Emphysematous Gastritis: A Systematic Review Exploring the Impact of Endoscopy on Mortality and Perforation Risk

Background Emphysematous gastritis (EG) is a rare but life-threatening condition caused by gas-forming bacterial infection of the gastric wall. Despite increasing recognition, there are no standardized guidelines, leading to variability in diagnosis, management, and outcomes. This systematic review synthesizes current evidence on EG, focusing on epidemiology, clinical presentation, diagnostic modalities, treatment strategies, and prognostic factors. Methods A systematic literature search was conducted in PubMed, Embase, and Scopus from inception to November 15, 2024, including case reports and case series of adults with EG. Primary outcomes were pooled mortality and complication rates, while secondary outcomes included risk factors and the role of diagnostic imaging and esophagogastroduodenoscopy (EGD). Univariate and multivariate analyses were performed to identify predictors of perforation and mortality. Results A total of 189 cases of EG were identified, with a mean age of 61.7 years and a male predominance (62.4%). Common symptoms included abdominal pain (78.3%), vomiting (59.8%), and hematemesis (23.8%). Computed tomography (CT) imaging was the primary diagnostic tool (89.9%), and EGD was performed in 49.7% of cases. Treatment included antibiotics (76.0%), nasogastric decompression (26.7%), total parenteral nutrition (10.6%), and surgical intervention (28.0%). The overall mortality rate was 26.9%. Alcohol use (OR: 4.16, p = 0.022), chemotherapy (OR: 5.60, p = 0.003), and abdominal perforation (OR: 6.59, p < 0.001) significantly increased mortality, while EGD was associated with reduced mortality (OR: 0.44, p = 0.021) and lower risk of perforation(OR = 0.08, p < 0.01). Conclusions EG carries high mortality and management variability. Broad-spectrum antibiotics and supportive care remain essential. EGD could enhance early diagnosis and guide therapy, and is considered safe when combined with CT.