Gastric Antral Vascular Ectasia (GAVE), or "Watermelon Stomach," Is Associated With Chronic Occult Gastrointestinal Blood Loss, Leading to Iron-Deficiency Anaemia and an Increased Risk of Falls Due to Fatigue and Reduced Physiological Reserve.

Gastric antral vascular ectasia (GAVE) is an under-recognised cause of chronic gastrointestinal blood loss and iron-deficiency anaemia, caused by dilated antral vessels that cause chronic gastrointestinal bleeding, gradually depleting iron stores and leading to reduced haemoglobin levels. Its presentation is often subtle and may occur without overt gastrointestinal bleeding. We report an 82-year-old patient admitted following an unwitnessed fall, associated with postural hypotension and normocytic anaemia (Hb 90 g/L). Oesophagogastroduodenoscopy (OGD) demonstrated linear GAVE in the gastric antrum without active bleeding. The patient also sustained a fragility pelvic fracture. Intravenous iron therapy was administered to correct severe iron deficiency, resulting in improved haemoglobin levels and resolution of underlying clinical symptoms. This case highlights an important and often under-recognised presentation of GAVE, in which anaemia manifests predominantly through falls or orthostatic features rather than gastrointestinal symptoms. Early recognition of this pattern is crucial, as targeted treatment may reduce the risk of recurrent falls, fractures, and subsequent functional decline in older adults.