Gastric Ischemia Secondary to Atherosclerotic Disease: A Case Report and Literature Review

Gastric ischemia is an uncommon entity, as the stomach has an extensive collateral arterial blood supply; clinically significant injury usually requires multivessel mesenteric compromise.When it occurs, it closely mimics peptic ulcer disease and gastric malignancy, and diagnosis is often delayed.A 77-year-old female patient with poorly controlled type 2 diabetes mellitus and dyslipidemia (non-compliant with metformin and atorvastatin) presented with a one-month history of severe postprandial epigastric pain, progressive food avoidance, and 10 kg of unintentional weight loss.She was admitted for pain management and further evaluation.Upper GI endoscopy revealed severe erosive gastroduodenitis with multiple gastric ulcers and a large duodenal ulcer.Tests for Helicobacter pylori were negative.Nonsteroidal anti-inflammatory drug use was not reported.Histopathology was negative for malignancy.Serum lactate and lactate dehydrogenase were within normal limits.Contrast-enhanced computed tomography angiography showed severe multivessel atherosclerotic disease, with near-complete occlusion of the coeliac trunk, a 3-cm segment of severe superior mesenteric artery stenosis with areas of near-complete luminal occlusion, and 40% stenosis of the inferior mesenteric artery.At multidisciplinary review, the diagnosis of chronic mesenteric ischemia presenting as ischemic gastroduodenitis was made, and the patient underwent endovascular angioplasty with stenting of the superior mesenteric artery with resolution of symptoms and complete endoscopic mucosal healing.She was discharged on dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) in addition to fenofibrate, atorvastatin, and strict low-fat diet.At six-month follow-up, she was asymptomatic with a normal complete blood count and liver enzyme panel, and her lipid profile had markedly improved from admission.Chronic ischemic gastroduodenitis should be considered in elderly patients with postprandial pain, weight loss, and diffuse H. pylori-negative gastroduodenal ulceration.Normal serum lactate does not exclude the diagnosis.Revascularization of the isolated superior mesenteric artery can reverse ischemic gastric injury even with coeliac artery occlusion.