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Clinical characteristics and early recognition of gastroptosis: a propensity score-matching analysis
Jiyuan Zhang1, Hang Yin1, Tianyu Liu1
1Department of General Surgery, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Background:
While some surgeons have reported that gastroptosis is associated with relaxation of abdominal wall muscles and ligaments, the influencing factors related to gastroptosis still remain incompletely understood.
Aim:
To analyze the clinical characteristics of gastroptosis and identify independent associated factors for early recognition.
Methods:
A total of 188 patients with confirmed gastroptosis and 376 non-gastroptosis controls were initially enrolled. The degree of gastroptosis, gastric motility parameters, and the aortomesenteric angle were evaluated via oral gastric contrast-enhanced ultrasound (OGUS) in a specific fasted, sitting position. After balancing confounding factors using 1:1 propensity score matching (PSM), inter-group clinical variables were investigated via univariate analysis; logistic regression was then utilized to identify predictors of gastroptosis. Finally, a receiver operating characteristic (ROC) curve was constructed to determine the optimal predictors of gastroptosis.
Results:
Univariate analysis showed significant differences between the two groups in body mass index (BMI), gastric motility index (GMI), aortomesenteric angle, duodenal reflux, and bloating. Additionally, GMI and aortomesenteric angle significantly varied across different gastroptosis grades. Logistic regression identified lower BMI, lower GMI, and a smaller aortomesenteric angle as independent predictors for gastroptosis. The combined diagnostic model of these three factors demonstrated a strong predictive value, with an area under curve (AUC) of 0.909, yielding a sensitivity of 84% and a specificity of 80%.
Conclusion:
Lower BMI, reduced GMI, and a smaller aortomesenteric angle serve as primary independent predictors for gastroptosis, whereas bloating, positive duodenal reflux as secondary clinical indicators. Recognizing these primary and secondary features allows practitioners to stratify high-probability patients early, significantly reducing misdiagnosis, enabling timely, targeted management to prevent severe gastroptosis and ultimately optimizing patient clinical outcomes.