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Stomach

Gastritis

Reactive (chemical) gastropathy

Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 1 August 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● 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
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(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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Various images

End of Stomach > Gastritis > Reactive (chemical) gastropathy

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