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Five risk factors identify patients with gastroesophageal intussusception
G F Gowen1, H S Stoldt, F E Rosato
1Department of Surgery, Pennsylvania Hospital, Thomas Jefferson University, Philadelphia, USA.
Insights
Gastroesophageal intussusception risk factors include eating disorders, alcohol abuse, exertion, bowel obstruction, peptic disease, and pregnancy. Identifying these helps predict severe vomiting and Mallory-Weiss tears.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Gastroesophageal intussusception is a rare condition often presenting with noncardiac chest pain.
- Identifying risk factors is crucial for early diagnosis and management.
Purpose of the Study:
- To identify and analyze risk factors associated with gastroesophageal intussusception.
- To understand the demographic and clinical characteristics of affected patients.
Main Methods:
- Prospective study of 43 patients with gastroesophageal intussusception.
- Diagnosis confirmed via upper gastrointestinal tract endoscopy with photographic documentation.
- Data collected on patient demographics, medical history, and precipitating factors.
Main Results:
- Gastroesophageal intussusception was diagnosed in 42 of 43 patients.
- Five key risk factors identified: eating disorders/alcohol abuse, sudden exertion, small-bowel obstruction, acid bile peptic disease, and pregnancy.
- Men (younger than 35) often presented with athletic exertion and binge behaviors; women (older than 35) with binge eating, peptic disease, and pregnancy complications.
Conclusions:
- Risk factors like severe vomiting, eating disorders, and pregnancy can predict gastroesophageal intussusception, a precursor to Mallory-Weiss tears.
- Upper GI endoscopy is the gold standard for diagnosis.
- Medical management is often sufficient, but surgery may be needed for obstruction or hemorrhage.
Hypothesis:
Risk factors in patients with gastroesophageal intussusception who have noncardiac chest pain need to be identified and analyzed.
Design:
Prospective consecutive series of 43 patients with gastroesophageal intussusception.
Setting:
Outpatient gastrointestinal endoscopy suite for 42 patients; 1 patient sustained gastroesophageal intussusception during labor and delivery and underwent an emergency laparotomy.
Intervention:
Upper gastrointestinal tract endoscopy under intravenous sedation with appropriate monitoring of vital signs and photographic documentation in most patients.
Results:
Gastroesophageal intussusception was documented endoscopically in 42 of 43 patients and was found to occur equally in men and women. Five risk factors have been identified: eating disorders or alcohol abuse, sudden sustained exertion, small-bowel obstruction, acid bile peptic disease, and pregnancy. Fifteen (70%) of 22 men were younger than 35 years; precipitating factors included sustained athletic effort and binge eating and drinking episodes. Fifteen (70%) of the 21 women were older than 35 years and had binge eating, peptic disease, and complications of pregnancy as risk factors.
Conclusions:
Five risk factors identify patients with severe vomiting or retching who are most likely to develop gastroesophageal intussusception, the precursor of a Mallory-Weiss tear. Upper gastrointestinal tract endoscopy with photographic documentation is the most accurate method of diagnosis. For most patients, medical management can reverse the cause of the vomiting. If vomiting is caused by mechanical obstruction or massive hemorrhage, surgical intervention may be necessary.
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