Gastropathy is when something is injuring your stomach lining. The injury can be sudden (acute) or gradual (chronic). Without its protective lining, your stomach becomes vulnerable to its own acid. Acid and other factors continue to wear it down from the inside.
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.
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.
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.
Many things can injure your stomach lining, either all at once or over time. Some causes include:
Different causes of gastropathy fall under different sub-types.
Types of gastropathy include:
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:
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:
Other stress factors that can wear down your mucosa’s defenses and prevent it from healing include:
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 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.
Many people don’t notice any symptoms. But if you do, you might notice:
If you have complications related to gastrointestinal bleeding, you might have:
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.
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.
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:
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.
Last reviewed by a Cleveland Clinic medical professional on 02/02/2023.
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