cascade stomach

A cascade stomach, also known as a cup-and-spill configuration, is an anatomic variant of the stomach involving an angulation separating the fundus and body of the stomach [1]. This deformity is characterized by a folding over of the fundus in a dorsal direction, creating a biloculation of the gastric cavity into a ventral and dorsal recess [3].

The causes of cascade stomach are manifold and can be attributed to various factors such as congenital, functional, and organic disorders [2][4]. Some intrinsic or extrinsic factors may lead to dyspepsia by causing deformities in the stomach, including cascade stomach [4].

On barium studies, a cascade stomach is diagnosed from its characteristic appearance, which consists of two separate air-fluid levels in an antero-posterior X-ray [13]. The criteria for diagnosing a complete cascade stomach include the presence of an angulation of a demarcation line posteriorly between the fundus and body of the stomach [10].

It's worth noting that cascade stomach can be confused with other conditions, such as volvulus, but is generally considered to be less serious [5]. The relationship between cascade stomach and upper gastrointestinal symptoms has been investigated in various studies, which have shown a correlation between the two [11][12].

Upper Abdominal Symptoms Associated with Cascade Stomach

Cascade stomach (CS) is a deformity of the stomach that can present with various upper abdominal symptoms. According to recent studies, patients with CS are more likely to experience upper gastrointestinal symptoms, such as:

• Reflux esophagitis: A condition characterized by inflammation and irritation of the esophagus due to acid reflux [2].
• Upper gastrointestinal symptoms: Symptoms such as heartburn, regurgitation, and difficulty swallowing can be associated with CS [5, 6].
• Delayed gastric emptying: This has been believed to contribute to the development of upper GI symptoms in patients with CS [6].

Additionally, some studies have reported that CS is often difficult to diagnose due to its nonspecific presentation. However, endoscopic criteria can help confirm the diagnosis.

Other Associated Symptoms

While not directly related to CS, it's worth noting that other conditions such as:

• Gastritis: Inflammation of the stomach lining, which can cause symptoms like indigestion and abdominal pain [15].
• Peptic ulcers: Sores in the stomach or duodenal lining, which can cause symptoms like abdominal pain and bleeding [11].

may also present with similar upper abdominal symptoms.

References

[2] - A cascade stomach is a rare cause of upper gastrointestinal symptoms and is often difficult to diagnose (6). Mostly barium studies and endoscopical examination are used for diagnosis. [5, 6] - There has been sparse research into the relationship of the presence of cascade stomach and upper GI symptoms for a number of years. Literature suggests there is a risk factor and association of cascade stomach with oesophageal reflux. [11] - Symptoms & causes of peptic ulcers (stomach or duodenal ulcers). American Cancer Society. [15] - Signs and

What are the diagnostic criteria for Cascade Stomach?

Cascade Stomach, also known as a deformity of the stomach where the fundus is folded over the corpus in the dorsal direction, can be diagnosed using various methods. According to research [1], upper gastrointestinal endoscopy is one of the diagnostic tools used to identify this condition.

A study conducted on 475 consecutive patients found that the frequency of Cascade Stomach was unknown, and a preliminary study was performed to determine endoscopic diagnostic criteria [2]. The study used statistical analysis, including student t-test in variables with mean values and chi-square plus "fisher exact" tests in categorical variables, to evaluate the diagnostic accuracy of upper gastrointestinal endoscopy in patients with obscure symptoms.

In addition, barium studies under fluoroscopy are also considered diagnostic for Cascade Stomach [6]. Mild cases may respond to medical management, while severe cases require further evaluation and treatment.

What is the best test to diagnose Cascade Stomach?

Once more common causes of dyspepsia, such as GERD, medication effects, ulcer, are ruled out, an upper GI study is likely the best test to diagnose Cascade Stomach [9]. This diagnostic approach can help identify the presence of a cascade stomach and guide further treatment.

References:

[1] Diagnostic accuracy of cascade stomach by upper gastrointestinal endoscopy in patients with obscure symptoms: A multi-center prospective trial. [2] Aim: Cascade stomach (CS) is a deformity of stomach, capable of leading dyspepsia, and its actual incidence is unknown. We investigated its frequency and performed a preliminary study to determine endoscopic diagnostic criteria. [6] by MK Chhabra · 2016 · Cited by 4 — The upper gastrointestinal contrast study under fluoroscopy is diagnostic. [9] by SGASA CURATIVE · 2024 — Once more common causes, such as GERD, medication effects, ulcer, are ruled out, an upper GI study is likely the best test to diagnose cascade stomach.

Treatment Options for Cascade Stomach

Cascade stomach, also known as gastric cascade or cup and spill stomach, is a rare anatomical variant of the stomach that can lead to upper abdominal symptoms such as dyspepsia. While there are limited data on the treatment of this condition, various studies have suggested the following drug treatment options:

• Gastric acid-secretion inhibitors: These medications, such as proton pump inhibitors (PPIs), can help reduce stomach acid and alleviate symptoms.
• Acetylcholinesterase (AChE) inhibitors: Acotiamide is a prokinetic agent that has been shown to be potentially effective in improving symptoms when added to PPI treatment [4].
• Antacids, H2 blockers, and antispasmodics: These medications may provide temporary relief or no benefit at all for patients with cascade stomach [2].

It's essential to note that the effectiveness of these treatments can vary depending on individual cases, and more research is needed to determine the best course of treatment for cascade stomach.

References:

[1] Young E ... Andersen A, Knop FK, Vilsbøll T (2021) Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold. [5] [2] MK Chhabra (2016) Medical treatment like antacids, PPI, H2 blockers and antispasmodics usually are of no benefit or bring temporary relief if at all. Breathing ... [3] [4] Tu1400 Cascade Stomach Is a Risk Factor for Reflux Esophagitis With the New Endoscopic Classification of Cascade Stomach Motoyasu Kusano*, Shiko Kuribayashi, Hiroko Hosaka, Akiyo Kawada (2022) [9] [5] H Miwa (2022) The first-line treatment includes gastric acid-secretion inhibitors, acetylcholinesterase (AChE) inhibitors (acotiamide, a prokinetic agent), ... [10]

Please consult a healthcare professional for personalized advice on treating cascade stomach.