A female adolescent aged 13 years with joint hyperlaxity and possible hypermobile Ehlers-Danlos syndrome (EDS) presented with epigastric pain and constipation. The findings of the initial imaging tests (including an abdominal ultrasound and an upper gastrointestinal endoscopy) were normal, yet the patient responded poorly to pharmacological treatment, which prompted performance of a barium swallow (Fig. 1). It was conducted with the patient standing (Fig. 2), and it revealed elongation and downward displacement of the stomach, compatible with gastroptosis stage 2, radiologically defined by visualization of the greater curvature at the level of the horizontal line joining the iliac crests.1

Figure 1.

Barium swallow with patient in supine position.

Figure 2.

Barium swallow with patient standing.

Gastroptosis is characterized by an abnormal downward displacement of the stomach in the abdominal cavity in the standing position, and into the pelvic region in the most severe cases. It is associated with gastrointestinal symptoms such as epigastric pain, early satiety, nausea, vomiting or constipation.1,2

Its etiology is not well understood, although it has been associated with abdominal wall hyperlaxity or relaxation of the ligaments that hold the stomach. The diagnosis requires performance of a barium swallow in the upright position, an aspect that needs to be considered in patients with hyperlaxity, for example, those with EDS.3

The treatment of gastroptosis is chiefly conservative: postural changes (avoiding prolonged standing, promoting supine position after meals), nutritional support, smaller and more frequent meals, strengthening abdominal muscles, and use of abdominal binders.1,3