by Subhash Garikipati, MD and Klaus Klaus Mönkemüller, MD, PhD, FASGE, FJGES
Department of Gastroenterology, Carilion Memorial Hospital, Virginia Tech Carilion School of Medicine, Roanoke, USA
A 35-year-old man presented with nausea and vomiting followed by hematemesis. During EGD prolapse gastropathy was diagnosed (Figure 1).
Figure 1. Prolapse gastropathy. Upper panels show the patchy area of prolapsed stomach fundus mucosa with erythema, edema and congestion (yellow circle, arrow shows scope). The proposed mechanism of formation of prolapse gastropathy is shown in the lower graphics (C, D) (graphics source: Byfield F et al. GIE 1998).
Prolapse or emesis gastropathy is an underrecognized cause of hematemesis (1, 2). This condition was initially described in the late 70s (1). Retching and vomiting results in prolapse of the lesser curvature of the stomach fundus into the esophagus (1-3). Temporary “prolapse with strangulation” results in submucosal edema, congestion and hemorrhages. Some experts also call this condition “mechanical gastritis of the cardia (3). We believe that prolapse gastropathy is a precursor of Mallory-Weiss tears and even Boerhaave’s syndrome. Therapy is aimed at relieving the underlying causes of nausea and vomiting.
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References:
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Retrograde gastric mucosal prolapse as a cause of haematemesis. Young GP, Thomas RJ, Wall AJ. Med J Aust. 1976;2:488–489.
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Hematemesis due to prolapse gastropathy: an emetogenic injury. Byfield F, Ligresti R, Green PHR, Finegold J, Garcia-Carrasquillo RJ. Gastrointest Endosc. 1998;45:527–529.
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Mechanical gastritis involving the cardia: the trauma of retching and vomiting. Chen YL. J Clin Gastroenterol. 1990;12:63–66.
