VI. Gastric Prolapse

VI. Gastric Prolapse

This condition is not uncommon; clinically, it is often misdiagnosed. It occurs when the gastric mucosa in the pyloric region separates from the muscular layer and protrudes into the duodenum. X-ray imaging reveals a central filling defect in the duodenum as the primary diagnostic finding. The muscular layer of the pyloric region is abnormally thickened, forming a rigid pyloric sphincter that controls the flow of gastric contents into the duodenum. Because the tension and relaxation of the sphincter change too frequently, the attached gastric mucosa is prone to separation. The detached mucosa bulges outward and, with gastric peristalsis, enters the duodenal lumen; in severe cases, it can even extend all the way to the antrum. These changes lead to three main outcomes: ① obstruction, ② bleeding, and ③ mucosal congestion, edema, erosion, and ulcers. The primary symptom in patients is pain in the epigastric region, which typically begins 0.5 hours after meals. The pain is often more severe than in chronic gastritis or ulcer disease, and is frequently accompanied by nausea and vomiting. Some patients experience significant abdominal distension due to pyloric obstruction, making it difficult to swallow food and liquids. Bleeding is often minor, with occult blood in stool and black stools being more common; massive hematemesis is rare. Western medicine once recommended surgery for this condition, but in recent years scholars have raised objections. Today, it is generally believed that, except for cases of severe prolapse leading to obvious pyloric obstruction, routine treatment is best managed conservatively by internal medicine. Based on my experience, I often use the following formula with modifications: 10g Wuyao, 3g Shen Xiang, 10g Bin Lang, 6g Gan Cao, 6g Chuan Xiong, 10g Shan Zhi, 6g Cang Zhu, 10g Shen Qu, 10g Ma Huang, 6g Chen Pi, 6g Jiang Chong, 6g Gan Jiang, 6g Bai Zhi, 3g Xi Xin, 20g Jie Bing, 10g Dang Shen, 6g Mu Xiang, 6g Cao Kou, 6g Da Huang, 10g Zhi Ru, 6g Hou Pu—decocted and taken once daily. This formula addresses pyloric obstruction; when taking the medication, it is advisable to divide the dose into smaller portions and mix the first two decoctions together, then take them over five doses throughout the day, each dose around 100ml.