Gastroptosis is an omission of the stomach, accompanied by its elongation and hypotension. In the early stages, it may not manifest in any way, and in the later stages, the patient begins to worry about pain after eating (especially in an upright position), during physical exertion and running. Gastroptosis is often accompanied by omission of other internal organs, then the corresponding symptoms are added. The main diagnostic method is gastrography with the introduction of a contrast agent, which allows to identify and determine the degree of gastric prolapse. In therapy, the main place is occupied by physical therapy and physiotherapy, medications are prescribed only as symptomatic treatment.
ICD 10
K31.8 Other specified diseases of the stomach and duodenum
Meaning
Gastroptosis is a congenital or acquired omission of the small curvature and pyloric part of the stomach, rarely of the entire organ. The disease is quite rare, affects mainly young women. Epidemiological data indicate that most of the cases are in the age group of 15-45 years, but gastroptosis can occur at an older age. High morbidity among women is associated with frequent dieting, excessive thinness, childbirth and concomitant stretching of the abdominal wall muscles and ligamentous apparatus. In men, gastroptosis is often associated with an incorrect distribution of loads, lifting weights with poor physical fitness. The disease can be corrected by conservative methods, therapeutic gymnastics and massage sessions.
Causes of gastroptosis
The causes of congenital pathology are the structural features of the body – asthenic body type, high growth, congenital weakness of the ligamentous apparatus. Often, the omission of the distal parts of the stomach is due to the elongation of the mesentery of the large intestine, combined with the ligamentous apparatus of the stomach. Because the mesentery is too long, the intestine goes down and pulls the stomach with it. Usually congenital gastroptosis is accompanied by a number of external features: tall, long limbs and fingers, narrow chest, weight deficit.
Acquired gastroptosis can occur for various reasons: with rapid and significant weight loss, removal of large abdominal tumors, elimination of long-existing ascites. Gastroptosis is often detected in women in the postpartum period – during pregnancy, the abdominal muscles and ligaments of internal organs stretch and can no longer hold the organs in their proper places. In severe diseases accompanied by cachexia, all internal organs, including the stomach, are lowered.
The condition of the diaphragm is of great importance for the development of gastroptosis. When the lungs are affected (large tumors, massive pleurisy), the diaphragm falls down, the pressure in the abdominal cavity increases. These factors affect the position of the stomach, provoking gastroptosis.
Gastroptosis symptoms
The clinical picture of gastroptosis depends on the degree of omission of the organ: at the 1st degree, the bottom of the stomach is two to three centimeters above the line connecting the upper points of the iliac bones; at the 2nd degree, the bottom of the stomach coincides with this line; at the 3rd degree, the stomach falls below the scallop line.
Most often, in the initial stages of gastroptosis, nothing bothers the patient. A bright clinic occurs with a significant omission of the stomach. The patient complains of abdominal pain that occurs after eating, during physical exertion, especially when running and jumping. Soreness is associated with stretching of the stomach, violation of the promotion of food masses in the gastrointestinal tract. The pain is dull, aching, can radiate to the heart area. A pathognomonic symptom is the disappearance of soreness in a horizontal position, when pulling the abdomen up.
The clinic of the disease is caused not only by gastroptosis, but also by concomitant damage to other organs. With a significant omission of the stomach, there is an inflection of the 12-duodenum, the promotion of food from the stomach into the intestine is difficult. In this regard, nausea, belching, constipation occur. Gastroptosis can be combined with the omission of other abdominal organs (enteroptosis, hepatoptosis), then the clinic joins the lesion of these organs.
Diagnostics
During the consultation of a gastroenterologist, gastroptosis is possible for a number of external signs. During the examination, attention is drawn to the lack of weight, flabbiness of the anterior abdominal wall, sagging of the abdomen. Patients with gastroptosis are usually asthenic, complain of fatigue and fatigue. Palpation of the abdomen can reveal the displacement of the boundaries of the stomach down, sometimes the bottom of the stomach is determined in the pelvis.
Esophagogastroduodenoscopy determines the expansion of the stomach cavity, a decrease in peristalsis. With gastroptosis, the stomach lengthens, occupies an upright position (normally this organ has the shape of a fish hook). An overview X-ray of the abdominal organs may not reveal gastroptosis, but an X-ray of the stomach with contrast makes it possible to establish an accurate diagnosis. During this examination, the expansion and elongation of the stomach, a change in its normal position, and a decrease in motor skills are recorded.
The contrast introduced is not delayed by the walls of the stomach, as if it falls into its lower part and accumulates there. Evacuation of stomach contents is significantly slowed down, motor skills are reduced. Electrogastrography (EGG) allows you to confirm hypotension of the stomach – in this case, a decrease in the electrical activity of the stomach is recorded. Ultrasound of the abdominal cavity is informative only in the presence of pathological changes on the part of other abdominal organs.
Gastroptosis treatment
Specialists in the field of clinical gastroenterology do not yet have effective surgical methods for treating the disease. This is due to the fact that the operation does not eliminate the cause of gastroptosis, and without following a special diet and moderate physical exertion, relapse almost always occurs. At the same time, proper nutrition, maintaining good physical shape and physical therapy allow you to restore the size, position and motility of the stomach without surgery.
It is necessary to eat with gastroptosis often, in small portions, excluding overstretching of the stomach. After eating, it is recommended to maintain a horizontal position for an hour and a half. The nutritionist should choose the optimal therapeutic nutrition for the patient. The purpose of diet therapy is to restore normal body weight, providing the body with a sufficient amount of nutrients, vitamins and trace elements. To prevent relapses of the disease, the patient needs to develop the right eating habits – it is necessary to follow them for the rest of his life.
For patients with gastroptosis, bed rest and insufficient activity are contraindicated, they provoke the progression of the disease. To improve the condition, physical therapy is recommended under the supervision of a competent methodologist. Exercises are done lying down, with raised legs – in this position, the stomach occupies a physiological position. Gymnastics should be aimed at strengthening the abdominal press and stabilizing muscles of the trunk. Under the guidance of a physical therapy doctor, the patient studies all the necessary exercises for their subsequent performance at home. Gymnastics needs to be given enough time every day, because only in this case the position of all internal organs will be restored. With gastroptosis, increased loads, lifting weights are prohibited.
Massage is also of great importance for recovery – at the beginning of treatment it should be performed by a specialist, as you recover, you can switch to self-massage. After completing the set of exercises, it is necessary to gently massage the abdomen in circular movements for several minutes. Patients with severe gastroptosis are recommended to wear a bandage – it is worn in a supine position, its upper edge should not be higher than the most prominent point of the abdomen.
Symptomatic treatment for gastroptosis is aimed at restoring the normal functioning of the digestive tract. With constipation, laxatives are prescribed, a large amount of fiber is included in the diet. Reduced appetite can be restored with the help of herbal medicine. Physiotherapy procedures, spa treatment (mineral baths, therapeutic showers, swimming) have a good effect.
Prognosis and prevention
The prognosis for gastroptosis is favorable. Prevention of the disease consists in early training of children to moderate physical activity: gymnastics, swimming, group sports. In preparation for pregnancy, it is necessary to include strengthening the abdominal muscles; and during pregnancy, wear a special bandage. It is necessary to exclude pronounced physical activity. If the patient’s work is associated with lifting weights, the issue of transferring to lighter work should be resolved.
