[Watermelon stomach: a cause of chronic blood loss in the elderly]

Watermelon stomach, or gastric vascular ectasia, is a relatively new, distinct clinical entity. This rare vascular abnormality of the stomach causes severe chronic blood loss and iron-deficiency anemia, particularly in the elderly. Endoscopically it is characterized by longitudinal antral folds which contain visible vessels radiating from the pylorus, and resembling the dark stripes on the surface of some watermelons. This endoscopic picture may easily be misinterpreted as antral hemorrhagic gastritis. The specific histologic features which establish the diagnosis on endoscopic biopsy are dilation and thrombosis of mucosal capillaries and fibromuscular hyperplasia of the lamina propria. Associated diseases, including achlorhydria, pernicious anemia and chronic liver disease have been reported. We recently encountered 2 cases of watermelon stomach associated with pernicious anemia and hypothyroidism. This entity should be considered in the differential diagnosis of iron-deficiency anemia.