S3130 Unrevealing Emphysematous Gastritis: Insight From a Comprehensive Systematic Review

Introduction: Emphysematous gastritis (EG) is a rare and fatal condition. It is associated with a high mortality rate, but early diagnosis and treatment can significantly reduce mortality and improve patient outcomes. We aim to compile relevant data from known cases of EG to enhance our understanding of the disease. Methods: We searched PubMed, Scopus, Web of Science, and Embase from inception until October 2024 to find relevant case reports or case series on EG. Results: One-hundred sixteen case reports and case series revealed that patient ages ranged from 4 months to 96 years (mean age: 55 years), male (60%). Most cases were reported in Asia and the U.S. The majority of symptoms were 90% abdominal pain and 80% vomiting and nausea. Infection of the gastric wall by gas-forming organisms was commonly Sarcina ventriculi. Abdominal computed tomography (CT) scans identified emphysematous changes in 95% of cases. Endoscopic examinations revealed gastric mucosal erythema in 80% of patients, with elevated leukocytosis in 80% of cases. The majority of the recovery rate was 70%, and the mortality rate was 15% (75% received medical treatment, 25% surgical treatment). Conclusion: This review highlights the clinical and diagnostic characteristics, management strategies, and outcomes of EG. EG, though rare, is a severe condition that requires prompt recognition and management due to its potential for high morbidity and mortality. CT was consistently the dominant diagnostic modality across the included cases. As an initial imaging test, CT is highly sensitive for detecting hallmark features such as gastric wall thickening, intramural gas, and portal venous gas. Management approaches were categorized into medical management, such as broad-spectrum antibiotics, fluid resuscitation, and supportive care, as well as surgical interventions, including partial or total gastrectomy. Mortality rates varied across reported cases but were generally lower than historically described for EG. Advances in diagnostic imaging, early initiation of antibiotics, and critical care support may have contributed to improved survival rates in recent reports. Despite this, the condition remains life-threatening, needs close monitoring and timely intervention. EG requires a multidisciplinary approach for optimal outcomes. CT imaging remains pivotal for diagnosis, and management should be individualized based on disease severity and patient factors.