Stomach
Gastritis
Reactive (chemical) gastropathy

Authors: Elliot Weisenberg, M.D. (see Authors page)

Revised: 23 November 2016, last major update August 2012

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: reactive chemical gastropathy
Cite this page: Reactive (chemical) gastropathy. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/stomachchemical.html. Accessed December 6th, 2016.
Definition / General
  • Also called reflux gastritis, type C gastritis
  • Second most common diagnosis for gastric biopsies in North America
  • Associated with gastrectomy, biliary and duodenal-pancreatico reflux, gastroesophageal reflux disease, NSAIDs (leading cause in developed world, Mod Pathol 2003;16:325), acid, alkali, ethanol (severe abuse)
  • Increased surface cell exfoliation after toxic injury causes loss of mucus barrier and back diffusion of gastric acid; usually diffuse (present on more than one biopsy)
  • Increased risk of gastric malignancy after partial gastrectomy, but number of cases far lower than era before effective medical therapy for peptic ulcer disease
Micro Description
  • (a) prominent foveolar hyperplasia
  • (b) fibromuscular replacement of the lamina propria
  • (c) lamina propria edema
  • (d) vascular dilation/congestion of superficial mucosal capillaries
  • (e) paucity of active and chronic inflammatory cells

  • Can grade each feature on 0-3 scale to provide reflux score (maximum 15, 10+ indicates reactive gastropathy)
  • Glandular compartment unchanged
  • Foveolar cell vacuolization associated with bile reflux (Am J Surg Pathol 1988;12:773)
  • Foveolar hyperplasia: corkscrew appearance of superficial mucosa with loss of cytoplasmic mucus, nuclear enlargement and hyperchromasia; most useful feature for diagnosis since easiest to assess, may see increased mitoses
  • Definitive diagnosis requires clinical correlation (drug / surgical history)
  • In post-gastrectomy cases, polypoid lesions near anastomotic site (known as gastritis polyposa or gastritis cystica profunda), forms from dilated irregular foveolae may occur and mimic neoplasia
Micro Images

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