Emphysematous gastritis: a systematic review of reported cases exploring predictors of mortality

Emphysematous gastritis (EG) is a rare but life-threatening condition caused by gas-forming bacterial infection of the gastric wall. The rarity of this disease has resulted in limited consolidated data, making it essential to review reported cases to identify clinical predictors of mortality. This systematic review synthesizes current evidence on EG, focusing on epidemiology, clinical presentation, diagnostic modalities, treatment strategies, and factors associated with mortality.

A systematic literature search was conducted in PubMed, Embase, and Scopus from inception to November 15, 2024, to identify published case reports and case series of adults diagnosed with EG. Extracted data included demographics, clinical presentation, laboratory findings, imaging modalities, endoscopic evaluation, therapeutic approaches, and reported complications. Descriptive analyses were first performed to characterize the clinical, diagnostic, and management patterns of EG across reported cases. The primary outcome of interest was mortality, and univariate and multivariate logistic regression analyses were conducted to identify independent predictors of death. This review was registered on PROSPERO (CRD42025630471). Study quality was assessed using the Joanna Briggs Institute (JBI) checklist. A total of 180 articles describing 189 cases were included.

A total of 189 cases of EG were identified, with a mean age of 61.7 years and a male predominance (62.4%). Common symptoms included gastric pain (78.3%), vomiting (59.8%), and hematemesis (23.8%). Computed tomography (CT) imaging was the primary diagnostic tool (89.9%), and esophagogastroduodenoscopy (EGD) was performed in 49.7% of cases. Treatment included antibiotics (76.0%), nasogastric decompression (26.7%), total parenteral nutrition (TPN) (10.6%), and surgical intervention (28.0%). The overall mortality rate was 26.9%. Alcohol use [odds ratio (OR): 4.16, P=0.02], chemotherapy (OR: 5.60, P=0.003), and gastric perforation (OR: 6.59, P<0.001) significantly increased mortality, while EGD was associated with reduced mortality (OR: 0.44, P=0.02) and lower risk of gastric perforation (OR: 0.08, P<0.01).

EG is a rare condition with high mortality. Alcohol use, chemotherapy, and gastric perforation are associated with a higher risk of death, while EGD appears safe. Early recognition, CT diagnosis, and timely supportive care remain central to management.