What are the symptoms or manifestations of gastric mucosal prolapse?

Gastric mucosal prolapse refers to the prolapse of the gastric wall mucosa through the pylorus to the bulb of the duodenum. The disease is mainly associated with inflammation of the gastric antrum; it is common in male patients aged 31-60 years.

The symptoms of gastric mucosal prolapse can be mild or severe, and most people with gastric mucosal prolapse can be reset. This feature is called "reversibility". If gastric mucosal prolapse can be reset within a short period of time, the patient will have no symptoms, or only mild abdominal distension, heating, etc.; if it cannot be reset immediately, upper abdominal pain and burning sensation may occur. Severe gastric mucosal prolapse may even cause incarceration, that is, pyloric muscle contraction, the prolapsed mucosa cannot go up or down, and pyloric obstruction occurs.

The clinical manifestations of gastric mucosal prolapse depend on the amount and degree of prolapsed mucosa. About 1/3 of the patients do not have any symptoms, and only the patients with frequent prolapse or severe prolapse will appear the following post-symptomatic signs.

(1) Abdominal pain or substernal pain: The abdominal pain caused by this disease is neither regular nor fixed. Pain can be in the epigastrium or upper right side of the abdomen, or in the lower sternum. Upper abdominal pain generally occurs 0.5-1 hour after meals. The nature of abdominal pain is various, including dull pain, distending pain, burning pain or strangulation pain, and radiates to the back. There are also some patients who have severe abdominal pain at night, which makes them sleepless all night.

(2) Nausea and vomiting: This is a common symptom of gastric mucosal prolapse. Most of the vomit is food. Some patients will feel more comfortable after vomiting, and the pain will be relieved accordingly.

(3) Indigestion: Patients with severe prolapse often have symptoms of indigestion such as upper abdominal fullness, discomfort, heating and loss of appetite, which are caused by food retention in the pylorus. Patients with a long course of disease often suffer from malnutrition, anemia, and even weight loss.

(4) Upper gastrointestinal bleeding: This may be related to erosion or ulceration of the prolapsed mucosa. According to reports, about 20% of patients with gastric mucosal prolapse have upper gastrointestinal bleeding. Patients often experience nausea, vomiting, and abdominal pain before bleeding. If the amount of bleeding is not large, although the sick stool is still yellow, the occult blood test of the stool is often positive; if the amount of bleeding is large and fast, hematemesis and melena may occur.

(5) Pyloric obstruction: only a small number of patients with gastric mucosal prolapse have this symptom. Before the attack, patients often have fullness, upper abdominal pain, accompanied by repeated nausea and vomiting. When the patient turns or turns over, he or she will feel the sound of "gudong, gurgling" in the stomach. This is because the pyloric opening is blocked by the prolapsed gastric mucosa, and the stomach has gastric juice and food.

(6) Signs: Patients with gastric mucosal prolapse generally have no specific signs. Only in severe prolapse patients, sometimes a soft mass can be seen in the pylorus. In addition, some patients will aggravate abdominal pain when lying on the right side, while the pain can be relieved or disappeared when lying on the left side. Gastric mucosal prolapse can be diagnosed by X-ray film, and gastroscopy is of little significance. The disease is mainly treated with internal medicine, using cholinergic receptor blockers such as sedatives, atropine and 654-2. The patient should eat less and more meals, and the left side lying position can relieve symptoms.

However, once pyloric obstruction and massive bleeding occur, surgical treatment should be considered.