Chronic ischemic gastroduodenitis: an unusual endoscopic finding

Results A 71 years-old woman referred to our Endoscopy Unit for recurrent post-prandial epigastric pain.She was a smoker (40 packs/year) with a history of systemic hypertension and breast cancer. Since 2019, the patient had undergone several esophagogastroduodenoscopies (EGDs), which showed patchy erosions of the gastric antrum. The histological report evidenced mild gastritis (OLGA score I). A previous abdominal CT scan (without contrast medium) showed no pathological features. During the last three weeks, she has complained of worsening symptoms after an episode of suspicious gastroenteritis. We decided to repeat EGD, showing a hypoperistaltic stomach with ulcers and pale mucosa in the whole gastric antrum. The duodenum has also been involved with multiple erosions and hyperemic appearance. An abdomen CT scan with contrast medium showed a proximal abdominal aortic aneurism with total occlusion of the celiac trunk and mesenteric superior artery without radiological findings suggesting acute gastric ischemia. The patient has been treated with enteral nutrition, iv antibiotics, antiplatelet agents, high-dose statin and infusion of prostaglandins with clinical improvement. An EGD has been repeated with a demonstration of partial healing of the described ulcers and reduced palish appearance of the gastric and duodenal mucosa. The patient has been referred to Vascular Surgeon for endovascular treatment.