Your pathology report for chemical gastropathy

by Jason Wasserman MD PhD FRCPC
October 15, 2025

Chemical gastropathy is a condition that develops when the lining of the stomach is damaged by irritating substances such as bile, non-steroidal anti-inflammatory drugs (NSAIDs), or alcohol. Another name for this condition is reactive gastropathy.

Under normal conditions, the inside of the stomach is lined by special foveolar cells that produce mucus, a protective layer that shields the tissue from stomach acid. In chemical gastropathy, this protective barrier becomes damaged, allowing stomach acid and other substances to injure the cells that line the stomach wall.

Although this is a noncancerous condition, ongoing irritation can lead to chronic inflammation, discomfort, and—if untreated—ulcers or bleeding.

What are the symptoms of chemical gastropathy?

The symptoms of chemical gastropathy vary but often include:

  • Abdominal pain or discomfort, especially after eating.

  • Nausea or vomiting.

  • Bloating or fullness after meals.

  • Loss of appetite.

  • In more severe cases, vomiting blood or black, tarry stools may occur, which can be signs of bleeding in the stomach.

Some people have no symptoms, and the condition is discovered only when a biopsy is taken for another reason.

What are the possible complications of chemical gastropathy?

If chemical gastropathy is not treated, the ongoing damage to the stomach lining can lead to:

  • Erosions or ulcers, which are open sores on the stomach lining

  • Bleeding into the stomach

  • Chronic inflammation, which can cause long-term discomfort and may increase the risk of other stomach problems

Fortunately, treating the underlying cause—such as stopping irritating medications or controlling bile reflux—usually allows the stomach lining to heal completely.

What causes chemical gastropathy?

A layer of foveolar cells covers the inner surface of the stomach. These cells produce mucus, which protects the stomach lining from the strong acid that aids in digestion.

In chemical gastropathy, certain substances damage the foveolar cells and reduce their ability to make mucus. Without this protective barrier, acid and other chemicals irritate the tissue, leading to inflammation and injury.

Common causes include:

  • Bile reflux: The backward flow of bile or pancreatic fluids from the small intestine into the stomach. This is the most common cause.

  • Medications: Regular use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin can damage the stomach lining.

  • Alcohol: Alcohol irritates and weakens the mucous barrier.

  • Smoking: Smoking increases acid production and reduces the stomach’s ability to heal.

  • Previous surgery: Some types of stomach or gallbladder surgery increase the chance of bile reflux.

In many cases, more than one factor contributes to the condition.

How is chemical gastropathy diagnosed?

A pathologist makes the diagnosis of chemical gastropathy after examining a biopsy of the stomach under a microscope.

A biopsy is a small tissue sample taken during a procedure called a gastroscopy or upper endoscopy. During this procedure, a doctor passes a thin, flexible tube with a camera into the stomach to look for visible damage and collect tissue samples.

What does chemical gastropathy look like under the microscope?

Under the microscope, chemical gastropathy shows several characteristic changes in the surface cells and glands of the stomach lining.

  • Foveolar hyperplasia: This means there are more foveolar cells than normal. The increased number of cells causes the glands in the stomach to look twisted or elongated, sometimes described as having a “corkscrew” appearance.

  • Mucin depletion: Normal foveolar cells are filled with mucin, the substance used to make mucus. In chemical gastropathy, the cells contain less mucin, making them look pale or empty.

  • Erosion: Erosion means that the surface cells have been damaged or lost, exposing the underlying tissue.

  • Intestinal metaplasia: Intestinal metaplasia is a change that occurs when the damaged stomach cells are replaced by cells normally found in the small intestine. The stomach does this to protect itself from ongoing irritation by bile or other chemicals.

These changes help distinguish chemical gastropathy from other causes of inflammation in the stomach, such as Helicobacter pylori-related gastritis.

What are the treatment options for chemical gastropathy?

Treatment focuses on removing or controlling the cause of irritation and helping the stomach lining heal.

Common treatments include:

  • Stopping or reducing NSAID use: Your doctor may suggest switching to another type of pain medication.

  • Reducing bile reflux: Medications that bind bile acids (such as cholestyramine) or drugs that improve stomach emptying may help.

  • Avoiding alcohol and smoking: Both delay healing and worsen irritation.

  • Acid-reducing medications: Proton pump inhibitors (PPIs) or H2 blockers can reduce stomach acid and allow the lining to recover.

  • Dietary changes: Eating smaller, more frequent meals and avoiding spicy or fatty foods may reduce symptoms.

With treatment, most people experience improvement within weeks.

What is the prognosis for chemical gastropathy?

The prognosis is excellent once the underlying cause is identified and treated. The stomach lining can heal completely, and symptoms often improve quickly.

If the cause is not corrected, ongoing irritation can lead to chronic inflammation or ulcer formation, which may cause bleeding or anemia. Regular medical follow-up ensures proper healing and helps prevent recurrence.

Questions to ask your doctor

  • What caused my chemical gastropathy?

  • Were any ulcers or erosions seen during my endoscopy?

  • Do I need to stop taking any medications, such as NSAIDs?

  • What treatment will help my stomach heal?

  • How long will it take for my symptoms to improve?

  • Do I need a follow-up endoscopy or repeat biopsy?

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