From the Guidelines
The initial workup for ischemic gastritis should include a thorough history and physical examination, followed by laboratory tests including complete blood count, comprehensive metabolic panel, and lactate level to assess for systemic hypoperfusion, as recommended by the most recent guidelines 1. The management of ischemic gastritis begins with hemodynamic stabilization through intravenous fluid resuscitation and correction of underlying causes of hypoperfusion, with the goal of enhancing visceral perfusion and preventing further mucosal damage 1. Key aspects of the initial workup and management include:
- Urgent endoscopy to diagnose and assess the extent of mucosal damage
- Administration of proton pump inhibitors, such as pantoprazole 40mg IV twice daily, to reduce gastric acid and prevent further mucosal damage
- Broad-spectrum antibiotics, such as piperacillin-tazobactam 3.375g IV every 6 hours, if perforation is suspected, as the high risk of infection among patients with AMI outweighs the risks of acquired antibiotic resistance 1
- Nasogastric decompression to reduce gastric distension
- Avoidance of anticoagulation unless specifically indicated for another condition
- Nutritional support via parenteral nutrition while bowel rest is maintained
- Surgical consultation for cases with perforation, necrosis, or clinical deterioration despite medical management Close monitoring in an intensive care setting is crucial, as ischemic gastritis carries high mortality rates due to the compromised blood supply to the stomach, which can lead to necrosis and perforation if not promptly addressed 1. The most recent guidelines emphasize the importance of a multidisciplinary approach, including general surgeons, vascular surgeons, interventional radiologists, and intensivists, to optimize outcomes in patients with ischemic gastritis 1.
From the Research
Initial Workup for Ischemic Gastritis
The initial workup for ischemic gastritis involves a combination of clinical evaluation, laboratory tests, and imaging studies. The presenting symptoms of ischemic gastritis can include gastrointestinal bleeding, abdominal pain, nausea, and symptomatic anemia 2.
- Laboratory tests: Complete blood count, electrolyte panel, liver function tests, and coagulation studies to evaluate for signs of bleeding, infection, or organ dysfunction.
- Imaging studies:
- Endoscopy to visualize the gastric mucosa and identify signs of ischemia, such as mucosal congestion and erythema with or without ulceration 3.
- Computed tomography (CT) scan to evaluate for gastric pneumatosis and portal venous air, which can be indicative of gastric ischemia 3.
- Angiography to evaluate the blood supply to the stomach and identify any vascular occlusions or stenosis.
Management of Ischemic Gastritis
The management of ischemic gastritis depends on the underlying cause and severity of the condition.
- Supportive care: Acid suppression, antibiotics, and nasogastric tube decompression may be necessary to manage symptoms and prevent further complications 3.
- Revascularization: Interventional radiology or surgical revascularization may be necessary to restore blood flow to the stomach in cases of vascular occlusion or stenosis 2.
- Surgery: In some cases, surgical intervention may be necessary to manage complications such as perforation or bleeding.
Etiologies and Outcomes
Ischemic gastritis can be caused by a variety of factors, including local vascular causes, systemic hypoperfusion, and mechanical obstruction 3. The outcomes of ischemic gastritis can be poor, with high mortality rates reported in the literature 2, 3, 4. Early diagnosis and treatment are essential to improve survival in patients with ischemic gastritis.
- Mortality rates: The 30-day and 1-year mortality rates for ischemic gastritis have been reported to be as high as 33% and 41%, respectively 2.
- Treatment outcomes: The treatment outcomes for ischemic gastritis can be variable, with some patients requiring prolonged hospitalization and others experiencing significant morbidity and mortality 3, 4.