Gastric Volvulus: Causes, Symptoms, Treatment and Cost

Gastric volvulus is a condition in which the stomach twists around itself, cutting off its own blood supply. It usually occurs when the stomach becomes enlarged, often due to overeating or due to a hernia. If left untreated, it can be life:threatening and require emergency surgery.

Gastric volvulus can be divided into two types:

• Axial Volvulus: This type of gastric volvulus occurs when the stomach twists around its long axis, causing obstruction of the oesophagus and duodenum. This type of volvulus can cause severe pain and nausea, vomiting, and difficulty swallowing.
• Organoaxial Volvulus: This type of gastric volvulus involves both a twisting of the stomach along its long axis as well as rotation around its short axis. It typically causes more severe symptoms than axial volvulus and has a higher risk for death if not treated promptly.

The most common cause of gastric volvulus is a congenital abnormality of the diaphragm, which can lead to the stomach becoming twisted or rotated. This condition is also known as 'volvulus of the stomach.'

Other causes include hiatal hernia, enlarged lymph nodes due to infection and tumors, which can all lead to gastric volvulus.

Certain activities such as heavy lifting, coughing and straining during bowel movements can also increase the risk of gastric volvulus.

• Abdominal pain and discomfort
• Nausea and vomiting
• Bloating or distention of the abdomen
• Difficulty swallowing or breathing
• Heartburn or acid reflux
• Rapid heart rate
• Sweating
• Lightheadedness or dizziness

• Maintain a healthy body weight and eat a balanced diet to reduce the risk of gastric volvulus.
• Stay away from risk factors including smoking and consuming alcohol as much as possible.
• Participate in regular physical activity to help strengthen the abdominal muscles which can help support the stomach and reduce risk of gastric volvulus.
• Avoid straining during activities such as lifting heavy objects or participating in strenuous exercise as it increases pressure on the stomach and can lead to gastric volvulus.
• See a doctor right away if you experience any signs or symptoms associated with gastric volvulus, such as abdominal pain, vomiting, bloating or difficulty swallowing, so that early diagnosis and treatment is possible.

• Diagnosis: Gastric volvulus is usually diagnosed by imaging tests such as an upper gastrointestinal series (UGI) or computed tomography (CT) scan. These tests will show if there is a twist in the stomach. Your doctor may also order an endoscopy to take a closer look at your stomach and rule out other causes for your symptoms.
• Barium swallow or barium meal x:rays: This type of x:ray can help diagnose gastric volvulus. It involves drinking a liquid containing barium, which shows up on the x:ray and highlights the stomach and intestines. The barium will show if there is a twist in the stomach, which could indicate a volvulus.
• Endoscopy: An endoscopy is an examination of the stomach using a thin, flexible tube with an attached camera. The endoscope can be used to examine the stomach for any signs of twisting or obstruction that might indicate gastric volvulus.
• CT scan: Another imaging test that could be performed to identify stomach volvulus is a computed tomography (CT) scan. It employs. These photos can assist medical professionals in examining the stomach for any indications of twisting or blockage that can point to the presence of a gastric volvulus.
• Ultrasound: Ultrasound is another imaging test that can be used to diagnose gastric volvulus, although it’s not as commonly used as other tests like X:rays or CT scans. It uses sound waves to create images of organs inside the body and can help doctors look for any signs of twisting or blockage in the stomach that might suggest a volvulus has occurred.
• Esophageal manometry: Esophageal manometry is a test that measures the pressure and contractions in your oesophagus (the tube that connects your mouth to your stomach). The test is used to diagnose problems in the oesophagus, such as difficulty swallowing, chest pain, and reflux. During the test, a thin tube with sensors is inserted through your nose or mouth and passed down into your oesophagus.

• Peritonitis: This is a serious complication of gastric volvulus, which occurs when the stomach twists and the wall of the stomach becomes damaged, leading to bacteria entering the abdominal cavity and causing inflammation.
• Bowel obstruction: Gastric volvulus can cause partial or complete blockage of the intestine, leading to difficulty passing stools and severe abdominal pain.
• Vomiting: The twisting motion caused by gastric volvulus can cause severe vomiting, leading to dehydration and electrolyte imbalances.
• Acid reflux: Gastric volvulus can lead to acid reflux due to decreased pressure in the stomach allowing acid from the stomach back into the oesophagus.
• Perforation: In extreme cases, gastric volvulus can cause damage or tearing of the stomach wall and lead to leakage of digestive juices into surrounding organs or tissue in the abdomen and chest cavity which can be life threatening if not treated promptly.

• Consume ginger: Ginger is known to be an effective remedy for treating gastric volvulus. It helps to reduce inflammation and relieves nausea and vomiting.
• Drink coriander juice: Coriander has anti:inflammatory, antispasmodic, and carminative properties that can help in relieving the symptoms associated with gastric volvulus.
• Drink fennel tea: Fennel has antispasmodic properties which can help in treating gastric volvulus by relaxing the abdominal muscles and reducing the pain associated with it.
• Consume aloe vera juice: Aloe vera is known to have many healing benefits, including its ability to reduce inflammation and control the stomach acidity levels which can help in treating gastric volvulus effectively.
• Apply a hot compress on your abdomen: A hot compress on your abdomen can help alleviate some of the pain associated with gastric volvulus by relaxing your muscles and easing cramps and spasms in the stomach region.

• Instead of three substantial meals, eat several smaller meals often throughout the day.
• Choose foods that are high in fibre, such as fruits, vegetables, and grains that are whole.
• Choose meats with a low fat content, such as fish and chicken.
• Low-fat dairy products, such as low-fat milk and yoghurt, should be included in your diet. This will assist you in maintaining a healthy weight.
• Stay hydrated by drinking enough fluids throughout the day to aid digestion.

• High-fat foods: Foods that are high in fat should be avoided, as they can contribute to an increase in abdominal pressure and the risk of gastric volvulus.
• Carbonated drinks: Carbonated beverages can increase gas levels in the stomach, contributing to increased pressure and risk of volvulus.
• Spicy foods: Spicy foods may cause irritation or inflammation of the stomach lining, leading to an increased risk of gastric volvulus.
• Fried foods: Fried foods contain a large amount of fat which can increase abdominal pressure and potentially contribute to gastric volvulus.
• Processed foods: Processed and pre:packaged meals are often high in sodium, sugar, fat, and additives which can irritate the stomach lining and increase abdominal pressure leading to an increased risk for gastric volvulus.

• Clinical assessment: The medical team will assess the patient's airway, breathing, circulation and vital signs.
• Endoscopic reduction: Endoscopic reduction is the preferred treatment for gastric volvulus, and usually requires more than one procedure depending on the patient's health. This procedure involves inserting a thin tube with a camera on the end into the stomach to help push it back into place.
• Open Reduction: This is a surgical procedure that attempts to push the stomach back into its normal position and can also involve closing off any hernias that are present
• Laparoscopic Reduction: This procedure involves making several small incisions in the abdomen and then using a laparoscope (a thin tube with a camera and light attached) to view inside the abdomen and push the stomach back into place.
• Surgical Repair: In more complicated cases, surgery may be necessary to repair any underlying hernias or other damage done by gastric volvulus. This may involve repairing or removing parts of the stomach, intestines, or other organs affected by gastric volvulus.
• Gastric decompression: A nasogastric tube is inserted to help reduce stomach distension and relieve pressure on the diaphragm.
• Intravenous fluids: Fluids are administered to maintain hydration status and correct electrolyte imbalances if needed.
• Fixation of gastric volvulus: Endoscopic suturing or placement of a gastrostomy tube may be done to fix the volvulus in place while allowing natural drainage of gastric contents.
• Nutrition support: Enteral nutrition via nasogastric or gastrostomy tube is provided for adequate nutrition until full oral intake can be resumed safely after resolution of the condition or surgery is performed if indicated

Your primary care physician can examine your condition and, if required, recommend you to a specialist.

Specialists who treat gastric volvulus include gastroenterologists and surgeons.

A gastroenterologist is a doctor who specialises in digestive system disorders, whereas a surgeon specialises in body surgery.

• Medicines to reduce the pressure in the stomach, such as proton pump inhibitors (PPIs) or H2 blockers, may be prescribed to reduce symptoms and help prevent further episodes of volvulus.
• Antibiotics: Antibiotics are commonly used to treat infections caused by bacteria in the stomach, such as gastric volvulus.
• Antispasmodics: Treatment for this condition typically includes medications such as antispasmodics (e.g., hyoscine:N:butylbromide, dicyclomine hydrochloride, or mebeverine hydrochloride) to relax the smooth muscles of the digestive tract and reduce abdominal pain and cramping.

Recovery from Gastric Volvulus can take anywhere from a few days to several weeks, depending on the severity of the condition and the individual's response to treatment.After surgery, patients will usually need to be monitored in a hospital setting for at least a few days as they recuperate and heal.

After being discharged, it is important for patients to follow their doctor’s instructions carefully in order to ensure a full recovery with minimal risk of complications or recurrence of symptoms.

The results of treatment for gastric volvulus vary depending on the severity of the condition and the underlying cause.The majority of instances may be effectively addressed with surgical repair, which is usually permanent.

However, for severe cases or those caused by underlying conditions, the outcome may not be permanent and further treatments may be necessary.

• Monitor the patient's vital signs frequently to ensure that the body is recovering from the surgery.
• Provide nutritional support with intravenous fluids, nutrition supplements, and electrolytes, as needed.
• Administer antibiotics to prevent infection and reduce inflammation in the abdomen.
• Monitor for post:operative complications such as abdominal distension or pain, fever, or vomiting.
• Educate the patient on proper wound care and hygiene while at home including changing dressings regularly, taking medications as prescribed and avoiding heavy lifting or straining activities for several weeks following surgery until fully recovered.
• Follow up with regular check:ups with the surgeon for monitoring of healing and recovery process as well as to assess any further treatment needs or lifestyle changes recommended for long:term health maintenance after gastric volvulus surgery

The cost of Gastric Volvulus treatment in India depends on the severity and complexity of the condition as well as the type of treatment being used.

Generally, treatments for Gastric Volvulus can range from a few thousand rupees for an outpatient procedure to several lakhs for a more complex surgical procedure.

The cost of Gastric Volvulus treatment in India varies depending on the severity and complexity of the condition and the type of treatment used.

Outpatient procedures may cost 1000-10000 rupees while more complex surgical procedures can cost several lakhs.

• Nausea: Nausea is a common symptom of gastric volvulus.Indigestion or straining of the stomach walls can both cause it. It is also possible to have vomiting and stomach discomfort.
• Abdominal Pain: Another sign of gastric volvulus is abdominal discomfort. Depending on the degree of the disease, it might range from moderate to severe. The discomfort might be localised or radiate across the abdomen.
• Vomiting: Vomiting is a common symptom of gastric volvulus and can range from mild to severe in intensity. It may also be accompanied by nausea and abdominal pain.
• Bloating: Bloating is a feeling of fullness that is often experienced with gastric volvulus due to gas build:up in the stomach as a result of food not being digested properly due to obstruction or twisting of the stomach wall.
• Loss of Appetite: Loss of appetite is another common symptom associated with gastric volvulus as it can make eating uncomfortable or difficult due to nausea, bloating, and abdominal pain associated with this condition.

If you have any difficulties related to stomach volvulus, you should see a doctor right away since they can cause 'vomiting, nausea, bowel blockage, and so on,' and treatment courses can range from a two or three months to a few years depending on the severity of the situation.