Gastropathy: Symptoms, Diagnosis, and Treatment

Introduction:

Indigestion, heartburn, epigastric pain, nausea, and vomiting are commonly present and have been observed by the majority of individuals at a certain point in their lives. These symptoms are frequently caused by pathology in the upper gastrointestinal tract. Unfortunately, the correlation between clinical manifestations (symptoms, signs, and endoscopic findings) and pathological findings, such as the degree and exact localization of the disease process, is poor. This is due to the absence of a somatic nerve supply to the gut wall. As a result, the stomach is a common site of pathology for upper gastrointestinal symptoms, which can have a wide variety of causes.

Gastropathy is when the stomach lining is damaged but not inflamed, and it can be clinically asymptomatic. Gastropathy and gastritis can be chronic, meaning they establish slowly over time, or acute, meaning they appear suddenly and last only a short time. Some types of gastropathy and gastritis cause tiny breaks in the stomach lining called erosions, which can lead to ulcers.

What Is the Classification of Gastropathy?

1. Chemical (Reactive) Gastropathy: Chemical gastropathy, which refers to endoscopic and histopathological changes in the gastric mucosa due to chemical injury, was selected as the preferred term. Chemical agents commonly associated with mucosal damage.

• Medications, particularly non - steroidal anti-inflammatory drugs (NSAIDs), but also drugs such as proton pump inhibitors (PPIs), iron, Kayexalate, Colchicine, antineoplastics, and corticosteroids have been linked to mucosal damage.

• NSAIDs harm the mucosa by inhibiting prostaglandin synthesis. However, gastric mucosa tolerates second-generation and selective NSAIDs and cyclooxygenase-2 (COX-2) inhibitors better.

• Long-term NSAID users may exhibit mucosal erythema, congestion, erosions, and ulcers when analyzed endoscopically. Histologically, the mucosa shows edema, foveolar hyperplasia,(the presence of abnormal branching and twisting) a proliferation of the smooth muscle, regeneration, and, in rare instances, erosion, and a relatively mild inflammatory cell response.

• Duodenopancreatic (bile) reflux is common in Billroth II partial gastrectomy (procedure that has been performed for tumor or severe ulcer disease in the distal stomach)patients. In addition, chronic gastritis with prominent foveolar hyperplasia, either cystic or polypoid, develops close to the stoma.

• Acids, alkalis, and profuse amounts of alcohol. The majority of these result in extensive, severe necrotizing lesions.

2. Vascular Gastropathy:

• A vascular gastropathy is a group of disorders distinguished by distinct changes in the blood vessels of gastric mucosa and a lack or absence of inflammation.

• Gastric antral vascular ectasia (GAVE), also called "watermelon stomach," is a rare disease of unknown etiology. Endoscopy shows longitudinal mucosal folds with dilation of the vessels converging from the proximal antrum (distal to antrum) into the pylorus.

• Histology shows mucosal capillaries are dilated, some of which have been possibly thrombosed and reactive gastropathy features. Occult bleeding(bleeding in the gastrointestinal system), melaena (dark stools), haematemesis (blood in the vomit) and anemia are all possible symptoms.

• Portal hypertensive gastropathy is observed in patients with portal hypertension who may present with gastric bleeding because of mucosal blood vessel dilatation, congestion, and proliferation, most prevalent in the proximal stomach.

• Endoscopic appearances can be snakeskin, cherry red spots, or a mosaic pattern. In addition, bypass surgery reduces the risk of bleeding when portal hypertension is decompressed.

What Are the Symptoms of Gastropathy?

Many people with gastropathy may have no symptoms. When symptoms are present, they may include:

• Abdominal discomfort or pain.

• An untimely feeling of fullness during a meal.

• Vomiting or nausea.

• Loss of weight and appetite.

As gastropathy can cause ulcers and intestinal bleeding, some people may also experience the following symptoms:

• Stool in black or tarry color.

• Maroon blood in the stool.

• Cramps in the abdomen.

• Fatigue.

• Breathing difficulty.

• Light-headedness.

• Blood in the vomit.

• Vomit that resembles coffee grounds.

How to Diagnose Gastropathy?

1. A physical examination and medical history can help to diagnose gastropathy. Sometimes the physician can perform an upper gastrointestinal (GI) endoscopy to confirm the diagnosis. Upper GI endoscopy entails inserting a flexible tube containing a camera into the digestive tract.

2. Sometimes, the physician may take a biopsy of the lining of the stomach during the endoscopy, enabling a pathologist to visualize clinical signs of gastropathy under a microscope.

3. The physician may order some additional tests to confirm a diagnosis of gastropathy, including:

• Blood and stool examinations.

• The upper gastrointestinal series involves swallowing a chalky liquid to help an X-ray see problems in the gastrointestinal tract.

What Is the Treatment for Gastropathy?

• The underlying reason determines the treatment for gastropathy. For example, suppose gastropathy is caused by non-steroidal anti-inflammatory drugs (NSAIDs) or alcohol, discontinuation of the drugs and alcohol. Proton pump inhibitors (PPIs) may be prescribed for reactive gastropathy to allow the stomach to heal.

• Other acid-reducing medicines, such as histamine blockers or Sucralfate, can aid in treating gastropathy.

• If bile reflux is present, the physician may prescribe Ursodiol to help heal the stomach lining. When bile from the small intestine flows back into the stomach, this is referred to as bile reflux. If patients with portal hypertensive gastropathy experience acute bleeding, peptide drugs, proton pump inhibitors (PPIs), or vasoactive drugs may be helpful.

• In severe cases, treatment with endoscopy or surgery may be required.

What Are the Complications of Gastropathy?

1. Ulcers of the Stomach: Peptic ulcers are sores on the stomach or duodenum lining. Peptic ulcers can develop as a result of acute erosive gastropathy (the stomach lining quickly develops erosions, ulcers, and bleeding.). Peptic ulcers are also increased by Helicobacter. pylori gastritis (gastritis caused by H.Pylori) and reactive gastropathy, particularly from NSAIDs.

2. Anemia: H. pylori and autoimmune gastritis can impair iron absorption, producing iron deficiency anemia. Autoimmune gastritis can impair vitamin B12 absorption from food. A lack of sufficient vitamin B12 prevents the body from producing enough healthy red blood cells, resulting in pernicious anemia. (anemia due to lack of vitamin B12)

3. Gastritis Atrophic: Atrophic gastritis can be caused by chronic gastritis, most commonly H. pylori gastritis and autoimmune gastritis. Chronic inflammation in atrophic gastritis causes the loss of glands in the stomach lining that produce stomach acid and enzymes. Atrophic gastritis has been associated with stomach cancer development.

4. Cancer of the Stomach: Chronic H. pylori and autoimmune gastritis increase the likelihood of stomach lining growth. These growths could be benign or cancerous NIH external links. H. pylori gastritis increases the risk of developing gastric mucosa-associated lymphoid tissue (MALT) lymphoma, a type of adult non-Hodgkin lymphoma. Some stomach ulcers can be avoided if H. pylori are detected and treated early.

What Is the Treatment for Reactive Gastropathy?

The underlying etiology of the stomach irritants determines the treatment. For example, if the irritation is due to NSAIDs, the physician will advise stopping the medication from relieving pain. If acid or bile reflux is the cause of reactive gastropathy, the physician may recommend stomach lining healing medications or surgery to prevent excess bile from flowing into the stomach.

Conclusion:

Gastropathy is defined as stomach lining damage. Long-term exposure to irritants and severe conditions can cause damage. Some people have no symptoms, while others experience abdominal pain, weight loss, or symptoms consistent with gastrointestinal bleeding. Acid-reducing medications, peptide drugs, and vasoactive medications. Surgery may be required in severe cases.