Pneumatosis Intestinalis and Associated Gas-Related Disorders
Summary
Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the gastrointestinal tract and ranges from benign, asymptomatic cysts to life-threatening conditions. Its manifestations include pneumatosis cystoides intestinalis, characterised by multiple gas-filled cysts in the submucosa and subserosa, and related disorders such as gastric emphysema, portal venous gas and emphysematous gastritis. Aetiologies span idiopathic forms, increased intraluminal pressure, mucosal injury, bacterial gas production and medication-induced mucosal changes. Clinical presentation varies from incidental radiological findings to acute abdominal pain, distension, diarrhoea and signs of peritonitis. Computed tomography remains the gold standard for detecting intramural gas and associated vascular gas, while endoscopy and endoscopic ultrasound afford direct visualisation of subepithelial gas collections. Management is tailored to underlying cause and severity, ranging from conservative measures—high-flow oxygen, antibiotics, dietary adjustments—to emergent surgery in cases of ischaemia or perforation. Recent advances have emphasised the role of gas-producing microbes, novel pathogens and drug-related triggers, informing refined diagnostic pathways and risk-stratified therapeutic strategies on a global scale.
Research from Nature Portfolio
Recent work has illuminated the clinical and endoscopic characteristics of gastric emphysema, a non-infectious intramural gas disorder of the stomach. A multicentre analysis of 45 patients described predominant risk factors—including nasogastric intubation, diabetes and gastrostomy—and demonstrated that conservative therapy with fasting and proton pump inhibitors led to resolution of intramural gas in the majority of cases. Computed tomography and endoscopic findings, such as longitudinal mucosal injuries and clear demarcations between injured and intact mucosa, were systematically characterised, informing non-operative management. Complementing this, a genomic and morphological investigation of a novel Sarcina bacterium associated with fulminant emphysematous gastritis in chimpanzees has revealed genetic determinants of virulence. This work extends understanding of gas-related pathology by identifying a distinct species with unique gas-producing capacity and underscores the potential for previously unrecognised sarcinae to contribute to severe gastrointestinal gas disorders across species.
Pneumatosis Intestinalis and Associated Gas-Related Disorders publication trend
The graph below shows the total number of articles in pneumatosis intestinalis and associated gas-related disorders across all publications each year (not limited to Nature Index journals).
Technical terms
Pneumatosis intestinalis: Presence of gas within the wall of the gastrointestinal tract, detected radiologically or endoscopically.
Pneumatosis cystoides intestinalis: A form of pneumatosis characterised by multiple gas-filled cysts in the submucosa and subserosa of the intestine.
Gastric emphysema: Non-infectious accumulation of intramural gas in the stomach wall, distinct from emphysematous gastritis.
Portal venous gas: Gas within the portal venous circulation, often indicating severe bowel ischaemia or other urgent pathology.
Emphysematous gastritis: A life-threatening infection characterised by gas-producing organisms in the gastric wall.
Endoscopic ultrasound (EUS): A technique combining endoscopy and ultrasonography to visualise the layers of the gastrointestinal wall and detect gas within.
Sarcina species: Gram-positive, gas-producing cocci implicated in emphysematous disorders of the gastrointestinal tract.
References
- Pneumatosis cystoides intestinalis in dermatomyositis: a case series report and literature review. Frontiers in Immunology (2023).
- Pneumatosis intestinalis post steroid use in a patient with immune-related adverse events: Case report, literature review and FAERS analysis. Frontiers in Pharmacology (2023).
- Endoscopic and clinical features of gastric emphysema. Scientific Reports (2024).
- Endoscopic Ultrasound View of Pneumatosis Cystoides Intestinalis. Diagnostics (2023).
- Clinical significance of pneumatosis intestinalis – correlation of MDCT-findings with treatment and outcome. European Radiology (2016).
- A Sarcina bacterium linked to lethal disease in sanctuary chimpanzees in Sierra Leone. Nature Communications (2021).
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