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Clinical Features and Outcomes of Gastric Ischemia
Ayush Sharma1, Saurabh Mukewar1, Suresh T Chari1
1Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Insights
Gastric ischemia is a rare but serious condition. This study highlights its clinical features, diagnostic methods like endoscopy and CT imaging, and management strategies, noting a 24% mortality rate.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Radiology
Background:
- Gastric ischemia is an uncommon condition with a high mortality rate.
- Understanding its clinical presentation and outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the clinical features, diagnostic modalities, and outcomes of patients diagnosed with isolated gastric ischemia.
- To identify factors influencing the prognosis and management of gastric ischemia.
Main Methods:
- A retrospective review of 17 patients diagnosed with isolated gastric ischemia between January 2000 and May 2016.
- Analysis of demographic, clinical, endoscopic, radiologic, and outcome data.
Main Results:
- The study identified 17 patients (65% male, mean age 69.3 years).
- Common etiologies included vascular causes, hypoperfusion, and obstruction. Presenting symptoms were abdominal pain, GI bleeding, and altered mental status.
- Endoscopy revealed mucosal changes, while CT showed gastric pneumatosis and portal venous air. Mortality was 24% within 6 months.
Conclusions:
- Gastric ischemia, though rare, carries significant mortality.
- Endoscopy and CT imaging are vital for diagnosis.
- Management should be tailored to disease severity and patient comorbidities.
Background And Aims:
Gastric ischemia is a rare condition associated with poor prognosis. Our study aim was to highlight the clinical features and outcomes of patients with gastric ischemia.
Methods:
A retrospective review of patients diagnosed with isolated gastric ischemia at our institution from January 1, 2000, to May 5, 2016, was performed. Demographic, clinical, endoscopic, radiologic, and outcome variables were abstracted for analysis.
Results:
Seventeen patients (65% men) with mean age of 69.3 ± 11.3 years and body mass index of 28.8 ± 11.1 were identified. The etiologies for gastric ischemia included local vascular causes (n = 8), systemic hypoperfusion (n = 4), and mechanical obstruction (n = 5). The most common presenting symptoms were abdominal pain (65%), gastrointestinal bleeding (47%), and altered mental status (23%). The typical endoscopic appearance was mucosal congestion and erythema with or without ulceration. Gastric pneumatosis and portal venous air were more commonly seen on CT imaging. Radiologic and/or surgical intervention was needed in 9 patients, while the remaining 8 patients were managed conservatively with acid suppression, antibiotics, and nasogastric tube decompression. The median duration of hospital stay was 15 days (range 1-36 days). There were no cases of rebleeding and the mortality rate as a direct result of gastric ischemia was 24% within 6 months of diagnosis.
Conclusion:
Although uncommon, gastric ischemia is associated with significant mortality. Endoscopy and CT imaging play an important role in its diagnosis. The management of gastric ischemia is dictated by its severity and associated comorbidities.
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