Chemical gastropathy

by Jason Wasserman MD PhD FRCPC
December 12, 2024

This article is designed to help you understand your pathology report for chemical gastropathy of the stomach. Each section explains an important aspect of the diagnosis and what it means for you.

What is chemical gastropathy?

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

What are the symptoms of chemical gastropathy?

The damage causes abdominal pain, which is often worse after a meal.

What are the possible long-term complications of chemical gastropathy?

If left untreated, chemical gastropathy can lead to ulcers or bleeding in the stomach.

What causes chemical gastropathy?

Specialized foveolar cells cover the inside of the stomach and produce mucus, which protects the cells from the strong acids normally found in the stomach. In chemical gastropathy, however, substances not normally found in the stomach damage the foveolar cells, preventing them from producing mucus.

Substances that cause chemical gastropathy can come from inside or outside the body. The most common cause is the movement of bile or pancreatic secretions into the stomach from the small bowel, which is called reflux. Other causes include alcohol and non-steroidal anti-inflammatory drugs (NSAIDs). Smoking has also been shown to cause chemical gastropathy.

How is this diagnosis made?

A pathologist diagnoses chemical gastropathy after examining a tissue sample inside the stomach under a microscope. The tissue sample is then removed in a procedure called a biopsy. The biopsy is usually performed after the patient is sedated, and a camera called an endoscope is inserted into the stomach.

Microscopic features

The following microscopic features are typically seen in chemical gastropathy:

• Foveolar hyperplasia – Hyperplasia is a word pathologists use to describe an increased number of cells. Foveolar hyperplasia means an increased number of foveolar cells on the inside surface of the stomach. The increased number of cells causes the glands normally found inside the stomach to look twisted. Pathologists sometimes describe these glands as having a “corkscrew” appearance. Small finger-like projections of tissue called villi may also be seen.
• Mucin depletion – The normal foveolar cells are full of mucin, which they release to produce mucus. Mucin depletion means that the foveolar cells on the inside surface of the stomach contain less mucin than normal, healthy cells.
• Erosion – Erosion is a word pathologists use to describe an injury that damages the cells on the surface of a tissue. In the stomach, erosion means a loss of foveolar cells.
• Intestinal metaplasia – Intestinal metaplasia means that the cells normally found inside the stomach have been replaced by cells normally found inside the small intestine. The stomach undergoes this change to protect itself from the bile and pancreatic secretions spilling into the stomach from the small bowel.