigue.
8. What should I eat after GAVE treatment?
Stick to bland, non-irritating foods like soups, smoothies, and eggs. Avoid alcohol, caffeine, and spicy or acidic foods.
9. Can I live a normal life with GAVE?
Yes. Many people successfully manage the condition with iron supplements or periodic endoscopic treatments.
10. Is GAVE the same as stomach ulcers?
No. While both can cause bleeding, GAVE involves dilated blood vessels, whereas ulcers are sores in the stomach lining.
11. How often will I need treatment?
Most people require a few sessions of endoscopic treatment (like APC) to fully seal the affected vessels.
12. Can I take ibuprofen if I have GAVE?
NSAIDs like ibuprofen can sometimes increase the risk of stomach bleeding. You should consult your doctor before taking these medications.
13. What causes the stripes to form?
The stripes are caused by dilated blood vessels (ectasia) in the ridges of the stomach lining.
14. Is a blood transfusion always necessary?
No, blood transfusions are only used in severe cases where significant blood loss has occurred.
15. Can GAVE come back after treatment?
Yes, some people experience recurring bleeding even after successful initial treatment and may need ongoing management.
Trusted External Resources
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Upper GI Endoscopy — what to expect from the procedure used to diagnose and treat GAVE.
American Liver Foundation: Cirrhosis of the Liver — patient information on cirrhosis, a common condition linked to GAVE.
Related Reading
References
Peng M, Guo X, Yi F, et al. Endoscopic treatment for gastric antral vascular ectasia. Ther Adv Chronic Dis. 2021;12:20406223211039696. PMID 34408826. https://doi.org/10.1177/20406223211039696
Gangwani MK, Haghbin H, Hasan F, et al. Comparing endoscopic treatment modalities for gastric antral vascular ectasia: efficacy, safety, and outcomes in a network meta-analysis. J Clin Gastroenterol. 2025;59(6):555-561. PMID 39312519. https://doi.org/10.1097/MCG.0000000000002057
Cooper JA, Statham E, Holyfield A, et al. Initial treatment approaches for nodular gastric antral vascular ectasia: a comparison of endoscopic band ligation and thermal therapies. World J Gastrointest Endosc. 2025;17(12):111872. PMID 41479935. https://doi.org/10.4253/wjge.v17.i12.111872
Cleveland Clinic. Watermelon Stomach (Gastric Antral Vascular Ectasis). Cleveland Clinic Health Library. Last updated August 21, 2024. https://my.clevelandclinic.org/health/diseases/watermelon-stomach
Medical Disclaimer
This content is for informational purposes only and does not constitute medical advice. Always seek the advice of a physician or other qualified health provider with any questions regarding a medical condition.
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