What is Gastropathy?
Gastropathy refers to structural alterations of the gastric mucosa characterized by the absence of significant inflammatory cell infiltration, distinguishing it from gastritis which is defined by mucosal inflammation. 1, 2
Key Distinguishing Features
Gastropathy is fundamentally different from gastritis:
- Gastropathy involves structural mucosal changes with minimal or no inflammatory infiltration 1, 2
- Gastritis is a histological diagnosis indicating mucosal inflammation with inflammatory cell infiltration 1
Major Types of Gastropathy
Portal Hypertensive Gastropathy (PHG)
Portal hypertensive gastropathy occurs in patients with portal hypertension and presents with characteristic endoscopic findings:
- Endoscopic appearance: Snake-skin appearance or mosaic pattern on the gastric mucosa, primarily affecting the stomach body and fundus 3
- Classification: Mild form shows only mucosal changes; severe form includes red or dark brown viscous changes along with mucosal alterations 3
- Clinical significance: Causes chronic bleeding leading to iron-deficiency anemia and repeated transfusions in affected patients 3
- Pathophysiology: Associated with increased portal pressure causing vascular mucosal and submucosal dilatation without significant inflammatory changes 4, 5
Reactive (Chemical) Gastropathy
Reactive gastropathy results from chemical injury to the gastric mucosa, most commonly from NSAIDs:
- Histological features: Foveolar hyperplasia, interfoveolar smooth muscle fibers, erosions, edema, and hyperemia without significant inflammation 2
- NSAID-induced changes: Subepithelial hemorrhages, erosions, and ulcers occur in approximately 50% of regular NSAID users, with 10-30% developing gastric ulcers 6
- Important caveat: NSAIDs do not cause diffuse histologic gastritis (inflammatory cell infiltration); any such gastritis is due to H. pylori infection 6
Gastric Antral Vascular Ectasia (GAVE)
GAVE is a distinct gastropathy associated with vascular abnormalities:
- Pathology: Dilated vessels with fibrin thrombi and fibromuscular hyperplasia of the lamina propria 3
- Association: Approximately 30% of GAVE patients also have portal hypertension, though the causal relationship remains unclear 3
- Clinical presentation: Causes acute and chronic upper gastrointestinal blood loss 5
Clinical Implications
The distinction between gastropathy and gastritis matters for treatment:
- Gastropathy requires addressing the underlying structural cause (portal pressure reduction, discontinuing offending medications) rather than anti-inflammatory therapy 3
- Different gastropathies have distinct treatment approaches and prognoses 1
- Histopathological diagnosis is essential because endoscopic appearance alone cannot definitively distinguish between conditions 1, 2
Common Pitfall
Do not confuse gastropathy with gastroparesis: Gastroparesis is a motility disorder defined by delayed gastric emptying with symptoms of nausea, vomiting, and early satiety 3, whereas gastropathy refers to structural mucosal changes without primary motility dysfunction.