DA40 - Acquired Anatomical Alterations of the Stomach: Complete Coding Guide

1. Introduction

Acquired anatomical alterations of the stomach represent a set of conditions in which the gastric structure undergoes morphological modifications throughout life, differentiating itself from congenital anomalies present since birth. This group of disorders, coded as DA40 in the International Classification of Diseases 11th Revision (ICD-11), encompasses various conditions that alter the normal anatomy of the stomach due to acquired processes, whether surgical, traumatic, chronic inflammatory, or other non-congenital causes.

The clinical importance of this diagnostic group lies in the fact that these anatomical alterations frequently result in significant functional consequences, affecting the stomach's capacity to perform its digestive functions, compromising patients' quality of life, and requiring specialized medical follow-up. Unlike primary functional or inflammatory conditions, acquired anatomical alterations involve visible and measurable structural changes in gastric architecture.

From an epidemiological perspective, these conditions are relatively common in gastroenterological practice, especially in populations with higher prevalence of previous gastric surgery, abdominal trauma, or chronic inflammatory diseases. The impact on public health is considerable, since patients with gastric anatomical alterations frequently require prolonged follow-up, specialized nutritional interventions, and in some cases, additional corrective procedures.

The correct coding of these conditions is critical for various aspects of healthcare: it enables appropriate epidemiological tracking, facilitates communication among health professionals, ensures appropriate reimbursement of procedures and treatments, and contributes to clinical research on these conditions. The transition to ICD-11 brought greater specificity and clarity in the classification of these alterations, making it essential that health professionals adequately understand when and how to use this code.

2. Correct ICD-11 Code

Code: DA40

Description: Acquired anatomical alterations of the stomach

Parent category: Diseases of the stomach

Official definition: This group incorporates gastric disorders primarily due to acquired morphological alterations of the stomach.

The code DA40 functions as a grouper category within the ICD-11 system, bringing together various conditions that share the common characteristic of representing structural changes acquired in the gastric organ. The keyword here is "acquired," distinguishing these conditions from those present since birth or fetal development.

This code belongs to the chapter on diseases of the digestive system and is positioned specifically within diseases of the stomach, reflecting its primarily gastric nature. The hierarchical structure of ICD-11 allows this code to be subdivided into more specific categories, offering greater diagnostic granularity when necessary.

It is important to understand that DA40 represents a category code, which means that in clinical practice, it will frequently be necessary to use more specific codes within this category to precisely detail what type of anatomical alteration is present. The definition emphasizes that the focus is on morphological alterations—that is, changes in the form and structure of the organ—distinguishing them from functional disorders where the anatomy remains essentially normal.

Classification as "acquired" implies that there was a previously normal stomach that underwent structural modification over time, whether by deliberate medical intervention (such as surgery), by pathological processes (such as perforating ulcers that heal with deformity), or by trauma. This temporal and causal distinction is fundamental for the correct application of the code.

3. When to Use This Code

The code DA40 should be used in specific clinical situations where there is clear evidence of acquired structural alteration of the stomach. Here are the main scenarios:

Scenario 1: Post-surgical gastric alterations Patients who underwent gastric surgery and developed anatomical alterations as a direct result of the procedure. For example, a patient who underwent partial gastrectomy several years ago who now presents with remnant stomach syndrome with dilation and anatomical deformity documented by endoscopy or radiological studies. The criteria include documented surgical history, radiological or endoscopic evidence of structural alteration, and symptoms related to the altered anatomy.

Scenario 2: Post-ulcerative scarring deformities Patients with a history of severe peptic ulcer disease that resulted in scarring with permanent deformity of gastric anatomy. An example would be a patient with a pyloric ulcer that healed resulting in stenosis and deformity of the pyloric channel, with evidence of fixed anatomical alteration (not merely functional spasm). Documentation should include imaging studies demonstrating the permanent structural deformity.

Scenario 3: Post-traumatic alterations Patients who suffered penetrating or blunt abdominal trauma that resulted in gastric injury with subsequent scarring and permanent anatomical alteration. For example, a victim of an accident with abdominal trauma who developed gastric perforation, underwent surgical repair, and subsequently presents with deformity of the gastric wall with alteration of the organ's volumetric capacity.

Scenario 4: Adhesions and pathological retractions Patients with extensive perigastric adhesions secondary to previous intra-abdominal inflammatory processes that cause significant anatomical distortion of the stomach. An example would be a patient with a history of peritonitis who developed dense adhesions involving the stomach, resulting in abnormal angulation and alteration of gastric shape documented by imaging studies.

Scenario 5: Acquired gastric fistulas Patients who developed abnormal communications between the stomach and other structures (gastrocolic fistulas, gastrocutaneous fistulas, etc.) as a result of surgery, inflammatory disease, or complications of ulcers. The presence of a fistula represents a definitive acquired anatomical alteration that modifies the normal structure of the organ.

Scenario 6: Secondary chronic gastric dilation Patients with persistent gastric dilation secondary to long-standing mechanical obstruction or other causes that resulted in permanent alteration of gastric anatomy, with significant and measurable increase in volume and alteration of organ shape. It is differentiated from acute or functional dilation by its permanent and structural nature.

In all these scenarios, it is essential that there be objective documentation of anatomical alteration through imaging methods (endoscopy, computed tomography, contrast studies, magnetic resonance imaging) or direct surgical findings. The mere presence of symptoms without documented structural alteration does not justify the use of this code.

4. When NOT to Use This Code

It is fundamental to recognize situations where code DA40 is not appropriate, avoiding coding errors that may compromise medical records and health statistics.

Exclusion 1: Congenital anomalies of the stomach If the anatomical alteration was present at birth or resulted from abnormal fetal development, the appropriate code is for structural developmental anomalies of the stomach. For example, a patient with congenital gastric duplication or congenital cascade stomach should not receive code DA40. The critical distinction is temporal: was the alteration present at birth or acquired later? Documentation of history since childhood and early imaging studies help in this differentiation.

Exclusion 2: Diaphragmatic hernias Although diaphragmatic hernias may involve the stomach and alter its anatomical position, these conditions have their own specific codes. A hiatal hernia, for example, should not be coded as DA40, even if it results in alteration of gastric anatomy. The reason is that the classification prioritizes the herniary nature of the condition over the secondary gastric alteration.

Exclusion 3: Functional disorders without structural alteration Conditions such as gastroparesis, achalasia, or other motor disorders where gastric anatomy remains essentially normal should not be coded as DA40. Even if functional studies demonstrate significant abnormalities, if the morphological structure is preserved, codes for functional disorders (DA41) are more appropriate.

Exclusion 4: Gastritis and primary inflammatory processes Acute or chronic gastritis, even when severe, should be coded as DA42, not as DA40. The distinction lies in the fact that gastritis is primarily an inflammatory process of the mucosa, not an alteration of gastric architecture. Only when gastritis results in permanent structural deformity (such as in the scenario of scarred ulcer with deformity) does code DA40 become appropriate.

Exclusion 5: Gastric vascular lesions Vascular disorders of the stomach, such as angiodysplasias or gastric antral vascular ectasia, have a specific code (DA43) and should not be classified as acquired anatomical alterations, even if they represent structural alterations of the blood vessels in the gastric wall.

The general rule is that DA40 should be reserved for alterations of the macroscopic architecture of the gastric organ as a whole, not for pathological processes that primarily affect other aspects (mucosa, motor function, vascularization) even when these have structural components.

5. Step-by-Step Coding Process

Step 1: Assess diagnostic criteria

The first critical step is to confirm that there is genuinely an acquired anatomical alteration of the stomach. This requires:

Documentation of previous normal anatomy: Whenever possible, establish that the stomach had normal anatomy previously. This can come from prior examinations, clinical history, or logical inference (for example, absence of significant gastric symptoms before a specific event such as surgery or trauma).

Objective evidence of structural alteration: Obtain documentation through:

Upper gastrointestinal endoscopy with detailed description of anatomical alterations observed
Contrast radiological studies (esophagogastroduodenal series) showing deformities
Computed tomography or magnetic resonance imaging demonstrating morphological alterations
Direct surgical findings when applicable

Characterization of the acquired nature: Identify the event or process that led to the anatomical alteration (prior surgery, trauma, ulcer disease, etc.). This contextual information is essential to confirm that the alteration is acquired and not congenital.

Step 2: Verify specifiers

Once the presence of acquired anatomical alteration is confirmed, determine:

Specific location: Identify which portion of the stomach is affected (fundus, body, antrum, pylorus, or multiple regions). This may influence the need for additional more specific codes.

Extent of alteration: Document whether the alteration is focal (affecting a limited area) or diffuse (involving the entire organ). Extensive alterations generally have greater functional impact.

Functional severity: Assess the impact of the anatomical alteration on gastric function. Is there significant obstruction? Is volumetric capacity compromised? Are there related symptoms?

Associated complications: Identify whether there are complications such as fistulas, obstruction, recurrent bleeding, or secondary malnutrition related to the anatomical alteration.

Step 3: Differentiate from other codes

Differentiation from DA41 (Motor or secretory gastroduodenal disorders): The key difference lies in the presence or absence of structural alteration. If imaging studies show preserved gastric anatomy, but functional tests demonstrate dysmotility, use DA41. If there is evident structural deformity, use DA40. In some cases, both codes may be applicable when there is both anatomical alteration and secondary motor dysfunction.

Differentiation from DA42 (Gastritis): Gastritis is primarily a histological/endoscopic diagnosis of gastric mucosal inflammation. Even severe gastritis with mucosal atrophy does not constitute anatomical alteration in the sense of DA40, unless there is deformity of gastric architecture. The presence of erythema, erosions, or mucosal alterations without structural deformity of the organ indicates DA42, not DA40.

Differentiation from DA43 (Vascular disorders of the stomach): Vascular disorders involve abnormalities of blood vessels in the gastric wall. Although technically structural alterations, they are classified separately. If the main finding is angiodysplasia, vascular malformation, or vascular ectasia, use DA43. If there is deformity of the gastric wall or alteration of the organ's shape, use DA40.

Step 4: Required documentation

For appropriate coding of DA40, ensure that the medical record contains:

Mandatory documentation checklist:

Clear description of the anatomical alteration present
Diagnostic method used (endoscopy, imaging, surgery)
History of the event or process that caused the alteration
Clinical symptoms related to the anatomical alteration
Assessment of functional impact
Prior treatments related
Associated complications, if present

Imaging records: Ensure that imaging examination reports are available and clearly describe the anatomical alterations. The images themselves should be archived when possible.

Clinical-radiological correlation: Document how imaging findings correlate with the patient's clinical presentation, establishing clinical relevance of the anatomical alterations identified.

6. Complete Practical Example

Clinical Case

A 58-year-old male patient presents to gastroenterology consultation with complaints of early postprandial fullness, frequent nausea, and unintentional weight loss of approximately 8 kilograms over the past six months.

Past medical history: The patient reports having undergone partial gastrectomy Billroth II type 15 years ago due to refractory gastric ulcer with an episode of significant bleeding. After surgery, he remained relatively asymptomatic for many years, with irregular follow-up. Over the past two years, he began presenting with progressive digestive symptoms.

Physical examination: Thin patient with reduced body mass index. Abdomen with median laparotomy scar, without palpable masses, slightly tympanic on percussion. No signs of acute obstruction.

Investigation performed:

Upper gastrointestinal endoscopy: Revealed significantly dilated remnant stomach with food stasis even after adequate fasting. Gastrojejunal anastomosis with moderate stenosis and cicatricial deformity. Mucosa of the remnant stomach with appearance of chronic gastritis. No active ulcers or malignant lesions were identified. Mucosal biopsies showed chronic gastritis without dysplasia or malignancy.
Computed tomography of abdomen with oral contrast: Confirmed significant dilation of the remnant stomach with increased dimensions (approximately 15 cm in greatest diameter). Gastrojejunal anastomosis with narrowing and angulation. No evidence of complete mechanical obstruction, but with significant delay in contrast emptying. Absence of masses or collections.
Laboratory studies: Mild anemia (hemoglobin 11.2 g/dL), serum albumin at the lower limit of normal (3.3 g/dL), indicating mild to moderate nutritional compromise.

Nutritional assessment: Patient presents signs of mild protein-calorie malnutrition, with visible muscle loss and reduced adipose reserves.

Step-by-Step Coding

Criteria analysis:

Anatomical alteration present: Yes, there is clear evidence of alteration in gastric anatomy with significant dilation of the remnant stomach and deformity of the gastrojejunal anastomosis.
Acquired nature confirmed: The alteration is clearly acquired, resulting from previous surgical procedure (partial gastrectomy). The patient had a presumably normal stomach before surgery.
Objective documentation: Multiple methods confirm the anatomical alteration (endoscopy and computed tomography), with detailed descriptions of structural abnormalities.
Clinical relevance: The anatomical alterations directly correlate with the patient's symptoms (early fullness, nausea, weight loss) and have significant functional impact.

Code selected: DA40 - Acquired anatomical alterations of the stomach

Complete justification:

This patient presents with acquired anatomical alteration of the stomach characterized by dilation of the remnant stomach post-gastrectomy with deformity of the gastrojejunal anastomosis. The condition meets all criteria for DA40:

It is a morphological alteration (dilation and documented structural deformity)
It is acquired (resulting from previous surgery)
It primarily affects the stomach (although it involves anastomosis, gastric dilation is the main finding)
It has significant functional impact (delayed emptying, related symptoms)

The condition does not fit better in other categories:

It is not a congenital anomaly (exclusion of malformation codes)
It is not primarily a functional motor disorder (there is clear structural alteration)
It is not primary gastritis (although gastritis is present, it is secondary to the anatomical alteration)

Applicable complementary codes:

Additional code for chronic gastritis (DA42) may be considered as a secondary diagnosis, given the endoscopic and histological findings of mucosal inflammation
Code for mild protein-calorie malnutrition (5B51.0) reflecting the nutritional consequence of the anatomical alteration
Code for history of partial gastrectomy (previous procedure code) for complete context

This multiple coding adequately captures the complexity of the case: the primary anatomical alteration (DA40), the associated mucosal inflammation (DA42), and the nutritional impact (malnutrition). The code DA40 as the primary diagnosis is appropriate because the anatomical alteration is the central problem that explains the clinical presentation and directs therapeutic management.

7. Related Codes and Differentiation

Within the Same Category

DA41: Motor or secretory gastroduodenal disorders

When to use DA41 vs. DA40: Use DA41 when the primary problem is motor or secretory dysfunction of the stomach without significant structural alteration. For example, diabetic gastroparesis where imaging studies show an anatomically normal stomach, but gastric emptying studies demonstrate significant delay. Use DA40 when there is documented structural deformity, even if a functional component also exists.

Main difference: DA41 focuses on "how the stomach functions" (motility, secretion), while DA40 focuses on "how the stomach is structured" (shape, anatomy). A stomach may have normal anatomy but abnormal function (DA41), or abnormal anatomy that may or may not affect function (DA40).

DA42: Gastritis

When to use DA42 vs. DA40: Use DA42 when the primary diagnosis is inflammation of the gastric mucosa, whether acute or chronic, identified by endoscopy and confirmed by histology. Use DA40 when there is alteration of the organ's architecture, not just the mucosa. In cases of post-gastrectomy, for example, gastritis of the gastric remnant would be coded as DA42, while the anatomical deformity of the remaining stomach would be DA40.

Main difference: Gastritis is a histological/endoscopic diagnosis of mucosal inflammation. Acquired anatomical changes involve the macroscopic structure of the organ. Both may coexist, but they represent different pathological processes at different structural levels (microscopic vs. macroscopic).

DA43: Vascular disorders of the stomach

When to use DA43 vs. DA40: Use DA43 when the main finding is vascular abnormality such as angiodysplasias, gastric antral vascular ectasia, or vascular malformations. Use DA40 when there is alteration of the form or structure of the gastric wall itself, not primarily of the vessels.

Main difference: DA43 is specific for vascular pathology of the gastric wall, often manifesting as bleeding. DA40 refers to alterations of global gastric architecture. A patient with bleeding from vascular ectasia receives DA43; a patient with post-surgical gastric deformity receives DA40.

Differential Diagnoses

Gastric neoplasms: Gastric tumors may cause anatomical alteration, but are coded in specific oncological categories, not as DA40. The distinction is made by biopsy and histology.

Gastric bezoars: Although they may cause gastric distension, bezoars are intraluminal foreign bodies, not alterations of the wall or gastric structure, and have their own codes.

Volvulus of the stomach acute: Represents acute twisting of the stomach, a surgical emergency with a specific code, different from chronic anatomical alterations.

Portal hypertensive gastropathy: Although it causes alterations in the gastric mucosa, it is secondary to portal hypertension and coded as such, not as primary acquired anatomical alteration.

The key to appropriate differentiation is identifying which is the primary and dominant pathological process, using additional codes when multiple conditions coexist.

8. Differences with ICD-10

In ICD-10, acquired anatomical alterations of the stomach did not have a specific grouping category equivalent to DA40. Conditions that now fall under DA40 were dispersed across various codes:

Related ICD-10 codes:

K31.8: Other specified diseases of the stomach and duodenum
K91.8: Other disorders of the digestive system post-procedures
K31.4: Pyloric obstruction

Main changes in ICD-11:

ICD-11 introduces greater specificity and hierarchical organization. While ICD-10 frequently grouped anatomical, functional, and inflammatory conditions under generic codes, ICD-11 creates clearer distinctions:

Separation by pathological mechanism: ICD-11 explicitly distinguishes anatomical alterations (DA40) from motor/secretory disorders (DA41) and inflammatory processes (DA42), something less clear in ICD-10.
Improved hierarchical structure: DA40 functions as a parent category with specific subcategories, allowing more granular coding when necessary, while maintaining the possibility of using the general code when greater specificity is not possible.
Clarity in acquired nature: ICD-11 explicitly emphasizes "acquired" in the nomenclature, reducing confusion with congenital anomalies that in ICD-10 sometimes shared similar codes.

Practical impact of these changes:

For healthcare professionals, the transition to ICD-11 requires updating knowledge about the new code structure. Billing systems and health statistics need to be adapted to reflect the new granularity. Greater specificity allows better epidemiological tracking of specific conditions, facilitating research and health planning.

Clinical documentation needs to be more detailed to take advantage of ICD-11 specificity, requiring professionals to describe not only symptoms but also specific structural findings. This change, while initially challenging, results in more precise medical records useful for longitudinal patient care.

9. Frequently Asked Questions

1. How is the diagnosis of acquired anatomical alterations of the stomach made?

The diagnosis requires objective demonstration of structural alteration through imaging methods. Upper digestive endoscopy is frequently the initial method, allowing direct visualization of gastric anatomy and identification of deformities, stenoses, or other structural alterations. Contrast radiological studies (esophagogastroduodenal series) offer complementary insight into gastric shape and function. Computed tomography or magnetic resonance imaging provide detailed evaluation of the gastric wall and adjacent structures, being particularly useful for assessing the extent of alterations and complications. In some cases, diagnosis is made during surgery when anatomical alterations are identified directly. Detailed clinical history is essential to establish the acquired nature of the alteration, identifying previous events such as surgeries, trauma, or diseases that may have caused the structural change.

2. Is treatment available in public health systems?

Treatment of acquired anatomical alterations of the stomach is generally available in public health systems, although accessibility may vary according to local resources and available infrastructure. Conservative treatments such as dietary modifications, nutritional support, and symptomatic medications are widely available. Endoscopic procedures for stenosis dilation or stent placement are available in centers with gastroenterology services. Corrective surgical interventions, when necessary, are performed in hospitals with adequate surgical capacity. The complexity of the case may determine whether treatment in a specialized center is necessary. Patients should work with their medical teams to develop appropriate treatment plans considering local availability of resources and individual needs.

3. How long does treatment last?

The duration of treatment varies greatly depending on the nature and severity of the anatomical alteration. Some conditions require only continuous conservative management with dietary modifications and periodic follow-up, representing long-term or permanent treatment. Endoscopic procedures such as dilations may require periodic repetition, with intervals varying from weeks to months. Corrective surgeries, when successful, may definitively resolve the problem, although postoperative recovery generally takes weeks to months. Associated nutritional complications may require prolonged nutritional support, sometimes for months or years. Regular medical follow-up is often necessary indefinitely to monitor progression, prevent complications, and adjust treatment as necessary. Each patient should discuss treatment duration expectations with their physician, considering their specific situation.

4. Can this code be used in medical certificates?

Yes, the code DA40 can and should be used in medical certificates when appropriate. Certificates documenting temporary or permanent incapacity related to gastric anatomical alterations should include the appropriate ICD code for purposes of official documentation. The code helps employers, insurers, and social security agencies understand the nature of the medical condition. In certificates, it is useful to complement the code with a brief description of the condition in accessible language. For prolonged absences or disability benefit requests, additional documentation detailing the severity of the anatomical alteration and its functional impact is usually necessary. Healthcare professionals should ensure that certificates are accurate, complete, and adequately reflect the limitations imposed by the condition on the patient.

5. Can gastric anatomical alterations reverse spontaneously?

In most cases, acquired anatomical alterations of the stomach are permanent and do not reverse spontaneously. Scarring deformities, post-surgical alterations, and other established structural changes generally persist indefinitely. However, some conditions may improve partially with appropriate treatment. For example, inflammatory stenoses may respond to treatment of the underlying inflammation with reduction of narrowing. Gastric dilation secondary to obstruction may improve if the obstruction is relieved. Adhesions sometimes remodel over time, although they rarely disappear completely. The possibility of reversal or improvement should be discussed individually with the physician, considering the specific cause and nature of the anatomical alteration. Even when complete reversal is not possible, appropriate treatment often can significantly improve symptoms and quality of life.

6. Do patients with gastric anatomical alterations need a special diet?

Often yes. Gastric anatomical alterations commonly affect the stomach's ability to process food normally, necessitating dietary adaptations. Typical recommendations include smaller and more frequent meals to accommodate reduced gastric capacity, careful chewing to facilitate digestion, avoiding foods that tend to cause symptoms (frequently fatty, fibrous, or difficult-to-digest foods), and adjusting food consistency as necessary. Post-gastrectomy patients may require nutritional supplementation, particularly vitamin B12, iron, and calcium. Adequate hydration is important, although liquids may need to be consumed separately from solids in some cases. Consultation with a nutritionist specialized in gastrointestinal conditions is highly recommended to develop an individualized meal plan that optimizes nutrition while minimizing symptoms. Specific dietary needs vary according to the exact nature of the anatomical alteration and the patient's individual symptoms.

7. Is there a risk of gastric cancer in patients with acquired anatomical alterations?

The risk of gastric cancer varies depending on the underlying cause of the anatomical alteration. Post-gastrectomy patients, particularly those who underwent Billroth-type procedures, have a slightly increased risk of cancer in the remaining stomach, generally manifesting many years after surgery. This risk justifies periodic endoscopic surveillance in selected patients. Anatomical alterations secondary to chronic ulcer disease or atrophic gastritis may also be associated with increased risk, depending on factors such as Helicobacter pylori infection and the presence of intestinal metaplasia. However, it is important to emphasize that the majority of patients with acquired anatomical alterations do not develop cancer. Individual discussion with a gastroenterologist regarding the need and frequency of endoscopic surveillance is appropriate, considering specific risk factors, family history, and characteristics of the anatomical alteration present.

8. Do gastric anatomical alterations affect medication absorption?

Yes, gastric anatomical alterations can significantly affect medication absorption. Changes in gastric pH, emptying time, and available absorption surface can alter the pharmacokinetics of various medications. Medications that require an acidic environment for proper dissolution may have reduced absorption in patients with alterations affecting acid secretion. Accelerated or delayed gastric emptying modifies the exposure time of medications to the gastric and duodenal mucosa, altering absorption. Post-gastrectomy patients frequently require dose adjustments or alternative medication formulations. It is crucial to inform all prescribers about gastric anatomical alterations present so they can consider appropriate adjustments. Monitoring of serum levels may be necessary for medications with a narrow therapeutic window. Clinical pharmacists can provide valuable guidance on optimizing medication regimens in patients with altered gastric anatomy.

Conclusion

Acquired anatomical alterations of the stomach represent a diverse group of conditions that share the common characteristic of structural modification of the gastric organ after birth. Appropriate coding using DA40 in ICD-11 requires clear understanding of diagnostic criteria, careful differentiation of related conditions, and detailed documentation of structural alterations present. The transition from ICD-10 to ICD-11 brought greater specificity and organization, benefiting epidemiological tracking, clinical research, and patient care. Healthcare professionals should familiarize themselves with this coding framework to ensure accurate medical records and effective communication among healthcare teams. Appropriate management of these conditions requires a multidisciplinary approach, often involving gastroenterologists, surgeons, nutritionists, and other specialists, with a focus on optimizing function, minimizing symptoms, and preventing long-term complications.

External References

This article was prepared based on reliable scientific sources:

References verified on 2026-02-03

Acquired Anatomical Changes of the Stomach

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