INTRODUCTION: Gastric ischemia is rare due to the rich vascular supply to the stomach. This arterial supply is achieved through five major direct sources, which include the right and left gastric, the right and left gastroepiploic, and the short gastric arteries. Upper GI bleeding caused by Ischemic gastropathy from mesenteric ischemia is rare, however isolated gastric ischemia resulting in bleeding is even less common with only few cases reported in literature. We report a case of a 71-year-old man with history of peripheral vascular disease who presented to the hospital with upper GI bleed. CASE DESCRIPTION/METHODS: A 71-year-old man with history of severe peripheral vascular disease, hypertension and hyperlipidemia presents to the hospital with complaints of abdominal pain worsened by food ingestion and melena. On presentation Hb was 7.4 mg/dL, which dropped to 6.0 mg/dl. CT scan of the abdomen showed diffuse atherosclerosis of the celiac, superior mesenteric (SMA) and inferior mesenteric arteries. Patient underwent upper endoscopy which showed multiple ulcers through the body of the stomach as well as areas of pale gastric mucosa raising suspicion for ischemic gastropathy. Patient underwent aortogram which showed celiac artery occlusion and severe stenosis of the SMA. Subsequent stenting of the SMA resulted in the resolution of patient’s symptoms. Repeat EGD performed 8 weeks later showed healing of the ulcers. DISCUSSION: Ischemic gastropathy is a rare cause of upper GI bleeding due to the rich blood supply of the stomach. The definitive treatment is revascularization. It should be suspected in patients with risk factors that presents with upper GI bleeding and endoscopic findings of multiple ulcers and pale gastric mucosa. Few cases showed clinical improvement with revascularization of the superior mesenteric artery. Our patient is a rare case of isolated ischemic gastropathy with complete occlusion of the celiac artery who responded to SMA revascularization.Figure 1.: Endoscopy showing multiple ulcers.Figure 2.: Patchy areas of pale mucosa observed during first EGD.Figure 3.: Last endoscopy showing appropriate ulcer healing.