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George F. Gowen, MD; H. Stefan Stoldt, MD; Francis E. Rosato, MD

Arch Surg. 1999;134:1394-1397.

Hypothesis  Risk factors in patients with gastroesophageal intussusception who have noncardiac chest pain need to be identified and analyzed.

Design  Prospective consecutive series of 43 patients with gastroesophageal intussusception.

Setting  Outpatient gastrointestinal endoscopy suite for 42 patients; 1 patient sustained gastroesophageal intussusception during labor and delivery and underwent an emergency laparotomy.

Intervention  Upper gastrointestinal tract endoscopy under intravenous sedation with appropriate monitoring of vital signs and photographic documentation in most patients.

Results  Gastroesophageal intussusception was documented endoscopically in 42 of 43 patients and was found to occur equally in men and women. Five risk factors have been identified: eating disorders or alcohol abuse, sudden sustained exertion, small-bowel obstruction, acid bile peptic disease, and pregnancy. Fifteen (70%) of 22 men were younger than 35 years; precipitating factors included sustained athletic effort and binge eating and drinking episodes. Fifteen (70%) of the 21 women were older than 35 years and had binge eating, peptic disease, and complications of pregnancy as risk factors.

Conclusions  Five risk factors identify patients with severe vomiting or retching who are most likely to develop gastroesophageal intussusception, the precursor of a Mallory-Weiss tear. Upper gastrointestinal tract endoscopy with photographic documentation is the most accurate method of diagnosis. For most patients, medical management can reverse the cause of the vomiting. If vomiting is caused by mechanical obstruction or massive hemorrhage, surgical intervention may be necessary.

From the Department of Surgery, Pennsylvania Hospital, Thomas Jefferson University, Philadelphia.

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