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- W2912611922 abstract "Introduction Prolapse gastropathy is a rare clinical syndrome in which patients present with abdominal pain and/or hematemesis, often preceded by recurrent retching and vomiting. Endoscopically, it is characterized by a well-defined area of congested and erythematous gastric mucosa, often found near the gastroesophageal (GE) junction, either along the lesser and greater curvatures and surrounded by normal mucosa.1 We report 2 cases of prolapse gastropathy. Case #1 A 23 year-old man presented with hematemesis and abdominal pain, which was preceded by severe nausea and vomiting due to viral gastroenteritis. Physical exam was normal. Labs showed stable hemoglobin. Upper endoscopy was significant for a well-demarcated area of submucosal hemorrhage with scattered erosion (Figure 1). No tear was present at the GE junction. Biopsy showed oxyntic gastric mucosa with congestion at the lamina propria.Figure: Case 1 showing demarcated area of submucosal congestion and erythema with mild oozing of blood in the gastric body.Case #2 A 45 year-old man presented with coffee-ground emesis and abdominal pain, preceded by retching. History included end-stage renal disease on hemodialysis, diabetic gastroparesis, and daily marijuana use. Physical exam showed mild tachycardia and hypertension. Labs were significant for elevated BUN of 52 mg/dL and creatinine of 12.29 mg/dL. Upper endoscopy showed focal areas of hemorrhagic gastropathy at the greater curvature of the stomach without active bleeding (Figure 2). There was no evidence of alternative source of bleeding. Biopsy showed superficial hemorrhage and hemosiderin-laden macrophages.Figure: Retroflexed view of Case 2 showing demarcated areas of submucosal congestion and erythema in the gastric body.Discussion In 1984, Shepherd et al. reported 22 patients that presented with hematemesis or abdominal pain and were found to have similar endoscopic findings, thus creating a distinct clinical syndrome, “Prolapse Gastropathy Syndrome.”1 Precipitating factors include gastroenteritis, uremia, alcohol intoxication, and emesis of pregancy.2 Interestingly, the literature mentions a very unique endoscopic finding in several of these patients in which a portion of gastric mucosa will forcefully prolapse, in a retrograde manner, through the GE junction into the distal esophagus during witnessed episodes of retching.1,3,4 Usually there are no other abnormal endoscopic findings. As most cases of prolapse gastropathy are self-limited, there are no current indications for endoscopic intervention in management of these episodes. Addressing the precipitating factors that cause recurrent retching and vomiting may be the best course of action.1Figure" @default.
- W2912611922 created "2019-02-21" @default.
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- W2912611922 date "2017-10-01" @default.
- W2912611922 modified "2023-10-05" @default.
- W2912611922 title "Prolapse Gastropathy: An Atypical Presentation for Upper Gastrointestinal Bleeding" @default.
- W2912611922 doi "https://doi.org/10.14309/00000434-201710001-01958" @default.
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