E0159 - Too Much of Gut Gives You Reflux

Rutwik Pradeep Sharma, MD¹, Alexander Kusnik, MD², Divya Ravi, MD¹, Jay Bapaye, MD³, Ahmed Shehadah, MD³, Tausif Syed, MD¹, Ari Chodos, MD^4
1Rochester Regional Health/Unity Hospital, Rochester, NY; ²Rochester Regional Health - Unity Hospital, Rochester, NY; ³Rochester Regional Health, Rochester, NY; ⁴Rochester Gastroenterology Associates; Rochester Regional Health/Unity Hospital, Rochester, NY

Introduction: Gastroesophageal reflux disease (GERD) is a very common disease that often presents with symptoms such as heartburn, dysphagia, odynophagia, chronic cough, asthma, belching and regurgitation. Common etiologies of GERD are- Transient lower esophageal sphincter(LES) relaxation, motility disorder, lower esophageal sphincter (LES) incompetence, short lower esophageal sphincter (< 2 to 5 cm) and increased intra-abdominal pressure due to obesity or pregnancy for example. Dolichocolon is an uncommon disease in which patients have redundant colon. It commonly presents with constipation, lower abdominal pain and in severe cases, volvulus. Dolichocolon is an unusual cause of GERD. We present an unusual presentation of an uncommon pathology.

Case Description/Methods: Our patient is 56-year-old woman presented with chronic cough and chronic abdominal pain. Initially patient was diagnosed with GERD. Fundoplication was planned since patient failed medical management. During workup, dolichocolon was discovered and after subtotal colectomy, the patient’s symptoms of GERD resolved.

Discussion: Dolichocolon is defined as redundant colon. We can use the following criteria to diagnose it.

• Sigmoid colon above the line between iliac crests.


• Transverse colon below the aforementioned line.


• Extra loops at the hepatic and splenic flexure.

If all of the aforementioned redundancies are present at the same time a fully developed Dolichocolon is diagnosed. The reason for the redundant sigmoid colon is thought to be the pathological elongation of the hindgut and hence subsequently the elongation of the sigmoid colon. Although Dolichocolon largely is due to congenital malformation, there are certain theories that abnormal fecal transport, loss of Cajal cells and dietary habits also play a role in acquired dolichocolon. The imaging modality of choice for diagnosis is Barium enema, although we could still use computerized tomography, colonic transit study or magnetic resonance imaging.
Our proposed theory for the cause of patient’s symptoms is that the redundant colon increasing pressure on the stomach and hence resulting in symptoms of GERD.
This case highlights the importance of Dolichocolon as a cause of abdominal complaints and presents an unusual presentation of a rare pathology.



Disclosures:


Rutwik Pradeep Sharma, MD¹, Alexander Kusnik, MD², Divya Ravi, MD¹, Jay Bapaye, MD³, Ahmed Shehadah, MD³, Tausif Syed, MD¹, Ari Chodos, MD⁴. E0159 - Too Much of Gut Gives You Reflux, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.