Gastropathy: Spectrum of Gastric Mucosal Disorders

Gastropathy is a nonspecific term for any abnormal stomach condition, typically implying mucosal injury without primary inflammation (vs. gastritis).

Major Types

Gastropathy vs. Gastritis

• Gastritis: Histologic inflammation (neutrophils = active; lymphocytes/plasma = chronic). H. pylori, autoimmune, lymphocytic.
• Gastropathy: Epithelial injury/regeneration ± minimal inflammation. Chemical, vascular, congenital.
• Overlap: NSAIDs cause both chemical gastropathy + chemical gastritis.

Diagnosis

• Upper endoscopy with biopsies (distinguish gastropathy vs. gastritis vs. neoplasia)
• H. pylori testing (urease, histology, PCR, stool Ag, breath)
• Serology (parietal cell Ab, intrinsic factor Ab for autoimmune)

Treatment

• Remove offending agent (NSAIDs, alcohol)
• Acid suppression (PPI) for chemical/portal hypertensive
• Sucralfate, misoprostol, bismuth for mucosal protection
• Endoscopic therapy (APC, banding) for GAVE, Dieulafoy
• Treat underlying cause (cirrhosis, H. pylori, vasculitis)

Gastropathy is an endoscopic/morphologic descriptor; histology clarifies.

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Type	Pathophysiology	Key Causes	Endoscopic Appearance
Chemical/Reactive gastropathy	Bile reflux, NSAIDs, alcohol → disrupted mucosal barrier	NSAIDs, bile reflux (post-Billroth), alcohol, chemo	Erythema, edema, erosions, bile staining
Portal hypertensive gastropathy	Venous congestion from portal HTN	Cirrhosis, portal vein thrombosis	Mosaic/snake-skin pattern, cherry red spots
Congenital/Hereditary	Genetic defects (Ménétrier, GAVE)	Ménétrier (EGFR), GAVE (watermelon stomach)	Giant folds (Ménétrier); antral stripes (GAVE)
Infectious (non-H. pylori)	CMV, HSV, TB, syphilis, fungi	Immunocompromise	Ulcers, nodules, hemorrhage
Vascular	Ischemia (rare), Dieulafoy, AVM	Atherosclerosis, vasculitis, radiation	Pale mucosa, focal spurring vessel