Emphysematous gastritis is a rare and severe condition involving inflammation of the stomach lining with gas present within the stomach wall. This gas accumulation typically results from infection by gas-forming microorganisms. The condition is considered a medical emergency due to its rapid progression and potential for life-threatening complications. It is distinct from gastric emphysema, which also involves gas in the stomach wall but is generally a more benign, non-infectious condition.
Underlying Causes and Risk Factors
The primary cause of emphysematous gastritis is the invasion of the stomach wall by gas-producing bacteria. Common culprits include species such as Streptococcus, Escherichia coli, Clostridium perfringens, Enterobacter, Pseudomonas aeruginosa, and Staphylococcus aureus, with yeast species like Candida also implicated. These microorganisms produce gas after penetrating the stomach lining, often through an injury or compromised mucosal barrier.
Several non-infectious factors can also contribute. These include reduced blood flow to the stomach (ischemia), and the ingestion of corrosive substances like strong acids or alkalis. Complications from recent abdominal surgery or procedures such as endoscopy can also disrupt the gastric mucosa, creating entry points for bacteria. Gastric outlet obstruction, which increases pressure within the stomach, can predispose individuals.
Certain underlying health issues and lifestyle factors increase susceptibility. Individuals with diabetes mellitus face a higher risk due to impaired immunity and delayed gastric emptying. A compromised immune system also elevates the risk. Other contributing factors include alcoholism, peptic ulcer disease, and gastroenteritis.
Recognizing the Symptoms
Emphysematous gastritis often presents with non-specific symptoms, making early recognition challenging. Patients experience sudden, severe abdominal pain, which may worsen progressively. This pain is often localized to the upper abdomen.
Accompanying the pain, individuals commonly report nausea and vomiting, which may include blood (hematemesis or “coffee-ground” emesis). Abdominal distention is also a common complaint, indicating gas accumulation. Fever is another common sign, reflecting the body’s response to infection.
As the condition advances, signs of systemic toxicity or shock can become apparent. These severe manifestations may include a rapid heart rate, low blood pressure, and confusion or altered mental status. These symptoms collectively suggest a serious and spreading infection.
The Diagnostic Process
Confirming a diagnosis of emphysematous gastritis relies heavily on medical imaging, given the non-specific nature of initial symptoms. A computed tomography (CT) scan of the abdomen is considered the most effective method for diagnosis. This imaging technique can clearly visualize the presence of gas within the stomach wall.
The CT scan can also reveal additional findings that support the diagnosis, such as thickening of the stomach wall or gas within the portal venous system. The presence of gas in the portal vein is a concerning sign, indicating severe disease. While an abdominal X-ray may show abnormal gas patterns, it is less detailed and often not as conclusive as a CT scan for definitive diagnosis.
Supporting imaging findings, laboratory tests provide further evidence of infection and systemic distress. Blood work shows an elevated white blood cell count, a sign of the body fighting an infection. Tests may also indicate metabolic acidosis or elevated lactate levels, reflecting severe illness and poor tissue perfusion. These laboratory markers, combined with imaging, assist medical professionals in confirming emphysematous gastritis and assessing its severity.
Treatment Approaches
Immediate and aggressive medical interventions are necessary for emphysematous gastritis. The initial treatment involves conservative medical management. This approach includes strict bowel rest (no food or drink by mouth) to allow the stomach to heal. A nasogastric tube may be inserted to decompress the stomach, removing accumulated gas and fluids.
Aggressive intravenous (IV) fluid resuscitation is also administered to stabilize blood pressure and support organ function. Broad-spectrum IV antibiotics target the various gas-forming bacteria. These antibiotics aim to control the infection and prevent its spread.
Surgical intervention is reserved for specific situations when medical management alone is insufficient or complications arise. Surgery, which may involve a gastrectomy (removal of part or all of the stomach), is considered for patients who show signs of gastric perforation, extensive tissue death (necrosis), or failure to improve despite aggressive medical therapy. The decision for surgery is guided by the patient’s response to initial treatment and the presence of these severe complications.
Prognosis and Recovery Outlook
Emphysematous gastritis carries a serious outlook, with a reported mortality rate ranging from 55% to 61%. Some reports indicate the risk of death can be as high as 75% if gas is also present in the veins surrounding the stomach. Its prognosis is highly dependent on several factors.
A patient’s overall health and the presence of other medical conditions significantly influence the outcome. The specific cause of the gastritis, whether infectious or non-infectious, also plays a role in determining the course of the disease. The speed of diagnosis and prompt initiation of appropriate treatment are impactful on survival.
Early and aggressive intervention, including broad-spectrum antibiotics and supportive care, has been shown to improve patient outcomes. For those who survive, the recovery process can be prolonged, especially if surgical intervention was required. The extent of recovery often depends on the severity of the damage to the stomach and the patient’s ability to heal.