Spotting the MIRacle Sign

Understanding the MIRacle Sign: reversible gastric pallor as a diagnostic cue for ischemic risk.

This inducible phenomenon of reversible blanching of the gastric mucosa, most conspicuous at the top of the mucosal folds, appearing with inflation and disappearing with deflation, during the same procedure remains of clinical interest.

Although gastric mucosal pallor or white mucosa during endoscopy has been described as a potential pointer to a diagnosis of chronic mesenteric ischemia, the phenomenon of endoscopic inducibility and reversibility during the same exam has not been described in detail [2, 3]. Eliciting this sign during endoscopy should prompt the clinician to work up further causes of gastric/intestinal ischemia especially in patients with pertinent vascular history. Cross sectional imaging with angiography should be considered in such cases.