Watermelon stomach: a rare cause of anemia in patients with end-stage renal disease

Watermelon Stomach or gastric antral vascular ectasia (GAVE) is a rare cause of chronic gastrointestinal blood loss. It has been commonly associated with autoimmune connective tissue and chronic liver disease. It is characterized by endoscopic appearances of erythematous patches secondary to dilated vessels that can be diffusely located or in linear stripes. Histology is characterized by dilated mucosa capillaries with fibrin thrombi and fibromuscular hyperplasia. Unless recognized, the endoscopic findings can be misdiagnosed as severe gastritis. GAVE can be treated using various modalities with variable success. We report four cases of GAVE as the cause of chronic gastrointestinal blood loss in patients with end stage renal disease. A literature review of this rare and interesting entity is presented.