Clinical characteristics of five patients with gastric emphysema

Gastric emphysema is a rare condition in which gas from a nonbacterial source accumulates within the gastric wall. In this study, we retrospectively analyzed the cases of five patients who were diagnosed with gastric emphysema at the Okayama University Hospital between January 2010 and April 2021, to reveal the clinical features of the disease. Based on their reviews, we revealed that: i) gastric emphysema occurred in hospitalized bedridden patients (n=5), such as those during/after endotracheal intubation (n=3), those undergoing gastric tube placement (n=3), those undergoing percutaneous endoscopic gastrostomy (n=1), and those undergoing treatment for cerebral infarction (n=1);ii) gastric emphysema was accompanied by the accumulation of gas in the portal (n=4) or gastric veins (n=1); iii) gastric emphysema was accompanied by colon wall thickness increase (n=4); iv) esophagogastroduodenoscopy showed redness, erosions, coarse mucosa, and/or ulcers (n=5); v) a clear boundary between the damaged area and the intact mucosa was ob¬ served (n=5); vi) the anterior wall of the stomach was less affected (n=4); vii) mucosal damage was predomi¬ nant in the gastric folds, whereas the furrow of the mucosa was less affected; and viii) treatment with enteral nutrition suspension and the administration of proton pump inhibitors and antibiotics resulted in the recovery of patients from gastric emphysema (n=5). These results indicate that patients with gastric emphysema have distinct clinical, endoscopic, and radiological features. Furthermore, our results show that these patients can be conservatively managed.