PD508 - DIAGNOSTIC IMPACT OF BARIUM GASTRIC EMPTYING STUDY AND ENTERAL NUTRITIONAL SUPPORT STRATEGY IN VISCEROPTOSIS ASSOCIATED WITH EHLERS–DANLOS SYNDROME

PD508

DIAGNOSTIC IMPACT OF BARIUM GASTRIC EMPTYING STUDY AND ENTERAL NUTRITIONAL SUPPORT STRATEGY IN VISCEROPTOSIS ASSOCIATED WITH EHLERS–DANLOS SYNDROME

E. Luis Bethencourt^1,*, Y. López Plasencia¹, N. Pérez Martín¹, Y. García Delgado ¹, S. Quintana Arroyo¹, M. J. López-Madrazo Hernández¹

¹Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las palmas de Gran Canaria, Spain

Rationale: Secondary visceroptosis in Ehlers–Danlos syndrome may cause severe gastroptosis and refractory malnutrition, yet standard supine imaging often underestimates its severity. This study investigates whether barium gastric emptying under gravitational load can improve diagnostic accuracy and guide effective nutritional rehabilitation.

Methods: Ehlers–Danlos syndrome (EDS) involves systemic ligamentous laxity affecting visceral support. Secondary visceroptosis can lead to severe gastroptosis, mechanical distortion, and refractory protein–calorie malnutrition, frequently underestimated in supine imaging.

We assessed the diagnostic value of gastric emptying using high-density barium under gravitational load and evaluated nutritional rehabilitation via surgical jejunostomy.

A patient with EDS and >30% weight loss underwent comparative barium gastrointestinal transit studies in supine and standing positions, simulating oral intake to assess gravitational effects on gastric anatomy.

Results: While the supine assessment suggested normal anatomy, the standing barium study with simulated oral intake revealed massive visceroptosis, with ptosis of the gastric body, antrum, and small bowel extending to the level of the left iliac crest. This finding confirmed the mechanical component underlying oral intolerance.

After failure of nasojejunal tube feeding due to pain, surgical jejunostomy enabled sustained weight recovery (from 56.5 kg to 60.0 kg) and improvement in fat-free mass index (FFMI from 15 to 16.9 kg/m²).

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Conclusion: Postural transition to the standing position and gravitational loading using barium contrast are critical manoeuvres for the diagnosis of visceroptosis in patients with EDS. Identification of this mechanical functional impairment supports jejunostomy as an effective therapeutic strategy for nutritional rehabilitation in complex cases.

Disclosure of Interest: None declared