Reactive Gastropathy and Nutrient Absorption
Reactive gastropathy does not directly impair nutrient absorption, as it primarily affects the gastric mucosa's protective and structural integrity rather than the absorptive functions of the intestine. However, associated gastrointestinal disturbances may indirectly affect nutritional status through reduced intake and altered gastric function.
Primary Effects of Reactive Gastropathy
Reactive gastropathy is characterized by specific histological changes that do not inherently compromise nutrient absorption:
- Foveolar hyperplasia, edema, vascular ectasia, and smooth muscle fiber proliferation are the hallmark features, occurring without significant inflammation 1, 2
- Altered mucin expression (loss of MUC1, aberrant MUC5AC and MUC6 expression) affects the protective mucosal layer but not absorptive capacity 3
- The stomach's primary role is mechanical and chemical digestion, not nutrient absorption, which occurs predominantly in the small intestine 2
Indirect Nutritional Considerations
While reactive gastropathy itself doesn't impair absorption, associated conditions may affect nutritional status:
Gastric Motility Effects
- Gastroparesis can occur alongside reactive gastropathy, leading to impaired gastric emptying and digestive function 4
- Delayed gastric emptying may reduce oral intake due to early satiety, nausea, and vomiting, rather than causing malabsorption 4, 5
Micronutrient Considerations
- NSAID-induced reactive gastropathy may be associated with gastrointestinal blood loss, potentially leading to iron deficiency anemia through chronic bleeding rather than malabsorption 4
- Proton pump inhibitor use (often prescribed for reactive gastropathy) can contribute to magnesium deficiency over time 6
Clinical Pitfalls to Avoid
Do not confuse reactive gastropathy with conditions that truly impair absorption:
- Inflammatory bowel disease causes malabsorption through intestinal inflammation, increased protein turnover, and gut nutrient losses 4
- Short bowel syndrome results in genuine malabsorption requiring parenteral nutrition support 4
- Chronic renal failure affects gastrointestinal absorption through impaired intestinal motility and absorptive function 4
Practical Management Approach
Focus on symptom management rather than absorption supplementation:
- Address underlying causes (discontinue NSAIDs, manage bile reflux) to allow mucosal healing 1, 7, 2
- Use prokinetic agents like metoclopramide if gastroparesis symptoms are present 4
- Monitor for occult blood loss and check iron studies if chronic NSAID use is documented 4
- Ensure adequate oral intake rather than assuming malabsorption; reduced intake from nausea is more common than true malabsorption 4, 5
Nutritional supplementation should only be considered if there is documented deficiency from blood loss or reduced intake, not because of presumed malabsorption from reactive gastropathy itself 6, 2.