Purpose of Review <p>This review examines the pathopythiology, diagnostic features, and management of gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG).</p> Recent Findings <p>GAVE and PHG are distinct lesions that often present with evidence of chronic occult bleeding, often manifesting as IDA. GAVE is typically idiopathic, with a distinctive “watermelon stomach” appearance, although alternative morphologies exist. PHG is closely linked to portal hypertension, and features a mosaic/ snakeskin-like mucosal pattern. Histological assessment helps differentiate GAVE and PHG when endoscopic features overlap, especially in cirrhosis. Management differs significantly; PHG treatment focuses on reducing portal pressure (beta-blockade, TIPS or occasionally liver transplantation). Endoscopic management of PHG remain limited due to the diffuse nature of bleeding (e.g. argon plasma coagulation (APC) and hemospray). For GAVE, endoscopic ablative therapies including APC or banding are typically effective, and radiofrequency ablation (RFA) appears to be effective for refractory GAVE.</p> Summary <p>Differentiating GAVE and PHG is crucial due to their distinct management approaches.</p>