Digestive disorders

III/4.4: Symptomatology

Gastric and duodenal GISTs are often (10 to 30%) fully asymptomatic. Tumors of small size are detected by chance, often during endoscopy performed due to another cause. Clinical symptoms are not specific for the disease; their occurrence is determined by the localization and size of the tumor. The first symptoms of tumors localized in the stomach or small intestine include abdominal pain (20 to 50%), a sense of discomfort; an early sense of fullness, bloating and loss of blood. Hemorrhage, which can be also life-threatening, is the first sign in 20% of patients. Anorexia, fever and a palpable abdominal mass may also be frequent signs and symptoms. The tumor may lead to an intestinal obstruction in 25 to 40% of patients. Perforation may also develop.

Leading symptoms of GIST developing in the esophagus include dysphagia, odynophagia, retrosternal pain and hematemesis; those growing in the rectum may cause a change of defecation habits as a leading symptom. Tumors around the Vater’s papilla evoke the clinical picture of biliary obstruction.

As paraneoplastic symptoms, episodes of hypoglycemia due to the tumor’s production of insulin-like growth factor II may also occur. Due to its common asymptomatic nature and symptoms which are uncharacteristic for a long time, it is often recognized at an already advanced stage, based on symptoms caused by its metastases.