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home - Stomach - Gastritis and Gastropathy - Chronic Chemical Gastropathy Written by Dr Sebastian Zeki

Chronic Chemical Gastropathy

Bile reflux chemical gastropathy — Diagnosis — Chronic gastropathy in the absence of other causes is usually sufficient esp if surgically altered (eg gastroenterostomy)Duodenogastric reflux can be demonstrated by visualization during endoscopy, bile salt analysis in gastric juice, or radionuclide scanning.Treatment — Surgery (usually Roux-en-Y revision) improves symptoms in 50-90%A number of medical treatments have been evaluated in small clinical trials with variable success:Ursodeoxycholic improves symptoms but not histologySucralfate improved histologic features but not symptomsProstaglandin E2 is ineffectiveCholestyramine combined with alginates (to improve contact time in the gastric remnant) was ineffective on symptoms or histology. Paucity of inflammation (in contrast to H. pylori gastritis.)Variable degrees of foveolar hyperplasiaOedemaProliferation of smooth muscle fibers in the lamina propria Usually antral Histopathology —Features associated with stomas include:Foveolar hyperplasia (regresses with surgical correction)Discrete polypoid lesions (ie, polypoid hypertrophic gastritis or gastritis cystica polyposa). Chronic NSAID-associated chemical gastropathy — Associated with suppressed epithelial cell regeneration. Histology consistent with repeated episodes of erosion, ulceration, and repair. Alcohol Associated with acute gastritis but less convincing as a cause of chronic gastritis Chronic Chemical Gastropathy— Potassium and iron. Smoking is not a cause Foveolar hyperplasia Lengthening and corkscrewing of the foveolae (gastric pits), Individual cells have reduced height and intracellular mucin depletion. Bile salts (break down gastric mucosal barrier) Antral metaplastic gastritis. Foveolar hyperplasia (especially near stoma sites Causes Written by Dr Sebastian Zeki

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