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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3181fa0717
Image of the Month

Prolapse Gastropathy

Alkhouri, Razan H MBBS; Desai, Sonal MD; Gelfond, Daniel MD; Baker, Susan MD, PhD

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Digestive Disease and Nutrition Center, SUNY-Buffalo, Women and Children's Hospital of Buffalo, Buffalo, NY, USA.

Address correspondence and reprint requests to Dr Razan H. Alkhouri, Digestive Disease and Nutrition Center, Women and Children's Hospital of Buffalo, SUNY-Buffalo, 239 Bryant St, Buffalo, NY 14222 (e-mail: ralkhouri@upa.chob.edu).

The authors report no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

A 9-year-old boy had a medical history of gastroesophageal reflux disease, status postgastrostomy tube placement, and Nissen fundoplication. He presented with vomiting soon after starting zonisamide for a seizure disorder. Upper gastrointestinal tract radiography was performed. During the study, he had an episode of forceful emesis. A filling defect was seen (Fig. 1), but was not found on subsequent images (Fig. 2). This finding is consistent with gastric prolapse. After stopping zonisamide, the patient had no further episodes of emesis.

Figure 1
Figure 1
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Figure 2
Figure 2
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Prolapse gastropathy is thought to occur after retching and forceful emesis. The gastric mucosa prolapses into the lower esophageal sphincter. Direct trauma to the mucosa occurs when the gastric mucosa becomes incarcerated through the lower esophageal sphincter (1). This may cause submucosal hemorrhage and superficial ulceration (2). Biopsy of the affected mucosa often shows mucosal inflammation (3). The most common area involved is the stomach fundus to the left of the esophageal lumen. Treatment was achieved by controlling the primary cause of vomiting in our patient.

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REFERENCES

1. Pohl JF, Melin-Aldana H, Rudolph C. Prolapse gastropathy in the pediatric patients. J Pediatr Gastroenterol Nutr 2000;30:458–60.

2. Bishop PR, Nowicki MJ, Parker PH. Vomiting-induced hematemesis in children: Mallory-Weiss tear or prolapse gastropathy? J Pediatr Gastroenterol Nutr 2000;30:436–41.

3. Thomas E, Khatak KG. Hemorrhage due to retrograde prolapse of stomach. Am J Gastroenterology 1979; 71:477–480.

Copyright 2011 by ESPGHAN and NASPGHAN

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