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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical features and progress of ischemic gastritis with high fatalities: Seven case reports
Kento Shionoya, Akiko Sasaki, Hidekazu Moriya, Karen Kimura, Takashi Nishino, Jun Kubota, Chihiro Sumida, Junichi Tasaki, Chikamasa Ichita, Makomo Makazu, Sakue Masuda, Kazuya Koizumi, Jun Kawachi, Toshitaka Tsukiyama, Makoto Kako
Kento Shionoya, Akiko Sasaki, Karen Kimura, Takashi Nishino, Jun Kubota, Chihiro Sumida, Junichi Tasaki, Chikamasa Ichita, Makomo Makazu, Sakue Masuda, Kazuya Koizumi, Makoto Kako, 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
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
Author contributions: Shionoya K and Sasaki A contributed to the concept/design; Shionoya K, Sasaki A, Kimura K, Nishino T, Sumida C, Ichita C, and Tsukiyama T contributed to the observation, acquisition of data, and data analysis/interpretation; Sasaki A, Moriya M, Kimura K, Nishino T, Kubota J, Sumida C, Tasaki J, Ichita C, Makazu M, Masuda S, Koizumi K, Kawachi J, and Kako K contributed to the critical revision of the manuscript and approval of the article; Sasaki A supervised the paper; all authors read and approved the final manuscript.
Informed consent statement: Informed consent was waived by the Institutional Review Board of the hospitals.
Conflict-of-interest statement: The authors declare no conflict or competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Kento Shionoya, MD, Doctor, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura 247-8533, Kanagawa, Japan.
k_shionoya@shonankamakura.or.jp
Received: February 21, 2022
Peer-review started: February 21, 2022
First decision: April 5, 2022
Revised: April 11, 2022
Accepted: July 16, 2022
Article in press: July 16, 2022
Published online: August 26, 2022
Processing time: 175 Days and 13 Hours
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.
Core Tip: Ischemic gastritis is extremely fatal, especially in those with vascular risk. Early diagnosis and treatment is important. However, it is difficult to diagnose early unless the patient is symptomatic. Here we report seven cases of ischemic gastritis, of whom five patients died within 2 wk of diagnosis. Surgery could not be selected for our patients because of their poor general condition; instead, they were treated conservatively. Patients with improved mucosal findings on repeat endoscopy did not show increased survival. Characteristic computed tomography findings enable early detection of this disease.
