Incidence

The average age of diagnosis for GAVE is 73 years of age for female, 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.

The Typical Patient

Most patients with GAVE suffer from liver cirrhosis, autoimmune disease, chronic renal failure and bone marrow transplantation. The typical initial presentations range from occult bleeding causing transfusion-dependent chronic iron-deficiency anemia to severe acute gastrointestinal bleeding.

—Masae Komiyama, et al., 2010

Differential Diagnosis

GAVE results in intestinal bleeding similar to duodenal ulcers and portal hypertension.The GI bleeding can result in anemia, as well as occult blood in the stool.  It is often overlooked, but can be more common in elderly patients.   It has been seen in patients as young as 38 years of age.
Watermelon stomach has a different etiology and has a differential diagnosis from portal hypertension.  In fact, cirrhosis and portal hypertension may be missing in a patient with GAVE.  The differential diagnosis is important because treatments are different

Signs and Symptoms

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 medical doctor because he or she notices blood in the stools — either melena (black and tarry stools) and/or hematochezia (maroon stools).

GAVE: An Update on Clinical Presentation, Pathophysiology and Treatment

Gastric antral vascular ectasia (GAVE), though a rare disorder, causes up to 4% of non-variceal upper GI bleeding. This paper gives an overview of studies examining clinical presentation and pathophysiology, and reviews the current evidence for invasive and non-invasive treatments. GAVE is often associated with systemic illnesses, such as cirrhosis of the liver, autoimmune connective tissue disorders, bone marrow transplantation and chronic renal failure. The pathophysiological

changes leading to GAVE have not been fully explained and remain controversial. Patient presentation varies from chronic iron-deficiency anaemia to heavy acute gastrointestinal bleeding. It is important to differentiate GAVE from portal hypertensive gastropathy as GAVE does not respond to measures reducing portal pressures. Endoscopic ablation (Nd:YAG-laser or argon plasma coagulation) is the first-line treatment of choice. As evidence for pharmacological therapy with oestrogen (and/or progesterone), tranexamic acid or thalidomide stems from case reports

only, these should be used if endoscopic measures have failed to stop chronic blood loss.
Read more

My mother, Mary, mom, grandmother, nurse, and bike enthusiast (cross country bike tour video) has lived with GAVE for 2 years, and has undergone three treatments with argon plasma coagulation.  There is little known about this disorder, and that is the reason behind this blog.  If you have GAVE, or know someone with this disorder, any information you could provide would be appreciated.