A Rare Case of Methamphetamine-Induced Diffuse Gastrointestinal Ischemia

Abstract

Methamphetamine is a widely used substance known for cardiovascular and neurological complications; however, its gastrointestinal effects remain poorly understood. While rare, methamphetamine-induced gastrointestinal ischemia has high morbidity and mortality rates, with limited case reports in the literature. We present a case of a 48-year-old man with a history of gastroesophageal reflux disease, alcohol use disorder in remission, and previously documented methamphetamine use who presented with two weeks of episodic abdominal pain, nausea, and hematemesis. Significant laboratory and imaging findings included acute anemia, urine toxicology confirming the presence of amphetamines, and computed tomography imaging showing wall thickening in the distal esophagus and stomach. On endoscopy, he was found to have diffuse ulcerations in the distal esophagus and post-pyloric region with pathology indicative of methamphetamine-induced gastrointestinal ischemia. This case highlights the importance of considering amphetamine-induced gastrointestinal ischemia in patients with stimulant use disorders who present with acute abdominal symptoms. Early recognition of this etiology can guide targeted counseling and management to improve outcomes.

Keywords: clinical methamphetamine effects; drug-induced ischemia; extensive gi ulceration; gastrointestinal ischemia; methamphetamine; rare cause of acute abdominal pain; substance use.

Figure 1. Contrast-enhanced CT of the abdomen and pelvis.

CT imaging revealed nonspecific thickening of the distal esophageal (A), irregular thickening of the distal stomach (B), and a focal area of increased soft tissue density with luminal narrowing in the mid-transverse colon (C). All abnormal findings are indicated by blue arrows.

Figure 2. Endoscopic visualization of the upper and lower gastrointestinal tract.

Upper endoscopy identified ulcerations in the distal esophagus (A) and similar erosive changes in the post-pyloric region of the stomach (B), accompanied by diffusely pale gastric mucosa (C). Lower endoscopy revealed widespread pallor of the colonic mucosa, most prominent at the splenic flexure (D). Collectively, these findings are consistent with diffuse ischemic changes in the gastrointestinal tract.