Is prolapse gastropathy a cause of upper gastrointestinal bleeding?

Prolapse gastropathy is a clinical syndrome involving the invagination of a part of the gastric mucosa into the lower esophagus resulting in well demarcated hemorrhagic mucosa and sometimes bleeding. The importance of this syndrome is that it has been reported as a cause of hematemesis. As this syndrome is considered to be seen in patients with retching and vomiting and to be one of the causes of upper gastrointestinal bleeding, this study was undertaken to evaluate its frequency and importance in our patients.

The study groups comprised of 941 patients with hematemesis and 54 with recurrent retching and vomiting. Biopsies were obtained from the prolapsing mucosa when detected. Hematoxylin and eosin stained specimens were reviewed by an experienced histopathologist.

Prolapse gastropathy was detected in 20 patients (2%), of whom six (0.6%) were in the hematemesis group and 14 (25.9%) in the retching and vomiting group. The location of the lesion was the greater curvature in 10 patients (50%), lesser curvature in seven patients (35%) and anterior wall in three patients (15%). In all six cases from the hematemesis group, bleeding was not related to prolapse gastropathy because other causative lesions were identified. Histologic evaluation of the biopsies revealed acute inflammation, chronic inflammation and submucosal hemorrhage.

According to the results of this study, prolapse gastropathy is not a cause of hematemesis. Other causes should be identified when prolapse gastropathy is detected in a patient with hematemesis.