Reactive gastropathy

Histopathology of reactive gastropathy, annotated

Reactive gastropathy, also known as chemical gastropathy, is a condition of the stomach characterized by changes in the stomach lining (gastric mucosa) due to chronic exposure to irritants, such as nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, or bile reflux. Unlike other forms of gastrointestinal disorders, reactive gastropathy is not caused by infection with Helicobacter pylori.

Causes and Pathophysiology

Reactive gastropathy is primarily caused by the chronic use of NSAIDs, which inhibit the production of prostaglandins, substances that help protect the stomach lining from the acidic environment of the stomach. Other causes include excessive alcohol consumption, bile reflux, and physical stress from critical illness or surgery. The condition results from the stomach's exposure to these irritants, leading to mucosal damage characterized by edema, vascular congestion, and foveolar hyperplasia without significant inflammation or atrophy.

Symptoms

The symptoms of reactive gastropathy can vary but often include dyspepsia (indigestion), nausea, and sometimes vomiting or abdominal pain. Many individuals, however, may remain asymptomatic.

Diagnosis

Diagnosis of reactive gastropathy is typically made through endoscopy, where characteristic changes in the gastric mucosa can be visualized. These changes include a smooth, reddened mucosa with visible vessels. Biopsy and histological examination of the gastric tissue can confirm the diagnosis, showing the hallmark features of foveolar hyperplasia, edema, and minimal inflammation.

Treatment

The primary treatment for reactive gastropathy involves removing or reducing the exposure to the causative agent, such as discontinuing or lowering the dose of NSAIDs. In cases where NSAIDs cannot be discontinued, proton pump inhibitors (PPIs) or H2 receptor antagonists may be prescribed to reduce stomach acid production and promote healing of the gastric mucosa. Lifestyle modifications, including reducing alcohol consumption and avoiding spicy or acidic foods, may also help manage symptoms.

Prevention

Prevention of reactive gastropathy focuses on minimizing the use of NSAIDs and other known irritants. For individuals who require NSAID therapy, co-prescription of PPIs or the use of selective COX-2 inhibitors, which have a lower risk of causing gastric mucosal damage, may be considered.

See Also

• Gastritis
• Peptic ulcer disease
• Gastroesophageal reflux disease