Answer for BIR CoW 28 Jun 2026
Grade 3 Gastroptosis
Findings
AP and RAO images on barium swallow study show normal mucosal coating of barium with no evidence of stricture in esophagus. Contrast-filled stomach is displaced downwards, with the greater curve of the stomach partly projecting below the level of the iliac crests.Stomach appears elongated. No evidence of contrast extravasation.No evidence of filling defects /contrast filled outpouching in the esophagus.
Discussion
Gastroptosis is characterized by abnormal downward displacement of the stomach. It may be part of a wider spectrum called visceroptosis. Epidemiology :It is more common in females. Clinical presentation: It has nonspecific, non-life-threatening symptoms. Most patients will have abdominal discomfort, nausea, vomiting and belching after taking meals. On examination, they may lack body fat. Often, affected patients will be labeled as functional as there is an absence of any organic cause. Pathology: It is believed to be due to emaciation and relaxation of the abdominal wall muscles as well as reduction of abdominal fats, especially from the lesser omentum, gastrohepatic and gastrocolic ligaments There were two theories regarding its etiology. The first was Glenard's theory, which stated that it was due to nutritional diseases causing atrophy and prolapse of bowel loops. While another theory, Stiller's theory, favored universal asthenia, characterized by degeneration. Radiographic features: Fluoroscopy: It is diagnosed by barium swallow and is defined as the downward displacement of the stomach with the greater curve of the stomach partly projecting below the level of the iliac crests, in upright position. The cardiac end stays at its normal location. Additional findings:1)elongated stomach2)delayed gastric emptying in upright position3)stomach ascent in lying position with commencement of normal gastric emptying.Gastroptosis is graded as follows: Grade 1: Greater curvature lies within 3 cm above the iliac crest line. Grade 2: Greater curvature is at the level of the iliac crest line. Grade 3: Greater curvature lies below the iliac crest line. Treatment and prognosis: The only indication for an operative procedure is when there is actual obstruction, which is rare As it is uncertain that gastroptosis itself leads to gastrointestinal symptoms, nowadays, its treatment is symptomatic with prokinetics, abdominal strengthening exercises or wearing abdominal bandages.
References:
Sarangapani A, Rasane S, Kohli V, Chandy G. Glenard's Disease. Arch Med Health Sci. 2016;4(1):153. doi:10.4103/2321-4848.183372 Kusano M, Moki F, Hosaka H et al. Gastroptosis is Associated with Less Dyspepsia, Rather Than a Cause of Dyspepsia, in Japanese Persons. Intern Med. 2011;50(7):667-71. doi:10.2169/internalmedicine.50.4582 - Pubmed Beilin D. When Has Visceroptosis Clinical Significance? Radiology. 1930;15(2):223-6. doi:10.1148/15.2.223 Department of Paediatrics, Radboudumc Amalia Children’s Hospital, 6525 GA Nijmegen, The Netherlands, van Welie A, Klein W, Department of Radiology and Nuclear Medicine, Radboudumc Amalia Children’s Hospital, 6525 GA Nijmegen, The Netherlands, Th. Draaisma J, Department of Radiology and Nuclear Medicine, Radboudumc Amalia Children’s Hospital, 6525 GA Nijmegen, The Netherlands. The Clinical or Radiographic Diagnosis of Gastroptosis: Still Relevant? Gastro - Open J. 2017;2(1):14-9. doi:10.17140/goj-2-126 Christianakis E, Bouchra K, Koliatou A, Paschalidis N, Filippou D. Gastroparesis Associated with Gastroptosis Presenting as a Lower Abdominal Bulking Mass in a Child: A Case Report. Cases J. 2009;2(1):184. doi:10.1186/1757-1626-2-184 - Pubmed
Findings
AP and RAO images on barium swallow study show normal mucosal coating of barium with no evidence of stricture in esophagus. Contrast-filled stomach is displaced downwards, with the greater curve of the stomach partly projecting below the level of the iliac crests.Stomach appears elongated. No evidence of contrast extravasation.No evidence of filling defects /contrast filled outpouching in the esophagus.
Discussion
Gastroptosis is characterized by abnormal downward displacement of the stomach. It may be part of a wider spectrum called visceroptosis. Epidemiology :It is more common in females. Clinical presentation: It has nonspecific, non-life-threatening symptoms. Most patients will have abdominal discomfort, nausea, vomiting and belching after taking meals. On examination, they may lack body fat. Often, affected patients will be labeled as functional as there is an absence of any organic cause. Pathology: It is believed to be due to emaciation and relaxation of the abdominal wall muscles as well as reduction of abdominal fats, especially from the lesser omentum, gastrohepatic and gastrocolic ligaments There were two theories regarding its etiology. The first was Glenard's theory, which stated that it was due to nutritional diseases causing atrophy and prolapse of bowel loops. While another theory, Stiller's theory, favored universal asthenia, characterized by degeneration. Radiographic features: Fluoroscopy: It is diagnosed by barium swallow and is defined as the downward displacement of the stomach with the greater curve of the stomach partly projecting below the level of the iliac crests, in upright position. The cardiac end stays at its normal location. Additional findings:1)elongated stomach2)delayed gastric emptying in upright position3)stomach ascent in lying position with commencement of normal gastric emptying.Gastroptosis is graded as follows: Grade 1: Greater curvature lies within 3 cm above the iliac crest line. Grade 2: Greater curvature is at the level of the iliac crest line. Grade 3: Greater curvature lies below the iliac crest line. Treatment and prognosis: The only indication for an operative procedure is when there is actual obstruction, which is rare As it is uncertain that gastroptosis itself leads to gastrointestinal symptoms, nowadays, its treatment is symptomatic with prokinetics, abdominal strengthening exercises or wearing abdominal bandages.
References:
Sarangapani A, Rasane S, Kohli V, Chandy G. Glenard's Disease. Arch Med Health Sci. 2016;4(1):153. doi:10.4103/2321-4848.183372 Kusano M, Moki F, Hosaka H et al. Gastroptosis is Associated with Less Dyspepsia, Rather Than a Cause of Dyspepsia, in Japanese Persons. Intern Med. 2011;50(7):667-71. doi:10.2169/internalmedicine.50.4582 - Pubmed Beilin D. When Has Visceroptosis Clinical Significance? Radiology. 1930;15(2):223-6. doi:10.1148/15.2.223 Department of Paediatrics, Radboudumc Amalia Children’s Hospital, 6525 GA Nijmegen, The Netherlands, van Welie A, Klein W, Department of Radiology and Nuclear Medicine, Radboudumc Amalia Children’s Hospital, 6525 GA Nijmegen, The Netherlands, Th. Draaisma J, Department of Radiology and Nuclear Medicine, Radboudumc Amalia Children’s Hospital, 6525 GA Nijmegen, The Netherlands. The Clinical or Radiographic Diagnosis of Gastroptosis: Still Relevant? Gastro - Open J. 2017;2(1):14-9. doi:10.17140/goj-2-126 Christianakis E, Bouchra K, Koliatou A, Paschalidis N, Filippou D. Gastroparesis Associated with Gastroptosis Presenting as a Lower Abdominal Bulking Mass in a Child: A Case Report. Cases J. 2009;2(1):184. doi:10.1186/1757-1626-2-184 - Pubmed
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!