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Reactive gastropathy

What is reactive gastropathy?

Reactive gastropathy is a non-cancerous change that happens in the stomach. It means that the cells lining the inside of the stomach have become injured by substances not normally found in the stomach. The substances damage the foveolar cells and prevent them from producing the mucus required to protect the stomach from acid.

The damage causes abdominal pain which is often worse after a meal. If left untreated, reactive gastropathy can lead to ulcers or bleeding in the stomach. Another name for this condition is chemical gastropathy.

The stomach

The stomach is a part of the digestive system. It is a hollow organ that sits in the middle of the abdomen just below the ribs. Food that we eat travels from the mouth to the stomach down a long tube called the esophagus. Once in the stomach, it is mixed and broken down. When this is complete, the digested food moves into the small bowel. The stomach is specially designed to stretch when we eat a large meal and shrink when empty.

The stomach is divided into four parts: cardia, fundus, body, and pylorus. The first part of the stomach, the cardia, connects with the esophagus. The last part of the stomach, the pylorus, connects with the small bowel. When food leaves the stomach and enters the small bowel, it is mixed with fluids from the liver (bile) and pancreas (pancreatic secretions) which aid in digestion.

The inside surface of the stomach is lined by specialized foveolar cells. The foveolar cells form a barrier called the epithelium. The foveolar cells produce a substance called mucus which protects the tissue from the strong acids made inside the stomach. Below the epithelium is a thin layer of tissue called the lamina propria. Pathologists use the word mucosa to describe the epithelium and lamina propria together.

The cells on the inside of the stomach connect together to form long thin structures called glands. These glands extend down from the surface into the lamina propria. Specialized cells near the bottom of the glands produce the acid that fills the stomach and enzymes that help break down food.

What causes reactive gastropathy?

The substances that cause reactive gastropathy can come from inside the body or they can be from a source outside of the body. The most common cause of reactive 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 reactive gastropathy.

How do pathologists make this diagnosis?

The diagnosis of reactive 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.

Pathologists look for the following features to make this diagnosis:

  • Foveolar hyperplasiaHyperplasia 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 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.
  • ErosionErosion 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 metaplasiaIntestinal metaplasia means that the normal epithelium of the stomach has been replaced by a type of epithelium normally found in the small bowel. The stomach undergoes this change in order to protect itself from the bile and pancreatic secretions spilling into the stomach from the small bowel.
by Jason Wasserman MD PhD FRCPC (updated September 18, 2021)
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