E0704 - A Blip in the Fundus! A Case of Symptomatic Gastric Diverticulum

Idrees Suliman, MD¹, Preeyanka Sundar, MD², Suma Harsha Kosuru, MBBS², Sara Ancello, DO², Abdul Nadir, MD^1
1Mountain Vista Medical Center, Mesa, AZ; ²Midwestern University, Mesa, AZ

Introduction: Gastric diverticulum are pouches that can form within the stomach. In contrast to colonic diverticula, gastric diverticula are rare and are usually discovered incidentally during EGD. Estimates of prevalence are in the region of 0.04% to 0.01%. When they do occur they are usually found in the fundus. Most diverticulum are asymptomatic however when symptoms are present they are highly variable. The most common symptoms include epigastric pain, nausea, and early satiety. As with colonic diverticula the most common complications are ulceration, perforation, and hemorrhage. Management depends on the severity of the presenting complaints and the presence of complications. Patients who are symptomatic should be initiated on a proton pump inhibitor, H2 Blocker, or antacid therapy. This can occasionally relieve symptoms. When gastric diverticula are large ( >4cm) they may result in symptoms not responsive to acid suppression therapy.

Case Description/Methods: 87 year old female with history of HTN presented with intermittent hiccups, solid food dysphagia, and
epigastric pain. She said the hiccups were about once a month and associated with dysphagia during the
episodes which would last a day or two. She had an dull, aching epigastric pain associated with solid
food intake. EGD showed an unusually 4x 6cm large gastric fundal diverticulum with food and seeds
which was irrigated, but otherwise normal. Esophageal manometry and barium esophagram were
normal. She was managed conservatively with counselling, reassurance and Pantoprazole as needed. Her symptoms completely resolved and she has not required any further interventions to date.

Discussion: While rare, gastric diverticula can be a significant cause of symptoms and their complications can result in morbidity and mortality. Given that most Gastric Diverticula occur in the fundus, careful examination of the fundus with adequate insufflation is essential. The correct identification and evaluation of their size is essential to guide therapy and monitor for complications.



Disclosures:


Idrees Suliman, MD¹, Preeyanka Sundar, MD², Suma Harsha Kosuru, MBBS², Sara Ancello, DO², Abdul Nadir, MD¹. E0704 - A Blip in the Fundus! A Case of Symptomatic Gastric Diverticulum, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.