Gastric diverticula

　　First, Etiology

　　Congenital gastric diverticula are generally located 2-3 cm below the esophagogastric junction on the lesser curvature near the cardiac orifice of the posterior gastric wall, and are mostly true diverticula, accounting for about 70% of gastric diverticula. They are usually not accompanied by ulcers, granulomas, or tumors and are formed due to the weakness of the longitudinal muscle in this area. Secondary gastric diverticula can be both true and pseudo-diverticula, and are mostly caused by factors such as ulcers, granulomas, tumors, and surgery, and are mostly located in the prepyloric area. Diverticula formed due to increased intragastric pressure, such as pyloric obstruction, are also called intrapressure gastric diverticula. Those caused by adhesions around the stomach are also called traction diverticula. Gastric fundus and corpus diverticula are relatively rare and are mostly due to extragastric traction. The occurrence of gastric diverticula is unrelated to diverticula in other parts of the gastrointestinal tract.

　　Second, Pathogenesis

　　True diverticula include all layers of the gastric wall, namely the mucosal layer, muscular layer, and serosal layer, which protrude bag-like from the gastric wall in a pouch shape. They are soft to the touch, with a diameter of 2-4 cm, and some can reach 9-10 cm. Half of the gastric diverticula have normal mucosa, which may have congestion, erosion, and bleeding. Due to inflammation, the diverticular wall thickens, or it adheres to surrounding tissues, resulting in rare perforations. Diverticula may also develop mucosal necrosis and cancer, but this is rare. A few diverticula contain ectopic pancreatic tissue, causing irregular mucosa, and should be classified as congenital diverticula, which are more common in the lesser curvature of the stomach and the prepyloric area. Pseudo-diverticula only have the mucosal and serosal layers of the stomach. If the mucosal layer is embedded in the muscular layer and there are no abnormalities on the surface of the gastric serosa, it is called an intramural gastric diverticulum.

　　When diverticula merge with inflammation, patients may experience upper gastrointestinal bleeding or perforation. Most gastrointestinal diverticulosis is asymptomatic and is discovered incidentally during examination for other diseases. Once symptoms appear, they are related to the location of the diverticula, such as dysphagia in esophageal diverticulosis, bloating, diarrhea, constipation, and other symptoms in colonic diverticulosis.

　　1. Inducing local inflammation Acute diverticulitis can cause symptoms such as intermittent abdominal pain, bloating, constipation, fever, nausea, and vomiting. The symptoms of inflammation in the left half of the abdominal diverticula are very similar to appendicitis, known as 'left-sided appendicitis' (appendicitis usually causes pain in the lower right abdomen).

　　2. Systemic toxic symptoms Perforation, abscess, and peritonitis of diverticula are often due to untimely treatment of acute diverticulitis, along with poor drainage, resulting in many systemic toxic symptoms.

　　Prevention of gastric diverticula:

　　1. Maintain a regular lifestyle, eat at regular times and in appropriate amounts, choose easily digestible foods, chew slowly, avoid overeating, and avoid cold and spicy foods. Develop good eating habits, eat at regular times and in appropriate amounts, chew slowly, avoid extreme hunger or overeating, eat more easily digestible foods, engage in moderate exercise to increase gastrointestinal motility, and promote digestion.

　　1. Use ordinary medication, such as gastric motility drugs, intestinal flora regulators, digestive aids, and drugs for regulating stomach autonomic nerve dysfunction, etc. However, these drugs have significant side effects and should not be used randomly. They should be taken under the guidance of a doctor, and it is best to understand their side effects and contraindications.

　　Histological examination of living tissue is helpful in distinguishing between true and false diverticula.

　　1. X-ray examination:Gastric diverticula are mainly discovered through X-ray barium contrast examination, and if the diverticula are too small or the examination is not thorough enough, they are easily missed. The supine right anterior oblique position should be used for examination, as barium is more likely to concentrate at the gastric fundus, and it can also avoid the overlap of the diverticula shadow with the gastric fundus, making it easier to detect. The characteristic X-ray barium contrast findings of true diverticula in the cardia area include: the diverticula are often cystic, with a diameter of 3 to 4 cm, smooth edges, and protrude outside the stomach, with a narrow, long neck connecting to the stomach. During upright examination, a liquid surface may appear inside the diverticula. In most cases, mucosal folds can be seen passing from the stomach through the neck into the diverticula. In some cases, ulcers or other mucosal changes may be observed inside the diverticula. The barium in the diverticula empties more slowly, and there may still be barium remaining in the diverticula after the stomach has emptied the barium.

　　The gastric fundus diverticulum is cystic, with a narrow neck, and has characteristics such as the gastric mucosa extending into the diverticulum. It is easy to differentiate from the gastric fundus small curvature ulcer, but diverticula in the gastric small curvature or prepyloric area often have ectopic pancreatic tissue, making the mucosa inside the diverticulum irregular and easily mistaken for a tumor. A diagnosis should be confirmed by combining endoscopy.

　　2. Gastroscopy, fiberoptic gastroscopy:It can help in the diagnosis of gastric diverticula, and the endoscopy shows that the diverticulum entrance is round, the edges are regular and clear, the surrounding mucosa is completely normal without infiltration, and the mucosal folds directly enter the sac. There is a regular contraction at the diverticulum orifice, and the size of the orifice can change, even sometimes completely closing the orifice. The mucosa inside the diverticulum is generally normal, and sometimes inflammation and ulcers form.

　　Gastric diverticulum food therapy recipes:Patients should eat easily digestible and less irritating foods, take anti-secretory drugs, gastric mucosal protective agents, and antibiotics.

　　(The above information is for reference only, please consult a doctor for details)

　　I. Treatment

　　Asymptomatic patients do not need treatment, and patients without complications can undergo internal medicine treatment. Symptomatic patients should eat easily digestible and less irritating foods, take anti-secretory drugs, gastric mucosal protective agents, and antibiotics. If there is food retention in the diverticulum, position drainage can be performed at the optimal position under X-ray fluoroscopy to avoid long-term stimulation of the food, leading to diverticulitis, erosion, and ulcers. If the symptoms are severe and the effect of internal medicine treatment is not good, and the diverticulum neck is narrow and the base is wide, or complications such as ulcers and perforations occur, surgical treatment should be considered when excluding cancer and massive bleeding. The surgical methods include intramural inversion suture of the gastric wall, simple diverticulectomy, and partial gastrectomy. The surgery for diverticula at the cardia is more difficult, and sometimes a combined thoracoabdominal incision is needed to fully expose the area. The postoperative effect is generally good.

　　II. Prognosis

　　For patients with severe symptoms, the effect of internal medicine treatment is not good. After surgical treatment, the effect is generally better.