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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.


● 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

Various images

End of Stomach > Gastritis > Reactive (chemical) gastropathy

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