We often experience stomach upsets and heartburn. Sometimes we think it's normal, or maybe it's just something that happens when the food is a little spicy. However, sometimes there may be conditions behind these symptoms that we need to be a little concerned about. That's how we're going to talk about a condition called gastropathy, which is damage to the lining of our stomach, that is, the mucosa. This may sound like a bit of a medical term, but let's understand it simply.
What exactly is gastropathy?
Simply put, gastropathy means "disease of the stomach." Now you might be thinking, "When we say stomach disease, it can mean any disease that develops in the stomach." Yes, that's true. Not only the common stomach flu, peptic ulcer disease, gastroparesis, which is a condition in which the stomach's function is impaired due to certain nerve problems, but even stomach cancer can fall under the category of gastropathy in this broad sense.
However, doctors, especially those who specialize in gastrointestinal diseases, use the word "gastropathy" in a more specific sense. If a doctor tells you, "You have gastropathy," he or she is probably referring to something that is damaging the lining of your stomach .
What does it mean to have gastropathy?
Our stomach is a very amazing organ. It contains very strong digestive chemicals that help us digest the food we eat. So, to protect the stomach from these strong chemicals, the stomach wall has a protective layer made of a thick mucous lining or mucosa. It's like putting a ``screen protector`` on the screen of our phone.
However, if for some reason this protective lining is disrupted, or if it wears away, the harsh chemicals inside the stomach begin to damage the stomach wall. That process of damage to the stomach lining is what we call gastropathy.
What is the difference between Gastropathy and Gastritis?
Many of you have heard of gastritis. Gastritis is an inflammation of the lining of the stomach. Inflammation is the body's immune system's response to something that is trying to harm the stomach. It's like when you get a small wound, it turns red and swells. If this immune response can't control the harmful threat, the lining can become eroded.
However, doctors distinguish between erosive gastritis and erosive gastropathy, which is a condition in which the stomach lining is damaged and eroded, but there is no significant inflammation . Surprisingly, the causes of both conditions can sometimes be the same.
Simply put:
* Gastritis: Damage to the stomach lining + inflammation (symptoms such as swelling, redness)
* Gastropathy: Damage to the stomach lining, without significant inflammation
What are the causes of gastropathy?
There are various reasons why the stomach lining can be damaged, either suddenly or gradually over time. The main ones are:
- Substances we take: excessive alcohol use, certain medications (especially painkillers such as `(NSAIDs)`).
- Digestive chemicals: stomach acid, enzymes, and possibly bile that flows back up.
- Radiation therapy and chemotherapy.
- Swelling and constriction of the blood vessels in the stomach lining.
- Loss of blood flow to the stomach lining.
Based on these reasons, gastropathy is divided into different subtypes.
What are the different types of gastropathy?
Let's look at a few of the main types.
1. Acute Hemorrhagic Erosive Gastropathy
This is when the stomach lining is suddenly and severely damaged for some reason. "Acute" means sudden. This damage causes small scratches (erosions) or sores (ulcers) in the stomach lining. These sores can then become worse with stomach acid, and they can start to bleed (hemorrhagic) . This can be caused by:
- Excessive alcohol consumption: (increased alcohol concentration in the stomach above 10%).
- Taking high doses of nonsteroidal anti-inflammatory drugs (NSAIDs): For example, medications like Diclofenac and Ibuprofen.
- Chemotherapy and radiation therapy treatments for cancer.
- Sudden decrease in blood flow to the intestines (Acute mesenteric ischemia).
2. Reactive Gastropathy
What happens in this case is that the stomach lining is damaged due to continuous exposure to substances that are harmful to the stomach over a long period of time . The lining gradually wears away due to a chemical reaction with these substances. Therefore, this is also called chemical gastropathy. The main causes are:
- Long-term use of NSAIDs.
- Bile reflux: The bile that helps us digest food is located in the small intestine. But sometimes this bile can flow back into the stomach. If this happens, it can damage the stomach lining.
In addition, there are other factors that weaken the defense mechanisms of the stomach lining and hinder healing:
- Long-term alcohol use.
- Smoking for a long time.
- Long-standing H. pylori bacterial infection.
- Chronic ischemia is a prolonged decrease in blood supply.
3. Congestive Gastropathy
This is when the blood vessels in the stomach lining become swollen and tight, and they can easily burst and bleed . Because of the frequent small injuries and bleeding, a mosaic-like pattern of spots forms in the stomach lining. This can cause a significant amount of blood to be lost from our bodies. The main cause of this is portal hypertension. This is an increase in pressure in a large blood vessel connected to the liver. This often occurs as a side effect of liver disease. Therefore, it is also called portal hypertensive gastropathy.
4. Hypertrophic Gastropathy
This is a rare, genetic condition . It occurs when certain types of cells in the stomach lining grow excessively, changing the natural composition of the lining. Menetrier's disease is one of these conditions. It causes the stomach lining to produce too much mucus, and at the same time, proteins are released from the body. Zollinger-Ellison syndrome is another such condition, in which the stomach produces too much acid.
What are the symptoms of gastropathy?
Many people may not have any symptoms . However, if you do develop symptoms, you may experience things like:
- Stomach pain or discomfort.
- Nausea.
- Bloating, indigestion.
If complications related to gastrointestinal bleeding occur, you may also see symptoms such as:
- Symptoms of iron-deficiency anemia: pale skin, extreme fatigue.
- Black, tarry poop.
- Vomit that looks like coffee grounds.
Is Gastropathy a common condition?
Some types are common. Acute and reactive gastropathy, especially those caused by alcohol and NSAIDs, are the most common. Gastropathy caused by bile reflux and decreased blood supply is less common. Congestive gastropathy, caused by portal hypertension, is a common side effect, especially in people with cirrhosis of the liver. Hypertrophic gastropathy is very rare.
How is gastropathy diagnosed?
If a doctor suspects you have gastropathy, he or she will want to examine the lining of your stomach. The best way to do this is with an upper endoscopy exam (Esophagogastroduodenoscopy - EGD).
This involves inserting an instrument called an endoscope – a long, thin tube with a small camera attached to the end – through the mouth and down the esophagus into the stomach. The clear images from this camera can be viewed on a screen. A gastroenterologist can also use this endoscope to take a small tissue sample (biopsy) from the stomach lining and examine it in a laboratory. This can also be used to treat any bleeding that may be present.
What are the treatments for gastropathy?
Treatment depends on the type of gastropathy you have. If possible, your doctor will first try to eliminate the cause of the damage to your stomach lining – it could be a medication you’re taking, something like alcohol, a bacterial infection, bile reflux, or something more complex. While treating this underlying cause, they will also try to neutralize your stomach acid to help your stomach lining heal faster.
Treatment may include:
- Medications that reduce stomach acid: Medications such as histamine blockers (H2 blockers) and proton pump inhibitors (PPIs).
- Medicines that protect the stomach lining: Medicines such as bismuth subsalicylate and sucralfate.
- Antibiotics for bacterial infections.
- Drugs that neutralize bile salts in the stomach: Drugs such as ursodeoxycholic acid (UDCA).
- Medications for portal hypertension: Vasoconstrictors or beta blockers.
- Specialized surgical procedures for some conditions that do not respond to medications.
Can gastropathy be cured?
Yes, your stomach lining can heal. But for it to have a chance, the damage needs to stop. This can often be done with medication. However, some causes of gastropathy can be a little more complicated. If there is ongoing bile reflux or portal hypertension, you may need to have something like a minor surgery to correct it. Hypertrophic gastropathy may or may not be completely reversible with treatment. However, medication can often prevent further changes to the lining.
Remember, our stomach lining is a very strong thing. It takes a lot to break down its defenses. Gastropathy can be caused by either a very severe, sudden injury or by damage that has been going on for a long time. You need medical treatment to identify, stop, and reverse this process of damage. But, with a little help, our stomach lining can recover and heal better than most other organs. Once its defenses are back in place, it is not as easily damaged again.
Take-Home Message
- Gastropathy is damage to the lining of the stomach (mucosa) without inflammation (or with very little inflammation) .
- Alcohol, some painkillers (NSAIDs), bile reflux, and some medical conditions can cause this.
- Symptoms such as stomach pain, nausea, and indigestion may occur, but some people may not have any symptoms at all.
- If you have signs of bleeding (black stools, vomit that looks like coffee grounds), seek medical advice immediately .
- The disease can be accurately diagnosed through an endoscopy.
- Gastropathy can be cured by receiving proper treatment depending on the cause and type.
- Follow your doctor's instructions exactly. Do not continue to use medications such as painkillers without medical advice.
If you have any further questions about this, don't hesitate to ask your family doctor or a gastroenterologist. Stay healthy!
` Gastropathy, stomach diseases, stomach lining, stomach ulcers, NSAIDs, alcohol, endoscopy
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