The blood supply to the stomach comes from an extensive vascular network formed by the abdominal arteries and their branches, and is less likely to suffer ischemic injury compared to other parts of the gastrointestinal tract. As a result, cases of ischemic gastritis are rare. The concept of ischemic gastritis was first introduced by Cohen in 1951 when he reported 3 cases and found 1 case of gastric ischemia in 24,000 patients at autopsy. Since then, ischemic gastritis has been reported only in case reports or small samples, with a maximum of 7 patients included. Recently, Elwir et al. of the University of Minnesota published a case series with a larger sample in J Clin Gastroenterol, focusing on the etiology, treatment, and mortality of ischemic gastritis, which is summarized below. Demographic characteristics, disease duration, microscopic presentation, imaging, and intraoperative findings were extracted from the medical records. At the same time, the English literature in the Pubmed database was systematically evaluated for the search terms “gastric ischemia” and “ischemic gastritis”. A total of 12 patients were finally included. The mean age was 63.7 years (32.1 to 83.2 years), and 75% (9/12) were male. Clinical symptoms included gastrointestinal bleeding in 8 (67%), abdominal pain in 2 (17%), nausea in 1 (8%), and symptomatic anemia in 1 (8%). 4 patients had a combination of congestive heart failure, atrial fibrillation in 1, acute kidney injury in 4, and ischemic bowel disease in 2. Eight patients presented with gastrointestinal bleeding, including black stools and vomiting of blood in four cases, vomiting of blood in three cases, and black stools in one case. All patients were hemodynamically stable. 4 patients had hemoglobin values similar to baseline values, and the remaining 4 patients had a median hemoglobin of 2.5 g (range 1 to 3 g), which was below baseline values. Eleven patients underwent upper gastrointestinal endoscopy, of whom eight had ulcers and/or erosions and three had mucosal inflammatory erythema. The remaining 1 patient was evaluated and underwent surgery. 7 patients underwent abdominal CT scan and 2 of them were found to have abdominal artery stenosis. The etiology included: embolism after intervention in 2 (17%) patients, stenosis of the celiac artery in 2 (17%), vasculitis in 1 (8%), hypotension in 1 (8%), however, the etiology was unknown in half (6/12, 50%) of the patients. The patients were treated according to the main etiology and clinical symptoms, including medication, interventional therapy, microscopic therapy, and surgery. The 30-day and 1-year mortality rates of the patients were 33% and 42%, respectively. The rat model of gastric ischemia showed that ligation of the left gastric artery and the right artery and vein of the gastric omentum resulted in linear hemorrhage of the gastric body mucosa in 75% of the rats within 4 hours and in all rats after 8 hours. extensive hemorrhagic erosions of the gastric body developed after 2 days and large ulcers after 3-5 days. In an experimental pig model of hemorrhagic shock, ischemic lesions of the gastric fundus and body were found to develop after 3 hours. Gastric dilatation can also reduce gastric perfusion and leads to mucosal necrosis when intragastric pressure exceeds 20 cm H2O, i.e., exceeds venous pressure. In the rat model, gastric dilatation combined with arterial occlusion will result in a more severe reduction in gastric perfusion than other independent factors. Gastric ischemia will further lead to ischemic gastroparesis and eventually ulcer formation. Endoscopically, gastric mucosa pallor, erythema, erosion or larger ulcer formation is seen. The diagnosis of ischemic gastritis in this case series study was based primarily on microscopic biopsies. The investigators note that the cases in this study were diagnosed primarily on the basis of pathology, which likely underestimates the incidence of ischemic gastritis, and that it is clinically important to distinguish between acute ischemic injury and chronic course because of the large difference in disease outcomes in patients with the two. Acute ischemia often leads to necrosis and perforation, and patients present with an acute abdomen that usually requires surgical treatment, with the highest mortality rate in such patients. Chronic ischemic gastritis is often associated with stenosis of the celiac or superior mesenteric artery, and revascularization can resolve the patient’s symptoms with good short-term results.