Gave Syndrome – A Rare and Mysterious Cause of Gastrointestinal Hemorrhage in the Elderly

GAVE syndrome (gastric antral vascular ectasia) is a rare cause of gastrointestinal bleeding. It affects mainly the elderly. The syndrome was named “watermelon stomach” because of its typical endoscopic appearance of “watermelon stripes” observed at the gastric antral level. We present the case of an 80-year-old female patient, under iron substitution therapy for an iron deficiency anemia previously diagnosed. The woman was admitted to our hospital for non-specific symptoms, severe asthenia and postural instability. The clinical examination noted pallor of skin and sclera, without hematemesis or melena. Paraclinical tests revealed severe hypochromic microcytic anemia and hyposideremia, with a positive fecal occult blood test. Because the patient was refractory to the iron therapy, presenting with severe anemia, which required blood transfusions, we suspected a diagnosis of acute hemorrhagic gastritis. In order to reveal the source of the hemorrhage, an upper gastrointestinal endoscopy was performed, which described the typical appearance of prominent, tortuous, erythematous streaks traversing the antrum and converging toward the pylorus, creating the “watermelon stripes” pattern, with lesions that bleed easily during the biopsy process. In a different endoscopic session, the argon plasma coagulation treatment was applied, resulting in clinical and biological improvement.

Gastric antral vascular ectasia is a rare medical condition, insufficiently recognized and poorly understood, which can be treated efficiently by endoscopic means, if it is early diagnosed. Although this condition tends to be underdiagnosed at the present time, doctors may exceed their limits by acquiring a high grade of clinical suspicion.