Other nonneoplastic

Reactive (chemical) gastropathy

Topic Completed: 1 August 2012

Minor changes: 16 August 2021

Copyright: 2003-2021,, Inc.

PubMed Search: reactive chemical gastropathy

Elliot Weisenberg, M.D.
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Cite this page: Weisenberg E. Reactive (chemical) gastropathy. website. Accessed December 2nd, 2021.
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
Microscopic (histologic) 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
Microscopic (histologic) images

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Chemical gastritis (low)

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