Chemical gastropathy

by Jason Wasserman MD PhD FRCPC
March 7, 2023

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?

The inside of the stomach is covered by specialized foveolar cells which produce a substance called mucus. Mucus protects the cells from the strong acids normally found in the stomach. In chemical gastropathy, the foveolar cells have become damaged by substances not normally found in the stomach. This damage prevents the foveolar cells from producing mucus.

The substances that cause chemical gastropathy can come from inside the body or they can be from a source outside of the body. The most common cause of chemical gastropathy is the movement of bile or pancreatic secretions into the stomach from the small bowel. This 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 chemical gastropathy diagnosed?

The diagnosis of chemical gastropathy is made after a pathologist examines a tissue sample from the inside of the stomach under the microscope. The tissue sample is 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.

What are the microscopic features of chemical gastropathy?

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 there is an increased number of foveolar cells on the inside surface of the stomach. The increased number of cells causes the glands that are normally found on the inside of 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 on the inside of the stomach have been replaced by cells normally found on the inside of the small intestine. The stomach undergoes this change in order to protect itself from the bile and pancreatic secretions spilling into the stomach from the small bowel.