P4216 - Radiation Gastritis: A Rare Cause of Melena

Alexandria Markley, MD¹, Ahmun Zafar, DO¹, James Scharfen, MD¹, Dylan Suyama, MD¹, Mohamed Rabie, MD¹, Phuong Nguyen, MD¹, Guangjing Zhu, MD, PhD¹, Mark Alon, MD¹, Yuying Luo, MD², Zoe Lawrence, MD^1
1Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY; ²Mount Sinai Center for Gastrointestinal Physiology & Motility, New York, NY

Introduction: Chemoradiation-induced gastritis is an uncommon complication that arises from inflammatory and ischemic damage to gastric mucosa induced by radiation and chemotherapy. The resulting gastritis can lead to symptoms such as epigastric pain, nausea, vomiting, and gastrointestinal (GI) bleeding. We present a rare case of chemoradiation-induced gastritis following radiotherapy.

Case Description/Methods: A 72- year-old male with a history of colon cancer status post (s/p) hemicolectomy, Hepatitis C s/p treatment complicated by cirrhosis and hepatocellular carcinoma (HCC) s/p 10 fractions of radiation presented with three months of melena and epigastric pain. Upon presentation, vitals were stable, hemoglobin was 4.6 g/dl, and digital rectal exam revealed brown stool. He was started on IV protonix and an Esophagogastroduodenoscopy (EGD) revealed multiple gastric and duodenal ulcers as well as friable antral mucosa with oozing. Pathology revealed active chronic Russell body gastritis with erosions and reactive changes including foveolar hyperplasia, dilated capillaries and scattered smudge cells, suggestive of chemoradiation related changes. He received a total of 14 units of packed red blood cells and was discharged on oral protonix, sucralfate, and a prednisone taper. He has since resumed his chemotherapy and has not undergone further radiation.

Discussion: In a patient with no other risk factors for upper GI bleeding, consider radiation exposure as a possible etiology of gastritis. In chemoradiation-induced gastritis, EGD may reveal erythematous, hemorrhagic, or ulcerated mucosa focused within the field of radiation. This finding emphasizes the importance of minimizing the field of exposure as much as possible. Characteristic histologic features include epithelial apoptosis and atypia, mucosal eosinophilia and inflammation, and vascular dilation and thrombi. Although typical management of upper GI bleeding including PPI is indicated, radiation gastritis may not respond fully to acid suppression, such as in our patient's case. Sucralfate offers some mucosal protection and steroids can be considered for their anti-inflammatory properties. Other treatment options can be applied from treatment for the more common radiation proctitis, including argon plasma coagulation, hemospray, and hyperbaric oxygen therapy.








Disclosures:


Alexandria Markley, MD¹, Ahmun Zafar, DO¹, James Scharfen, MD¹, Dylan Suyama, MD¹, Mohamed Rabie, MD¹, Phuong Nguyen, MD¹, Guangjing Zhu, MD, PhD¹, Mark Alon, MD¹, Yuying Luo, MD², Zoe Lawrence, MD¹. P4216 - Radiation Gastritis: A Rare Cause of Melena, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.