Gastric mucosal prolapse
Introduction
Introduction to gastric mucosal prolapse Prolapseofgastricmucosa is due to the abnormally loose gastric mucosa retrograde into the esophagus or forward into the duodenal ampulla through the pyloric tube, which is more common in the clinic. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: gastritis, peptic ulcer, upper gastrointestinal bleeding
Cause
Causes of gastric mucosal prolapse
(1) Causes of the disease
When there is inflammation in the antrum of the stomach, the connective tissue under the mucosa becomes slack, the gastric mucosa and submucosa edema, hyperplasia, hypertrophy, hyperplasia, long-lasting mucosal folds, and gastric peristalsis is enhanced, the mucosal folds are easily sent to the pylorus The formation of gastric mucosal prolapse; in addition, the mucosal muscularis dysfunction, in the antrum of the gastric antrum can not maintain the normal crease of the antral mucosa, instead of rolling up a ring, the result of the contracted gastric antrum pushed into the pyloric to form the gastric mucosa Prolapse; when malignant lesions infiltrate the mucosa, it can cause mucosal hyperplasia, lengthy, normal gastric mucosal activity loss, hypertrophic mucosa as a foreign body, enhanced gastric peristalsis to extrude the pyloric tube, leading to gastric mucosal prolapse; When the anatomic abnormality, there is a layer of mucosal septum in the antrum of the stomach, which prevents the retrograde peristalsis of the mucous membrane, which is easy to cause the disease. In addition, mental stress, alcohol and tobacco, coffee stimulation, chemical factors and mechanical stimulation can cause the stomach. Severe peristalsis can also cause gastric mucosal prolapse.
(two) pathogenesis
Under normal circumstances, the mucous membrane at the pylorus of the stomach is thicker, and the mucosa and the submucosa jointly form wrinkles, and the arrangement is irregular. The mucosa on the inner surface of the pyloric sphincter forms a fold, called the pyloric valve. Its physiological function is: when the pyloric sphincter contracts, it will The pylorus is closed to prevent the contents of the stomach from entering the duodenum. Therefore, when the stomach squirmes, there is a tendency to push the mucosa at the pylorus out of the pylorus and into the duodenum, but due to the action of the mucosa, the antral mucosa It can change the size, shape, position and direction of its wrinkles without being controlled by the contraction of the gastric muscle layer. Before the antrum is contracted, the mucosal folds are arranged in a longitudinal direction parallel to the longitudinal axis of the stomach, due to the gastric mucosal muscle. Contraction, where there is a tendency to wrinkle away from the pylorus, thus ensuring that the gastric antrum does not cause the mucosa to be pushed into the duodenum.
Prevention
Gastric mucosal prolapse prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Gastric mucosal prolapse complications Complications gastritis peptic ulcer upper gastrointestinal bleeding
1. Concomitant gastritis
In patients with gastric mucosal prolapse, more than half of patients have chronic gastritis at the same time. Therefore, chronic gastritis should be treated first to reduce the factors leading to gastric mucosal prolapse. Therefore, various possible pathogenic factors should be removed: such as thorough treatment. Acute gastritis and chronic infection of the pharynx, avoid taking food and drugs that are irritating to the stomach; for those with dyspepsia, generally use the principle of treatment of peptic ulcer, such as various antacids, gastric mucosal protection Agents; complete eradication of Hp, because Hp infection is currently considered to be closely related to chronic gastritis, so active treatment; for patients with bile reflux gastritis, can be treated with metoclopramide and cholestyrate, methoxychlor Amine (gastric ampoules) promotes the peristalsis of the stomach and duodenum, accelerates the emptying of the stomach, and reduces the effect of bile reflux; biliary acid can be combined with bile salts in the stomach to accelerate the elimination of bile salts.
2. Complicated peptic ulcer
Among patients with gastric mucosal prolapse, some patients have peptic ulcers, so they should treat peptic ulcers and reduce their pathogenic factors. First, drugs that reduce the damage factors: antacids, anticholinergic drugs, H2 receptor antagonist, proglumide, prostaglandin E2 synthesis agent and omeprazole, etc., and drugs for gastric mucosal protection: such as sucralfate, expectorant, carbenoxolone, and antibiotics Applications.
3. concurrent upper gastrointestinal bleeding
In patients with gastric mucosal prolapse, some patients may have upper gastrointestinal bleeding at the same time, so they should be actively treated. When the patient has upper gastrointestinal bleeding, the patient should rest in bed, and closely observe the patient's blood pressure, pulse and blood volume. Changes, keep the airway unobstructed, at the same time, when the patient's hemoglobin is less than 90g / L, or systolic blood pressure is less than 12kPa (90mmHg), you should enter a sufficient amount of whole blood, and at the same time, if the patient's bleeding is still not controlled, then oral coagulation Enzyme, batroxobin (stand-stopping blood) or ice-salt aqueous solution containing norepinephrine, if the above method and conservative treatment of medical drugs still can not control bleeding, then high-frequency laser can stop bleeding under endoscopic direct vision, as above If the methods are ineffective, surgical treatment is feasible.
Symptom
Symptoms of gastric mucosal prolapse Common symptoms Upper gastrointestinal bleeding Abdominal pain Loss of appetite Severe pain Painful weight loss Hemorrhagic shock Nausea Alcoholic gastric mucosal injury
Abdominal pain
Abdominal pain is the most common manifestation, no obvious periodicity and rhythm, pain can be induced after eating, often with paroxysmal pain, but also burning pain, irregular pain or tingling, etc., generally no radiation pain Often accompanied by symptoms of upper abdominal fullness discomfort, belching, loss of appetite, and sometimes pain is often associated with body position, pain is easy to occur in the right lateral position, when the left lateral position, the pain occurs less or not, Some people think that this point is a characteristic manifestation of this disease. The treatment of acid-suppressing drugs is generally ineffective, and the treatment of alkaline drugs is not easy to relieve. Sometimes, when the prolapsed mucosa blocks the pyloric tube and incarceration or stenosis occurs, the upper abdomen continues. Severe pain, accompanied by nausea, vomiting and other symptoms.
2. Upper gastrointestinal bleeding
It is more common in gastric mucosal prolapse, most of which is a small amount of bleeding, a few can cause major bleeding, and even hemorrhagic shock. Feldman reported 270 cases of gastric mucosal prolapse, 22% of which occurred bleeding, of which 9.4% of major bleeding Bleeding can be caused by erosion or ulceration of the prolapsed mucosal surface, or by incarceration of the prolapsed mucosa. At the same time, it is often accompanied by gastric and duodenal ampullary ulcers. Therefore, the cause of bleeding is sometimes difficult to distinguish, so it is necessary to be serious. Ask about the medical history, careful physical examination, and diagnosis depends on endoscopy.
3. Pyloric obstruction
The incidence is very low, most patients have nausea at the onset, vomiting, vomiting can occur after eating, often severe pain in the upper abdomen, pain can be reduced or disappeared after vomiting.
4. Signs
The patient has weight loss, mild anemia, mild tenderness in the upper abdomen, no rebound pain. For example, when the mucous membrane is invaded into the pyloric canal, gastric or gastric peristaltic waves can be seen, and the soft mass can be touched on the upper abdomen. The abdomen can have a water sound.
Examine
Gastric mucosal prolapse examination
The fecal occult blood test can be positive; the gastric juice analysis is normal, and if high acid is present, there is a possibility of a duodenal ampulla ulcer.
Endoscopy
Its value is limited, it can only be used as a means. When examined, it can be seen that the gastric antrum mucosa is normal or punctiform congestion, edema, sometimes spotted hemorrhage, erosion or superficial ulcer. When the gastric antrum contracts, the mucosal folds are very obvious. It can form a chrysanthemum shape and cover the pylorus. When the antrum is relaxed, it can be seen that the wrinkles that have entered the duodenum have returned to the stomach cavity through the pyloric tube.
2. X-ray barium meal inspection
X-ray barium meal examination is an important basis for diagnosing gastric mucosal prolapse, but X-ray findings are diverse and often transient. In the right anterior reclining examination, the positive rate is high. At the same time, X-ray performance depends on prolapse. The degree, degree and weight of the mucosa, when a small amount of prolapse, only the pyloric tube has a strip of mucous membrane folds, the distal end slightly across the pyloric ring into the bottom of the ball, generally easy to appear under strong peristalsis, the typical X-ray performance is: The duodenal ampulla has a concave filling defect on the base of the abdomen. It is cauliflower-like, scorpion-like or umbrella-shaped, and the gastric mucosa that prolapses to the abdomen of the duodenum can form a small circle or Semi-circular translucent area, pyloric tube is often wider than normal, can see normal or more fat gastric mucosal folds through the pylorus to the duodenal ampulla, gastric motility is more enhanced, sometimes into the duodenum The light-transmissive area is on one side. As the stomach moves, the contraction and the method of examination are pushed, the prolapsed mucosal folds can be used for a long time, or sometimes it is not. Therefore, the above performance can be light and heavy, or hidden. Now.
Diagnosis
Diagnosis and differentiation of gastric mucosal prolapse
The disease lacks characteristic symptoms and signs in the clinic, and its diagnosis mainly depends on auxiliary examination.
Differential diagnosis
The disease has no characteristic clinical manifestations and therefore needs to be differentiated from the following diseases:
Gastric polyp
Duodenal ampullary polyps: When the stomach polyps are removed into the duodenal ampulla, the X-ray appears as one or several round or oval filling defects, gastric polyps, duodenal ampullary polyps The filling defect position is not fixed, the shape of the shadow is the same, the prolapsed gastric mucosa can not be seen, and when the filling defect of the ball disappears, X-ray signs of gastric polyps can appear in the stomach, endoscopy A diagnosis can be established.
2. Peptic ulcer
Clinically, the pain is periodic, rhythmic, and pain is not related to body position. X-ray examination can detect sputum, and endoscopy can help establish a diagnosis.
3. pyloric sphincter hypertrophy
The X-ray showed a clear impression on the base of the ball, but the edge of the impression was neat, the pyloric tube became narrow and prolonged, and the prolapsed mucosal pattern was not seen in the ball.
4. pyloric area cancer
If it invades the base of the duodenum, the X-ray findings may have a filling defect in the base of the ball, but the filling defect persists, the edge is not complete, the mucosal pattern disappears, and endoscopy can help confirm the diagnosis.
In addition, it should be differentiated from chronic gastritis and functional dyspepsia, and endoscopy can help differential diagnosis.
