Ischemic Gastropathic Ulcer Mimics Gastric Cancer

Upper gastrointestinal lesions in patients with lower extremity peripheral artery disease: data from a retrospective analysis

Aim. To assess the prevalence and structure of upper gastrointestinal (GI) lesions, as well as the factors associated with their development, in patients with lower extremity peripheral artery disease (PAD).

Material and methods. This retrospective analysis of medical records with lower extremity PAD includes data from 258 patients. All patients underwent multislice computed tomography angiography of abdominal aortic visceral branches and lower limb arteries, as well as esophagogastroduodenoscopy.

Results. Endoscopic evidence of upper GI lesions was detected in 164 (63,6%) patients. In particular, gastroduodenal erosions and ulcers were observed in 57,8% of patients. All patients were divided into two groups: group I — 149 (57,8%) patients with gastroduodenal erosions and ulcers, group II  — 109 (42,2%) patients without it. In group I patients, a higher incidence of mesenteric artery disease was recorded  — 61,7 vs 43,1% (p=0,003). An independent factor associated with the development of gastroduodenal erosions and ulcers in patients with PAD is mesenteric artery disease (relative risk: 4,43; 95% confidence interval: 1,15-17,12 (p=0,031)).

Conclusion. In patients with lower extremity PAD, upper GI diseases (63,6%) occur with a high frequency, while gastroduodenal erosions and ulcers was observed in 90,9% of them. The factors associated with the development of erosions and ulcers in patients with lower extremity PAD include mesenteric artery atherosclerosis.

Gastric ischaemia: a rare cause of gastric ulcers

Gastric ulcers secondary to gastric ischaemia is rare because of the rich blood supply of the stomach. We present a case where a patient with history of atherosclerotic vascular disease (ASCVD) presented with unintentional weight loss and failure to thrive for several months. Initial imaging studies ruled out any active malignancy. Oesophagogastroduodenoscopy revealed multiple shallow gastric ulcers. CT angiography was performed in later course of the hospital stay, which demonstrated a high-grade stenosis at the origin of both the superior mesenteric artery and the coeliac trunk. This combination stenosis is a rare finding, which can lead to ischaemia of the stomach by blocking the stomach's dual blood supply. Although the patient underwent revascularisation attempt with stent placement, she expired due to critical postoperative condition. This case signifies the importance of keeping a low threshold for suspicion for gastric ischaemia in patients with ASCVD risk factors and unexplained weight loss.