Pathogenesis, diagnosis, and management of gastric ischemia.
OBJECTIVE
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.
Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi. Electronic address: stang@umc.edu.
Shou-Jiang
SJ
Tang
Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
Sumanth R
SR
Daram
Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
Ruonan
R
Wu
Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi.
Feriyl
F
Bhaijee
D000328:Adult; D000369:Aged, 80 and over; D002445:Celiac Artery / Q000033:anatomy & histology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D011379:Prognosis; D013270:Stomach / Q000098:blood supply* / Q000473:pathology; D013277:Stomach Volvulus / Q000150:complications
CT; Endoscopy; GI; Gastric Ischemia; Gastrointestinal Bleeding; Ischemia; NG; PPI; Stomach; Ulceration; computed tomography; gastrointestinal; nasogastric; proton pump inhibitor