Archives of Medicine and Health Sciences

TEACHING IMAGES
Year
: 2016  |  Volume : 4  |  Issue : 1  |  Page : 153--154

Glenard's disease


Arulprakash Sarangapani, Sahil Rasane, Vikas D Kohli, George M Chandy 
 MIOT Advanced Center for Gastrointestinal and Liver Diseases, MIOT Hospitals, Chennai, Tamil Nadu, India

Correspondence Address:
Arulprakash Sarangapani
Plot No: 119 A, First Main Road, Second Cross Street, Lakshmi Nagar Extension, Porur, Chennai - 600 116, Tamil Nadu
India

Abstract

Through this teaching image of gastroptosis in a 21 year old girl, we reiterate that Glenard's disease should be revisited since there are only very few reports in the existing literature.



How to cite this article:
Sarangapani A, Rasane S, Kohli VD, Chandy GM. Glenard's disease.Arch Med Health Sci 2016;4:153-154


How to cite this URL:
Sarangapani A, Rasane S, Kohli VD, Chandy GM. Glenard's disease. Arch Med Health Sci [serial online] 2016 [cited 2019 Jul 20 ];4:153-154
Available from: http://www.amhsjournal.org/text.asp?2016/4/1/153/183372


Full Text

A 21-year-old girl admitted with complaints of progressive bloating sensation, vague abdomen discomfort of the upper abdomen and nausea for 8 months. She also had frequent episodes of nonprojectile vomiting. She was evaluated completely with blood investigations, upper gastrointestinal (GI) scopy and contrast enhanced computed tomography abdomen extensively earlier were normal. There was no significant past medical history. On examination, she was thin built and abdominal examination was normal. She underwent gastric emptying studies and was normal. Barium meal was done in both supine [Figure 1] and erect posture [Figure 2] clinched the diagnosis. The upper GI series with small bowel follow through [Figure 1] shows a normal stomach in lying posture. Erect posture [Figure 2] reveals the gastric lesser curvature angle located below a horizontal line connecting the bilateral iliac spines. The diagnosis is gastroptosis.{Figure 1}{Figure 2}

Gastroptosis is defined as the downward displacement of the stomach. Though in modern medicine, it is not considered to be pathological and very few reports available in the literature. This largely ignored clinical condition was named after French physician Frantz Glenard. Two acceptable theories were “Glenard theory: According to which it is a nutritional disease and “hepatic diathesis” with atrophy and prolapse of the small intestine. The other one is the Stiller's theory, according to which it is a universal asthenia, characterized by degeneration.[1] Though not the life-threatening clinical situation, most often associated with abdominal discomfort, vomiting, dyspepsia, anorexia, nausea and belching. An after meal activity in patients with gastroptosis may induce nausea and discomfort. Sagittal downward displacement of the stomach is often caused by relaxation, stretching, or decrease of the muscle tone. This may delay digestion and increase GI tract distension with gas that induces constipation.[2] Gastroptosis may be associated with the incorrect posture. In the 19th century, it was postulated as neurasthenia: A determinant of gastroptosis and enteroptosis.[3] At the beginning of 19th century, the preferred treatment was surgical.[4] Though treatment is symptomatic with prokinetics, abdominal strengthening exercises or wearing abdominal bandages. Other modalities alternative treatments like herbal and acupuncture have been tried.[1] Our patient was treated as functional dyspepsia, and she is on follow-up. There is a paucity of literature on gastroptosis and its clinical significance. Gastroptosis should be considered as a differential while evaluating unexplained dyspeptic symptoms, particularly in young females.

References

1Satterlee GR, Lewald LT. One hundred cases of watertrap stomach.J Am Med Assoc 1913;61:1340-4.
2Christianakis E, Bouchra K, Koliatou A, Paschalidis N, Filippou D. Gastroparesis associated with gastroptosis presenting as a lower abdominal bulking mass in a child: A case report. Cases J 2009;2:184.
3Hutchison R. The principles of treatment in gastroptosis. Br Med J 1910;1:1102-4.
4Nakayama K, Nakamura T, Tucker HE. Segmental resection for gastroptosis. J Am Osteopath Assoc 1959;58:412-4.