Mucosal Healing of Gastric Antral Vascular Ectasia (Watermelon Stomach) After Treatment With Azathioprine

Gastric antral vascular ectasia (GAVE), commonly known as "watermelon stomach," is characterized by parallel red stripes resembling watermelon stripes on endoscopic examination and is an uncommon but significant cause of chronic gastrointestinal bleeding, often associated with systemic diseases such as autoimmune conditions, liver cirrhosis, chronic renal insufficiency, and cardiovascular disease. Various therapeutic approaches have been introduced for GAVE treatment, including medical, endoscopic, and surgical interventions. We report a case of a 60-year-old man with a prior history of GAVE who developed melena and symptomatic severe anemia. Initial esophagogastroduodenoscopy (EGD) demonstrated oozing antral GAVE. The patient required weekly blood transfusions. In this article, we explored the safety and efficacy of azathioprine treatment for GAVE. We administered 100 mg (oral) of azathioprine once daily and evaluated the patient monthly for four months. After two months, the endoscopy examination results showed visible macroscopic improvement, and after four months, the lesions were healed. The healing process was complete with normal mucosa restored. After two months, there wasn't any need for blood transfusions or iron therapy. We present for the first time the endoscopic healing process of GAVE under azathioprine treatment confirming that the cause of GAVE is autoimmune. Further research is needed to optimize therapeutic strategies and improve patient outcomes.