Characteristic features of DIG associated with medications
| Agent | Clinical manifestations | Gastroscopy | Histology |
| NSAID Aspirin | Dyspeptic syndrome (epigastric pain, nausea, heartburn, sour belching, constipation, diarrhoea. Complications: bleeding, perforation, impaired patency of the small intestine. | Antral erythema, erosions, ulcers with defined edges, bleeding; diaphragm-like circular structures of the small (rarely large) bowel. | Mild/diffuse, mononuclear, infiltrate of the lamina propria; erosions/ulcers. Reactive gastropathy pattern: foveolar hyperplasia, mucous depletion, mucosal oedema with vascular ectasia, bundles of smooth muscle cells within the lamina propria (see figure 9A). |
| Anticoagulants | Abdominal pain, nausea, diarrhoea; haematemesis/haematochezia. Complications: iron-deficient anaemia. | Antral erythema, petechiae, haemorrhagic gastropathy with erosions/ulcers, Cameron’s lesions. | Reactive gastropathy pattern (see above). In severe cases: erosions/ulcers. |
| Glucocorticoids | Dyspeptic syndrome (epigastric pain, nausea, epigastrium heaviness), haematemesis, haematochezia. Complications: iron-deficiency anaemia. | Single/multiple erosions or ulcers; haemorrhagic foci in prepyloric, pyloric area. | Erosions/ulcers. |
| Mycophenolate mofetil (cytostatics) | Loss of appetite, nausea, vomiting, abdominal pain. | Spotted erythema, mucosal oedema, erosions. Giant gastric and duodenal ulcers (rare). | Hyaline degeneration of submucosal and muscular layers. Epithelial vacuolisation, necrosis, with mucosal erosions, apoptosis. Inflammation and oedema of lamina propria. |
| Immune checkpoint inhibitors | Loss of appetite, nausea, vomiting abdominal pain. | Mucosal oedema, erythema without manifestation. Whitish fibrin-like film on the surface of the mucous membrane. NBI: glandular destruction with oozing haemorrhages. | Pattern resembling Helicobacter pylori-associated gastritis, involving equally cranial and caudal stomach. Intraepithelial lymphocytes, pronounced apoptosis. Granulomatous lesions involving histiocytes, neutrophils and eosinophils. |
| Iron preparations | Loss of appetite, nausea, vomiting, abdominal pain. Complications: iron-deficiency anaemia. | Brown/yellow colour of the mucous membrane. Erythema with erosions. | Mucosal oedema/erosions; brown granular pigment covering the epithelial surface and extending into the gastric pits. Pigmented macrophages within the lamina propria. |
DIG, drug-induced gastritis; NBI, narrow-band imaging; NSAID, non-steroidal anti-inflammatory drug.