Gastric Diverticulum: An Unusual Endoscopic Finding

A 54-year-old white woman with a past medical history of gastroesophageal reflux disease (GERD) presented to the outpatient gastroenterology clinic with the complaint of persistent pyrosis despite proton pump inhibitor (PPI) therapy. Her symptoms were described as progressively worsening over 4 years. She also reported intermittent nausea and localized epigastric burning pain. The symptoms occurred more often in the evening and were unchanged with meals. She noted no symptomatic improvement with omeprazole 40 mg orally up to twice daily, and a switch to pantoprazole 40 mg twice daily was also ineffective. Complete laboratory studies were unremarkable. An upper endoscopy showed a 1-cm diverticulum in the gastric fundus (Figure 1), confirming a similar finding from an upper endoscopy performed 4 years prior. Biopsy specimens revealed mild esophagitis, mild chronic gastric inflammation without evidence of Helicobacter pylori, and 2 fundic gland polyps. The mucosa in the diverticulum appeared normal. An upper gastrointestinal series to characterize diverticular morphology was not performed, but would be encouraged preoperatively should she choose to pursue elective diverticular resection in the future