Introduction:

Gastric vascular ectasia (GVE) is a rare cause of upper gastrointestinal bleeding, responsible for roughly 4% of cases. Most commonly it affects the gastric antrum (gastric antral vascular ectasia or GAVE). However, it can rarely involve the fundus—referred to as gastric fundal vascular ectasia (GFVE). GVE is more frequently diagnosed in elderly females and is associated with liver cirrhosis, autoimmune diseases, and other systemic conditions. Its presentation ranges from chronic iron-deficiency anaemia to acute GI haemorrhage, and diagnosis is primarily based on endoscopic findings.

Case Description:

A middle-aged male with a history of psoriatic arthritis and chronic iron-deficiency anaemia, was admitted with a 2-week history of melaena. Initial bloods revealed an acute drop in Hb to 77g/L, down from 84g/L, indicating ongoing blood loss. After initial resuscitation, including blood transfusion, an urgent OGD revealed multiple vascular ectasia in fundus, with active bleeding at three points, along with mild GAVE. Pulsed Argon Plasma Coagulation (APC) was successfully applied, achieving immediate haemostasis. Additionally, small Grade-2 non-bleeding oesophageal varices were noted. Follow-up imaging confirmed liver cirrhosis (Child-Pugh-A). Patient's haemoglobin stabilised post-endotherapy, and no further GI bleeding episodes occurred. Intravenous iron therapy was administered, and symptoms markedly improved.

Discussion:

While GAVE is typically found in the antrum, on the other hand GFVE is rare and often overlooked during endoscopy. Unlike traditional GAVE, which shows characteristic striped lesions (watermelon stomach), this patient’s presentation was diffuse and scattered.This case is significant due to the unusual occurrence of bleeding originating from the fundal region. Endoscopic findings of GFVE may mimic other vascular lesions such as portal hypertensive gastropathy. Although not indicated, but histologically, it is characterised by dilated mucosal vessels, spindle cell proliferation, and fibrohyalinosis. Elevated vasodilatory hormones and impaired liver function may play a role in pathogenesis. Endoscopic therapy, particularly APC, remains the first-line treatment and is effective in controlling bleeding and reducing transfusion requirements.

Conclusion:

GFVE although rare, should be considered in patients presenting with unexplained GI bleeding, especially those with liver disease or autoimmune conditions. Early endoscopic evaluation is crucial, as diagnosis may easily be missed due to its atypical location and overlapping features with other gastric pathologies. APC is an effective treatment modality, as demonstrated in this case.