Definition
Gastric changes due to injury to the mucosa by abnormal luminal contents
Alternate/Historical Names
Chemical gastropathy
Environmental gastritis / gastropathy
Reactive gastritis
Type C gastritis
Some names based on specific causes
Bile reflux gastritis
NSAID gastritis
Diagnostic Criteria
Foveolar hyperplasia and expansion
Produces corkscrew or serrated appearance of elongated crypts
Usually involves antrum
May involve body if post-antrectomy
Regenerative changes in foveolar cells
Enlarged and hyperchromatic nuclei
Prominent nucleoli
Decreased cytoplasmic mucin
Parietal cells preserved in glands
Minimal to absent neutrophilic and lymphocytic inflammation
Acute inflammation without chronic occasionally seen
May be difficult to sort out if complicated by Helicobacter
Eosinophils may be present
Edema
Congestion
Muscle fibers may be seen in the lamina propria
Scant inflammation
Similar to ischemic injury
May form erosions and ulcers
Inflammation restricted to the ulcer
Surrounding mucosa has little or no inflammation
Hemorrhage and necrosis of superficial mucosa may be seen
Frequently linear and antral
Robert V Rouse MD
Original posting : September 9, 2009
Differential Diagnosis
Superficial biopsies showing foveolar hyperplasia may appear identical to:
Menetrier disease Localized hyperplasia adjacent to other lesions
Hyperplastic polyps
Cronkhite-Canada polyps
Full thickness specimens and clinical and endoscopic correlation are required to demonstrate the extent of foveolar hyperplasia and atrophy of oxyntic glands
Clinical
Most common causes
Ingested agents
Alcohol
Drugs
Aspirin / NSAIDs
Iron and potassium
Corrosive agents
Physical injury
Radiation
Instrumentation
Hepatic artery chemotherapy
GI motility problems
Prolapse gastropathy
Post-gastrectomy bile reflux
Occasionally seen with intact stomach
Ischemia
Stress
Idiopathic
Lists
Gastritis / Gastropathy
Reactive gastropathy
/ chemical gastritis
Includes most acute gastritis
Various causes including:
Alcohol
NSAIDS and other drugs
Bile and/or duodenal contents (alkaline) reflux
Chronic gastritis and chronic active gastritis
Non-atrophic, predominantly antral
Atrophic, fundic
Other drug related gastritis
Iron
Stainable iron crystalline material present
Aluminum based antacids (gastric mucosal calcinosis)
Small, pink, partially calcified. refractile crystals
Kayexalate
Rhomboid or triangular, non-polarizable basophilic crystals
Chemotherapy
See excellent reviews
Parfitt and Driman, Hum Pathol 2007, 38:927
Srivastava and Lauwers, Histopathol 2007, 50:15
Hypertrophic/hyperplastic gastritis
Special types
Vascular
Infectious
Bibliography
Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N. Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
Owen DA. Gastritis and carditis. Mod Pathol. 2003 Apr;16(4):325-41.
