Symptoms of Reactive Gastropathy
Reactive gastropathy is typically asymptomatic or presents with nonspecific upper gastrointestinal symptoms including epigastric pain, nausea, and dyspepsia, but importantly lacks the severe, persistent vomiting and early satiety characteristic of gastroparesis. 1
Clinical Presentation
Reactive (chemical) gastropathy represents a constellation of endoscopic and histological changes caused by chemical injury to the gastric mucosa, most commonly from NSAIDs or bile reflux. 1 The clinical manifestations are often subtle and nonspecific:
Primary Symptoms
- Epigastric discomfort or pain - typically mild and intermittent 1
- Nausea - present but usually not the predominant or most bothersome symptom 1
- Dyspepsia - vague upper abdominal symptoms 1
- Asymptomatic presentation - many patients have no symptoms despite histologic changes 1
Critical Distinction from Gastroparesis
The symptom profile differs markedly from gastroparesis, which presents with: 2
- Persistent, severe nausea as the most prominent symptom
- Vomiting of undigested food from hours earlier
- Early satiety and inability to finish normal-sized meals
- Postprandial fullness and bloating
- Symptoms worsening specifically with solid, high-fat, or high-fiber foods
Reactive gastropathy does NOT typically cause the chronic, debilitating nausea and vomiting pattern seen in gastroparesis. 1, 3
Endoscopic and Histologic Features
The diagnosis rests primarily on histopathological findings rather than clinical symptoms: 1
- Foveolar hyperplasia - elongation of gastric pits 1, 4
- Interfoveolar smooth muscle fibers - smooth muscle extending into lamina propria 1, 4
- Vascular congestion and edema - dilated capillaries in mucosa 1, 4
- Erosions - superficial mucosal breaks 1
- Absence of significant inflammation - key distinguishing feature from H. pylori gastritis 1, 4
Associated Conditions
Reactive gastropathy shows associations with inflammatory conditions throughout the gastrointestinal tract: 5
- Barrett's esophagus (OR 1.21)
- Duodenitis (OR 1.36)
- Active ileitis (OR 1.88)
- Collagenous colitis (OR 1.50)
Age and Epidemiology
- Prevalence increases with age, from 2% in the first decade to >20% in octogenarians 5
- Represents the second most common diagnosis on gastric biopsies 6
- Evenly distributed geographically across populations 5
Common Pitfall
The correlation between histological evidence of reactive gastropathy and clinical manifestations, particularly risk of bleeding, has not been documented. 1 Many patients with clear histologic changes remain asymptomatic, making this primarily a pathologic diagnosis rather than a clinical syndrome. The finding on biopsy may help identify patients who could benefit from medication adjustment (discontinuing NSAIDs or bile acid sequestrants), but symptoms alone cannot diagnose reactive gastropathy. 1
Treatment Approach
When reactive gastropathy is identified histologically:
- Identify and remove the offending agent - discontinue NSAIDs, reduce bile reflux 1
- Proton pump inhibitors - reduce acid-mediated injury 1
- Treat symptomatically - similar to functional dyspepsia if symptoms present 2
The nonspecific nature of reactive gastropathy means that various etiologies (NSAIDs, bile reflux) produce similar histologic and clinical patterns, supporting a final common pathway of chemical injury. 6