Emphysematous gastritis: Causes, treatment, and more

Emphysematous gastritis refers to inflammation in the stomach or gas in the wall of the stomach.

Emphysematous gastritis occurs when organisms that produce gas colonize the stomach and digestive tract. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, as well as medical conditions, such as kidney disease, diabetes, alcoholism, and recent stomach surgery, increase the risk.

A 2020 paper reports that it is very rare, with just 59 cases reported in the English language medical literature through 2014. For this reason, there is no standard treatment. Supportive care, including antibiotics and sometimes surgery, increases survival.

The condition can be very dangerous, with a death rate of around 60%. People with emphysematous gastritis require emergency treatment.

Read on to learn more about emphysematous gastritis, including the causes, symptoms, and treatment.

Gastroitis refers to inflammation in the stomach lining. Multiple causes underlying for this are possible, and the condition may have links to pain. Emphysematous gastritis means that there is gas in the wall of the stomach. Doctors may also call it gastric pneumatosis.

There may also be gas in the veins surrounding the stomach. This increases the risk of death to 75%.

Microorganisms that produce gas cause the gas in the stomach. Some common species involved include various types of Streptococcus bacteria, Escherichia coliand sometimes yeast.

People with emphysematous gastritis typically have systemic illnesses, not just stomach problems. The condition can affect the heart, lungs, circulation, and organs such as the kidneys and liver.

However, gastric emphysema is distinct from emphysematous gastritis. The former is usually benign and occurs when there is gas in the stomach wall, while emphysematous gastritis develops when an infection causes the gas.

Emphysematous gastritis occurs when microorganisms that release gas colonize the lining of the stomach. This can happen when the organisms enter through an injury in the stomach wall. Therefore, stomach injuries from surgery, excessive drinking, ulcers, or infections are major risk factors.

A person is more likely to develop emphysematous gastritis if they have certain comorbidities, such as diabetes, alcoholism, or recent stomach surgery. Drugs that increase the risk of ulcers and stomach bleeding, such as NSAIDs, can also elevate the risk.

However, this is a rare condition that even people with many risk factors do not usually develop.

The symptoms of emphysematous gastritis are nonspecific. They commonly occur with many different illnesses, and the absence of some symptoms does not mean a person does not have emphysematous gastritis.

Some common symptoms include:

  • having signs of systemic illness, such as rapid heart rate and low blood pressure
  • feeling very sick
  • stomach pain that gets progressively worse and leads to severe illness
  • vomiting, nausea, and diarrhea
  • signs of organ failure

People who have intense unexplained stomach pain that does not quickly get better or leads to other symptoms, such as a rapid heart rate, should contact a doctor or seek emergency care. Symptoms typically worsen very quickly without treatment and may become life threatening.

Doctors cannot diagnose emphysematous gastritis according to symptoms alone. This is because its symptoms are nonspecific and could indicate various medical conditions.

This means that a doctor may recommend imaging scans of the stomach if a person has intense stomach pain along with risk factors for serious illness.

A CT scan usually shows gas in the stomach. It may also indicate gas in the surrounding veins and looping or obstruction of the intestines.

Cultures of fluid from the stomach may reveal the presence of bacteria that release gas. Additionally, blood work may reveal signs of inflammation but may not show other specific signs.

There is no standardized treatment because emphysematous gastritis is so rare.

Before 2000, doctors often recommended surgery to look for injuries and remove blockages and damaged tissue. However, a 2020 paper reports that the decrease in surgeries for emphysematous gastritis also correlates with a decrease in deaths. Surgery for this condition can pose risks, especially since people who experience it may be older or have multiple health issues.

Newer evidence suggests that a person may have better outcomes with conservative treatment that monitors and manages symptoms as they arise.

For example, a 2019 case series detailed the history of three people with emphysematous gastritis. Doctors gave all three proton pump inhibitor drugs, intravenous fluids, and antibiotics while monitoring them in the hospital. All three avoided eating or drinking during treatment, and they all survived, despite being older adults with several comorbidities.

An older 2013 paper Points to a few absolute indications for surgery, including intestinal strictures, which are narrowed portions of the intestines, and perforations in the intestines or stomach.

Emphysematous gastritis is extremely rare, and doctors have identified some risk factors and comorbidities that tend to occur with this condition. However, they do not know why some people develop the condition and why most do not. Even those with many risk factors are unlikely to develop emphysematous gastritis.

Some risk factors include:

Additionally, people who develop emphysematous gastritis often have several comorbidities.

The outlook for emphysematous gastritis is typically not good. A diagnosis leads to death in nearly 60% of these cases. Many have underlying medical conditions that make recovery difficult and surgery dangerous.

However, emerging research suggests that conservative medical management, especially when a person seeks early treatment, may improve the chances of survival. In a 2019 case series, all three patients survived with conservative management. This suggests the outlook may improve with appropriate early care.

Emphysematous gastritis is a serious, life threatening condition that requires immediate medical care. Around 60% of people with this condition do not survive, but prompt care can increase survival rates.

People with intense stomach pain following a medical procedure or injury, or those who experience stomach symptoms with comorbidities, such as diabetes, should seek medical attention promptly.

If the pain is intense or a person feels very sick, they should go to the emergency room.

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