Prolapse of Gastric Mucosa: Summary of 150 Cases

Abstract

Prolapse of gastric mucosa through the pylorus is clinically indistinguishable from many other upper abdominal disorders. Because of almost identical symptomatology, prolapse may be confused with other lesions of the upper gastrointestinal and biliary tracts. In our series of 2404 consecutive barium meal examinations, 150 patients with prolapsing gastric mucosa were found, an incidence of 6.2%. This condition is present more frequently than benign gastric ulcer (2.3%) and is exceeded only by duodenal ulcer (10.2%). With the development of adequate techniques and the establishment of diagnostic roentgen criteria, an increasingly higher incidence of gastric mucosal prolapse has been reported. The reported frequency during the years 194Q-1949 ranges from 1.04 to 7.7% of all opaque meal studies of the upper gastrointestinal tract (Table 1). Age distribution. The patient ages in our series ranged from 18 to 81 years but the greatest number (47 cases, 31.3%) occurred in the fifth decade (Table 2). Etiology and pathogenesis. Although a variety of theories48• 10 • 11 • 14 • 16 • 20 concerning the etiology and pathogenesis of mucosal prolapse have been offered, it is generally agreed that Golden's11 concept of failure of the stretching provides the best explanation for hypermobility and prolapse of gastric mucosa into the duodenum. According to Golden, antral systole is associated with contraction of the longitudinal muscle toward the pylorus. Schindler has observed shortening of the antrum during systole through the gastroscope. The mucosal folds must therefore move cephalad if they are not to be forced or pushed down toward the pylorus. Failure of this mechanism probably results in a caudad movement of the mucosal folds and jamming toward the pylorus. Several other etiologic theories have been suggested since the publication of Golden's observations in 1937. The stomach wall may reflect systemic changes in fluid or protein balance as well as purely local inflammatory or other alteration. This is manifest in a variety of disease processes which predispose