Emphysematous gastritis: The silent storm within the stomach wall

Emphysematous gastritis is a rare, life-threatening condition characterized by inflammation of the stomach lining and gas within the gastric wall, with a mortality rate ranging from 55% to 61%. Emphysematous gastritis is caused by gas-producing bacteria and fungi that can infect both gastric and bowel walls. Risk factors include diabetes, corticosteroid use, prolonged nonsteroidal anti-inflammatory drug use, neoplasia, recent abdominal surgery, and other conditions that compromise immune function. Emphysematous gastritis can present with nonspecific symptoms such as abdominal pain, nausea, vomiting, diarrhea, and fever; however, severe manifestations such as hematemesis and sepsis may also occur. Symptoms alone are insufficient for establishing a definitive diagnosis; computed tomography is the most effective imaging modality to identify characteristic findings. Management typically involves conservative treatment with bowel rest, hydration, and intravenous antibiotics. Surgical intervention may be required in cases of clinical deterioration; however, its role remains controversial. Recent studies have questioned the necessity of surgery, emphasizing early medical management to improve outcomes. This narrative review aims to provide an overview of emphysematous gastritis, focusing on its pathophysiology, clinical features, diagnostic methods, and treatment strategies. It highlights the significance of timely intervention to improve survival and reduce the high mortality associated with this rare condition.