Gastropathy

What is gastropathy?

Gastropathy literally means “disease of the stomach”. In its broadest sense, “gastropathy” might refer to any disease that can affect your stomach. That would include common conditions such as the stomach flu and peptic ulcer disease, nerve conditions such as gastroparesis and even stomach cancer.

But gastropathy also has a narrower meaning among healthcare providers, particularly those who specialize in gastrointestinal diseases. If you receive a diagnosis of gastropathy, your provider is probably using this narrower meaning: they’re telling you that something is injuring your stomach lining.

What does it mean if you have gastropathy?

Your stomach is equipped with a thick mucous lining (mucosa) that protects it from the strong digestive chemicals inside. But when something disrupts or erodes this lining, your stomach becomes increasingly vulnerable to injury from the inside. Gastropathy is the active process of injury to your stomach lining.

Gastropathy vs. gastritis

Many disease processes that affect your stomach lining can cause inflammation in the mucosa, also called gastritis. Inflammation is a response from your immune system to whatever is attempting to injure your stomach. If the immune response doesn’t defeat the threat, erosion of the mucosa can follow.

But healthcare providers make a distinction between erosion with inflammation (erosive gastritis) and erosion without it (erosive gastropathy). They use “gastropathy” to describe an injury to your stomach lining without inflammation — even though the causes of erosion in both cases are often the same.

What causes gastropathy?

Many things can injure your stomach lining, either all at once or over time. Some causes include:

• Ingested substances, such as alcohol and drugs.
• Digestive chemicals, such as enzymes, acid and bile.
• Radiation therapy and chemotherapy.
• Swollen, congested blood vessels in your stomach lining.
• Loss of blood flow to your stomach lining.

Different causes of gastropathy fall under different sub-types.

What are the different types of gastropathy?

Types of gastropathy include:

Acute hemorrhagic erosive gastropathy

Acute erosive gastropathy happens when something injures your stomach lining acutely, meaning suddenly and forcefully. It causes erosions in the mucosa (stomach ulcers), which then become vulnerable to further injury by the acid in your stomach. These erosions or ulcers can bleed, which is why erosive gastropathy is also called “hemorrhagic.” Causes include:

• Heavy drinking (stomach alcohol concentration greater than 10%).
• High doses of nonsteroidal anti-inflammatory drugs (NSAIDs).
• Chemotherapy and radiation therapy treatments for cancer.
• Acute mesenteric ischemia (sudden loss of blood flow).

Reactive gastropathy

Reactive gastropathy is the long-term process of a mucosal injury caused by chronic exposure to irritating substances. These substances produce a chemical reaction that erodes your stomach lining over time, which is why reactive gastropathy is also called chemical gastropathy. However, other factors besides chemicals can contribute to the problem. The primary causes are:

• Chronic NSAID use.
• Bile reflux.

Other stress factors that can wear down your mucosa’s defenses and prevent it from healing include:

• Chronic alcohol use.
• Chronic smoking.
• Chronic H. pylori infection.
• Chronic ischemia (constricted or diminished blood flow).

Congestive gastropathy

Congestive gastropathy describes swollen and congested blood vessels in your stomach lining that are prone to rupture, causing frequent bruising and bleeding. It produces a mosaic-like pattern of lesions in your mucosa due to chronic wounding, and it can cause significant blood loss. It’s also called portal hypertensive gastropathy because portal hypertension is usually the cause. (Portal hypertension is most often a side effect of liver disease.)

Hypertrophic gastropathy

Hypertrophic gastropathy is usually a rare genetic disease that causes certain cells in your gastric mucosa to overproduce, disrupting its natural constitution. Menetrier’s disease is one form. It causes your stomach lining to overproduce mucus, losing protein in the process. Zollinger-Ellison syndrome is another form that causes your stomach to produce too much stomach acid.

What are the symptoms of gastropathy?

Many people don’t notice any symptoms. But if you do, you might notice:

• Abdominal pain or discomfort.
• Nausea.
• Indigestion.

If you have complications related to gastrointestinal bleeding, you might have:

• Symptoms of iron-deficiency anemia, such as pallor and fatigue.
• Black, tarry poop.
• Vomit that looks like coffee grounds.

Is gastropathy common?

Some types are common. Acute and reactive gastropathies related to alcohol and NSAID use are the most common. Bile reflux and ischemia are less-common causes of reactive and acute gastropathies. Portal hypertensive gastropathy (congestive) is a fairly common side effect of portal hypertension, especially in people with cirrhosis of the liver. Hypertrophic gastropathies are rare.

How is gastropathy diagnosed?

If a healthcare provider suspects you might have gastropathy, they’ll want to examine your stomach lining to look for the evidence. The most efficient way to do this is with an upper endoscopy exam.

An upper endoscopy (esophagogastroduodenoscopy, or EGD) examines your upper GI tract with an endoscope — a tiny camera on the end of a long tube that’s passed down your throat into your stomach. The camera projects high-definition images onto a screen. A gastroenterologist can take a tissue sample (biopsy) with the endoscope to examine in the lab. They can also treat active bleeding.

What is the treatment for gastropathy?

The treatment will depend on the type of gastropathy you have. If possible, your healthcare provider will want to eliminate what’s hurting your stomach lining — whether that’s a medication or substance you’re taking, a bacterial infection, bile reflux or something more complex. In addition to neutralizing the original cause, they’ll usually want to neutralize your stomach acid to help your mucosa to heal.

Treatments might include:

• Acid-blocking medications, such as histamine blockers (H2 blockers) and proton pump inhibitors (PPIs).
• Medicines that coat and protect your stomach lining, such as bismuth subsalicylate and sucralfate.
• Antibiotics to treat bacterial infections.
• Medicines to neutralize bile salts in your stomach, such as ursodeoxycholic acid (UDCA).
• Medications for portal hypertension, such as vasoconstrictors or beta blockers.
• Specific surgical procedures for certain conditions that don’t respond to medication.

Does gastropathy go away?

Your stomach lining can heal, as long as the damage stops long enough to give it the chance. Most of the time, medications can help achieve this. Some causes of gastropathy can be trickier, though. Persistent bile reflux or portal hypertension may require a minor procedure to fix. Hypertrophic gastropathy may or may not be reversible with treatment, but medications can often prevent further mucosal changes.

A note from Cleveland Clinic

Your stomach lining is tough, and it takes a lot to get past its defenses. When gastropathy sets in, it’s either due to a severe acute injury or a long-persistent injury. You’ll need medical treatment to help identify, stop and reverse the injury process. But with a little help, your stomach mucosa can regenerate and heal better than most organs can. Once its defenses are restored, it won’t be as easy to injure again.