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Surgical Pathology Criteria

Chemical Gastritis / Reactive Gastropathy


  • 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
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

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


  • 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


Gastritis / Gastropathy


  • 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.
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© 2009  Stanford University School of Medicine