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Turunen AM, Coombs RA, Garg SK. Semaglutide-Associated Gastric Pneumatosis. ACG Case Rep J 2025; 12:e01579. [PMID: 39734391 PMCID: PMC11671069 DOI: 10.14309/crj.0000000000001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 11/22/2024] [Indexed: 12/31/2024] Open
Abstract
Semaglutide, a glucagon-like peptide-1 receptor agonist, used for Type 2 diabetes mellitus and more recently for weight loss, often causes gastrointestinal adverse effects such as delayed gastric emptying and abdominal discomfort. Current literature has not described an associated case of gastric pneumatosis with semaglutide use. We report a 61-year-old man on semaglutide for 9 months with gastric pneumatosis. Symptoms resolved on discontinuation. Clinicians should be vigilant for significant gastrointestinal adverse effects, including pneumatosis with semaglutide use.
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Affiliation(s)
- Andrew M. Turunen
- School of Medicine, Medical College of Wisconsin-Central Wisconsin, Wausau, WI
| | - Reilly A. Coombs
- School of Medicine, Medical College of Wisconsin-Central Wisconsin, Wausau, WI
- Division of Gastroenterology, Mayo Clinic Health System, Eau Claire, WI
| | - Sushil Kumar Garg
- Division of Gastroenterology, Mayo Clinic Health System, Eau Claire, WI
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Ladna M, George J, Forsmark C. Large gastric ulcer presenting as gastric pneumatosis. BMJ Case Rep 2023; 16:e256724. [PMID: 37723089 PMCID: PMC10510873 DOI: 10.1136/bcr-2023-256724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/20/2023] Open
Abstract
A man presented with nausea, vomiting, abdominal pain and diarrhoea. Cross-sectional imaging of the abdomen and pelvis showed gastric pneumatosis. He was treated conservatively with broad-spectrum antibiotics, bowel rest, nasogastric tube placement for gastric decompression and intravenous proton pump inhibitor therapy. He developed an upper gastrointestinal bleed during hospitalisation and underwent an esophagogastroduodenoscopy (EGD) which revealed a large >50 mm cratered gastric ulcer. Initial biopsy was inconclusive for malignancy thus a repeat EGD was scheduled however prior to that procedure he returned to the emergency department with severe abdominal pain. CT of the abdomen and pelvis showed recurrence of gastric pneumatosis. Repeat EGD showed a 4 mm linear gastric ulcer and repeat biopsies showed gastric mucosa with moderate chronic inactive gastritis without any metaplasia, dysplasia, carcinoma or amyloid. He was once again treated successfully with conservative measures and discharged after short hospitalisation.
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Affiliation(s)
- Michael Ladna
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - John George
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Christopher Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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3
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Shionoya K, Sasaki A, Moriya H, Kimura K, Nishino T, Kubota J, Sumida C, Tasaki J, Ichita C, Makazu M, Masuda S, Koizumi K, Kawachi J, Tsukiyama T, Kako M. Clinical features and progress of ischemic gastritis with high fatalities: Seven case reports. World J Clin Cases 2022; 10:8686-8694. [PMID: 36157813 PMCID: PMC9453346 DOI: 10.12998/wjcc.v10.i24.8686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/11/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ischemic gastritis is a clinically rare and highly fatal disease that occurs when the hemodynamics of a patient with vascular risk is disrupted. Early diagnosis and treatment are possible only with upper endoscopy after symptom appearance. We report seven cases of ischemic gastritis and its clinical features, prognosis, and indicators that may help in early detection.
CASE SUMMARY Of the seven patients, six had vascular risk and five died within 2 wk of diagnosis. Their symptoms included hematemesis and hypotension. Although surgery is a choice for radical treatment, not all patients were tolerant. For such patients, conservative treatment was selected, but all of them died. In contrast, patients who underwent repeat endoscopy showed improved mucosal findings, suggesting that this improvement may not affect prognosis. Some ischemic changes such as wall thickening, mural emphysema, and fluid retention in the stomach were observed before diagnosis through endoscopy and computed tomography (CT). The CT scan can be effective for early detection, and improvement in circulatory failure and aggressive treatment may save the lives of patients with this disease.
CONCLUSION The characteristic CT findings enable early detection of ischemic gastritis. Early diagnosis increases the chance of survival if early therapeutic intervention and improvement of circulatory dynamics can be achieved in this highly fatal disease.
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Affiliation(s)
- Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Hidekazu Moriya
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Jun Kubota
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Chihiro Sumida
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Jun Kawachi
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Toshitaka Tsukiyama
- Department of Radiology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
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Bloom MD, Ladna M. Conservative management of gastric pneumatosis following left gastric artery embolisation. BMJ Case Rep 2022; 15:15/8/e249773. [PMID: 36041774 PMCID: PMC9438043 DOI: 10.1136/bcr-2022-249773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gastric pneumatosis, the presence of air within the stomach wall, is a very rare occurrence with poor outcomes. One of the most common mechanisms for gastric pneumatosis is gastric ischaemia, also a rare entity. Although patients with gastric ischaemia may require surgical intervention, they can often be treated with conservative measures such as a proton pump inhibitor, broad-spectrum antibiotics, nasogastric tube decompression, fluid resuscitation and total parenteral nutrition. We report a rare case of gastric ischaemia and pneumatosis following therapeutic left gastric artery argon plasma coagulation that was treated with conservative measures.
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Affiliation(s)
- Matthew D Bloom
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Michael Ladna
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Tomishima K, Sato S, Amano N, Murata A, Tsuzura H, Sato S, Kanemitsu Y, Shimada Y, Iijima K, Genda T, Wada R, Nagahara A. A case of ischemic gastroduodenal disease in a patient who was receiving hemodialysis treatment that was managed by conservative treatment. Clin J Gastroenterol 2018; 11:386-390. [PMID: 29737481 DOI: 10.1007/s12328-018-0865-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/23/2018] [Indexed: 02/06/2023]
Abstract
A 69-year-old man was under maintenance dialysis due to diabetic renal failure. He had a drop in blood pressure during dialysis, developed hematemesis, and was transported to our hospital. Emergency upper gastrointestinal endoscopy revealed diffuse erosion, mucosal sloughing, and edematous mucosa in the upper body of the stomach to the posterior wall of the antrum and to the greater curvature, which were considered to be an ischemic change. His underlying diseases included diabetic renal failure, chronic arteriosclerosis obliterans, cerebral infarction, internal carotid artery stenosis, hypertension, and myocardial infarction. Blood evaluation showed only mild inflammation and no fibrinolytic hyperactivity. Contrast-enhanced computed tomography (CECT) showed no occlusion of blood vessels. It was considered that the patient had a transient ischemic change due to blood pressure drop. The patient's condition improved with conservative treatment.
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Affiliation(s)
- Ko Tomishima
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, 410-2295, Japan
| | - Sho Sato
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, 410-2295, Japan
| | - Nozomi Amano
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, 410-2295, Japan
| | - Ayato Murata
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, 410-2295, Japan
| | - Hironori Tsuzura
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, 410-2295, Japan
| | - Shunsuke Sato
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, 410-2295, Japan
| | - Yoshio Kanemitsu
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, 410-2295, Japan
| | - Yuji Shimada
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, 410-2295, Japan
| | - Katsuyori Iijima
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, 410-2295, Japan
| | - Takuya Genda
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, 410-2295, Japan
| | - Ryo Wada
- Department of Pathology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
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Abstract
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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Tang SJ, Daram SR, Wu R, Bhaijee F. Pathogenesis, diagnosis, and management of gastric ischemia. Clin Gastroenterol Hepatol 2014; 12:246-52.e1. [PMID: 23920033 DOI: 10.1016/j.cgh.2013.07.025] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 07/11/2013] [Accepted: 07/11/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Gastric ischemia is infrequently reported in the medical literature and under-recognized clinically and histopathologically. Various medical terms are used to describe gastric ischemia. We define and review the pathogenesis, diagnosis, and management of gastric ischemia. METHODS We describe 6 cases of gastric ischemia. We discuss features of the gastric vascular supply and review literature on this disorder. RESULTS Gastric ischemia results from diffuse or localized vascular insufficiency caused by etiologies such as systemic hypotension, vasculitis, or disseminated thromboembolism. The disorder is managed by fluid resuscitation, nasogastric tube placement (for intermittent air and fluid aspiration, to prevent or reduce gastric distention), aggressive acid reduction (via intravenous administration of proton pump inhibitors), and selective use of broad-spectrum antibiotics for patients with sepsis or gastric pneumatosis. CONCLUSIONS Gastric ischemia has a poor prognosis. Early diagnosis is required for appropriate patient management.
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Affiliation(s)
- Shou-Jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Sumanth R Daram
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Feriyl Bhaijee
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
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Boucau C, Guibert A, Guibert A, Monneuse O, Oulié O, Pilleul F, Allaouchiche B. [Gastric necrosis complicating a gastroparesis]. Presse Med 2008; 38:668-70. [PMID: 18952405 DOI: 10.1016/j.lpm.2008.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 04/07/2008] [Accepted: 04/16/2008] [Indexed: 11/28/2022] Open
Affiliation(s)
- Cécile Boucau
- Service d'anesthésie-réanimation, Hôpital Edouard Herriot, F-69433 Lyon Cedex 03, France
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Kotani T, Fujimura T, Amagase K, Okabe S, Takeuchi K. A novel gastric lesion model induced in rats by partial gastric vascular ligation. Inflammopharmacology 2006; 13:261-72. [PMID: 16259745 DOI: 10.1163/156856005774423926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Previous studies have suggested that histamine treatment after gastric vascular ligation induces mucosal damage in the rat stomach. Although ligation of left gastric artery and vein (L-AV) alone did not cause any damage in the stomach within 4 h, but provoked mild lesions due to ischaemia 24 h later. In the present study we demonstrated a new model of gastric lesions induced by L-AV ligation and examined the effects of various anti-ulcer drugs on this lesion model. The gastric lesions induced by L-AV ligation occurred at the corpus and antrum, especially at the corpus-antrum border, when examined 24 h later, and the severity of damage reached maximum 3 days after L-AV ligation. Repeated treatment with omeprazole or sucralfate for 3 days significantly prevented the development of gastric lesions induced by L-AV ligation, in whole mucosa, including the antrum. By contrast, famotidine given for 3 days showed a significant protection against total lesions in the whole mucosa, but had no effect on the antral lesions. Both omeprazole and famotidine dose-dependently decreased gastric acid output while sucralfate raised the intraluminal pH due to the acid-neutralizing action. These results suggest that the pathogenesis of gastric lesions induced by L-AV ligation differs depending on the region, the corpus and the antrum, and the lesions occurred in the latter area seem to be resistant to acid suppression. It is assumed that this new model of gastric lesions is useful for screening the drugs that affect gastric mucosal defense rather than acid secretion.
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Affiliation(s)
- Tohru Kotani
- Department of Pharmacology and Experimental Therapeutics, Kyoto Pharmaceutical University, Misasagi, Yamashina, Kyoto 607-8414, Japan
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Abstract
This review discusses postoperative gastric ischaemia after detailed consideration of the gastric blood supply and the effects of devascularization. Special consideration is given to gastric remnant necrosis, lesser curve ischaemia after highly selective vagotomy, and gastric ischaemia after other operations.
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Affiliation(s)
- M Schein
- Department of Surgery, Medical School, University of the Witwatersrand, Johannesburg, South Africa
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Rau W, Eichelkraut W, Rasche A. [Experimental conditions for the reproduction of a submucous steal phenomenon in the dog stomach]. LANGENBECKS ARCHIV FUR CHIRURGIE 1986; 367:139-45. [PMID: 3959682 DOI: 10.1007/bf01259263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The influence of pentagastrin on gastric blood flow has been investigated using 9 mu-microspheres in dogs. As soon as 6 min after the onset of a pentagastrin infusion blood flow rises in all gastric probes in fasted animals. In dogs, fed two hours previously, such a response can only be seen in the corpus-mucosa areas. Blood flow in the antrum mucosa specimen falls beneath its initial value. This gastric steal-phenomenon takes place at the level of the submucous plexus, as has been shown earlier.
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Skarstein A, Lekven J. Influence of gastric banding on stomach blood supply with or without concurrent splenectomy. Am J Surg 1985; 149:351-6. [PMID: 3976990 DOI: 10.1016/s0002-9610(85)80106-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A lethal gastric perforation occurred after a gastric banding procedure, which was complicated with splenectomy. Prompted by this incident, an experimental study was undertaken in which regional blood flow in the stomach was measured in anesthetized cats after gastric banding or splenectomy or both. A fatal course with an extensive ischemic lesion of the stomach near the banding area was seen in all the cats with the combined procedure after 5 to 12 days. Banding alone reduced gastric blood flow within 24 hours, particularly on the greater curvature. Splenectomy also reduced blood flow along the greater curvature within 2 weeks. The combined procedure showed similar flow changes within 24 hours. The implication of these experimental results is that, if the spleen must be removed, the performance of gastric partitioning for morbid obesity should be reconsidered.
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