The stomach’s inner lining features a series of folds known as gastric rugae. The primary purpose of these folds is to allow the stomach to expand after a meal, increasing its volume to accommodate food and liquid. In a condition called rugae prolapse, these gastric folds slip out of position, or herniate. This displacement involves the rugae moving from the stomach into the first part of the small intestine, the duodenum, or less commonly, into the esophagus.
Causes and Symptoms of Rugae Prolapse
The exact cause of rugae prolapse is often unknown, or idiopathic. A leading theory suggests the condition develops from activities that repeatedly increase abdominal pressure, such as chronic vomiting, retching, or severe coughing. These actions can weaken the tissues holding the gastric folds, allowing them to prolapse. Underlying conditions like hiatal hernias or gastritis may also be associated with its development.
Individuals with this condition may experience a range of intermittent symptoms. A common complaint is upper abdominal pain, often described as a cramping or gnawing sensation. Other symptoms include feeling full after eating a small amount, bloating, and nausea. These discomforts are thought to arise from the mechanical interference caused by the displaced tissue.
Rugae prolapse can sometimes lead to gastrointestinal bleeding if the displaced tissue becomes irritated, inflamed, or develops shallow sores called erosions. Signs of bleeding include vomiting blood (hematemesis) or passing black, tarry stools (melena). Black stools occur because blood is digested as it moves through the gastrointestinal tract, and any sign of bleeding requires prompt medical evaluation.
The Diagnosis Process
Diagnosing rugae prolapse requires a direct view of the upper gastrointestinal tract. The most definitive tool is an upper endoscopy, or esophagogastroduodenoscopy (EGD). During this procedure, a physician guides a thin, flexible tube with a camera through the mouth into the esophagus, stomach, and duodenum. This allows for direct visualization of the stomach’s lining to confirm if the gastric folds have slipped out of place.
During the endoscopy, the dynamic nature of the prolapse can be observed as the tissue may move in and out of place. Another diagnostic method is an upper gastrointestinal (GI) series, or barium swallow. For this test, the patient drinks a barium liquid that coats the digestive tract, allowing a series of X-rays to outline the stomach and duodenum. This can reveal the characteristic mushroom shape of the prolapsed rugae.
An upper GI series can be a valuable complementary test to endoscopy, as it offers a different perspective on the structure and movement of the stomach lining. A radiologist interprets these images to identify the prolapse and rule out other conditions.
Medical Interventions
Treatment for rugae prolapse is tailored to the severity of symptoms and any complications. For mild or infrequent symptoms, a conservative approach is used first, focusing on symptom management. This involves medications designed to reduce stomach acid and alleviate discomfort. Common options include over-the-counter antacids, H2 blockers, or proton pump inhibitors (PPIs), which decrease acid production in the stomach.
When symptoms are severe, persistent, or complicated by chronic bleeding or obstruction, surgical intervention may be considered. Surgery is reserved for cases that do not respond to conservative management. The goal of a surgical procedure is to correct the anatomical displacement of the gastric folds. A common technique is gastropexy, where the stomach lining is sutured into its proper position to prevent it from prolapsing again.
In rare cases with significant tissue damage from chronic inflammation or bleeding, a partial gastrectomy may be performed. This procedure involves removing the affected portion of the stomach. The decision to pursue surgery is based on the severity of symptoms and the failure of less invasive treatments.