Difference between revisions of "Reactive gastropathy"

Reactive gastropathy
	Diagnosis in short
	; Reactive gastropathy. H&E stain.
LM	Foveolar hyperplasia - esp. tortuosity of glands in the "neck" region (S shaped glands), smooth muscle hyperplasia, scant inflammatory cells, +/-edema, +/-erosions
Site	stomach
Clinical history	classically NSAID use or alcohol use
Endoscopy	erythema, +/-erosions, +/-bile reflux
Clin. DDx	gastritis

Revision as of 08:09, 26 July 2013

Reactive gastropathy, abbreviated RG, a relatively common pathology of the stomach. It is also known as chemical gastropathy,^[1] and incorrectly referred to as chemical gastritis (see below).

General

May be seen in the context of a previous resection/surgical reconstruction, e.g. Billroth II.

Epidemiology

General assocations:

Increases with age.^[2]

Etologic factors - associated with:^[3]

Excess acid.
EtOH.
Bile.
H. pylori.
Drugs:^[1]
- Iron (brown pigment on histology).
- NSAIDs - synergistic effect with corticosteroids.

Drugs that cause erosions and/or ulcers -- adapted from Genta:^[1]

Drug	Comment	Indication for Rx
NSAIDs	common cause	pain, reduce cardiovascular risk
Corticosteroids	synergistic effect with NSAIDs	rheumatologic diseases + others
Potassium (KCl)	common cause	renal failure
Bisphophonates	uncommon cause	osteoporosis
Ferrous sulfate	very common if symptomatic	iron deficiency anemia
Chloroquine	uncommon	only in the context of malaria
Sodium polystyrene sulfonate (Kayexalate)	rare	renal failure patients

Relation to gastritis

May mimic a (true) gastritis symptomatically and visually in an endoscopic examination.
"Chemical gastritis" is misnomer. Etymologically, the -itis in gastritis, implies an inflammatory process. Chemical gastropathy is not (predominantly) an inflammatory process.
- This type of confusion is not uncommon. Steatohepatitis is another example of this; it is not a process with significant inflammation yet, confusingly, carries the -itis ending.

Gross/endoscopic

Features:^[4]

Antral erythema +/- erosions.
+/-Bile.

Microscopic

Features - triad:^[5]^[1]

Foveolar hyperplasia.
- Tortuosity of glands in the "neck" region of the gastric glands.
- Associated with "mucin depletion" - cytoplasm not clear -- as is usual.
Smooth muscle fibre hyperplasia.
- Abundant eosinophilic lamina propria.
Scant acute & chronic inflammatory cells.

Additional features.

+/-Edema.
+/-Erosions.

Notes:

Triad rarely present; mild inflammation common.

DDx:

Images

RG - low mag. (WC/Nephron)
RG - high mag. (WC/Nephron)

Sign out

STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH REACTIVE GASTROPATHY, SEE COMMENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

COMMENT:
This nonspecific finding may be due to a number of causes, including 
medications (especially NSAIDs), alcohol and bile reflux.

Not well-developed

STOMACH, BIOPSY:
- BODY-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS.
- ANTRAL-TYPE GASTRIC MUCOSA WITH SMOOTH MUSCLE HYPERPLASIA,
  RARE GLAND TORTUOSITY AND NO SIGNFICANT INFLAMMATION, SEE COMMENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.


COMMENT:
These findings are suggestive of a reactive gastropathy; however, gland 
corkscrewing is not evident.

STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH PROMINENT SMOOTH MUSCLE, OTHERWISE WITHIN NORMAL
LIMITS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 Genta, RM. (Nov 2005). "Differential diagnosis of reactive gastropathy.". Semin Diagn Pathol 22 (4): 273-83. PMID 16939055.
↑ Maguilnik, I.; Neumann, WL.; Sonnenberg, A.; Genta, RM. (Aug 2012). "Reactive gastropathy is associated with inflammatory conditions throughout the gastrointestinal tract.". Aliment Pharmacol Ther. doi:10.1111/apt.12031. PMID 22928604.
↑ ALS. 5 February 2009.
↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 69. ISBN 978-0443066573.
↑ El-Zimaity. 18 October 2010.
↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 69. ISBN 978-0443066573.

[pmid16939055-1] 1.0 ^1.1 ^1.2 ^1.3 Genta, RM. (Nov 2005). "Differential diagnosis of reactive gastropathy.". Semin Diagn Pathol 22 (4): 273-83. PMID 16939055.

[pmid22928604-2] Maguilnik, I.; Neumann, WL.; Sonnenberg, A.; Genta, RM. (Aug 2012). "Reactive gastropathy is associated with inflammatory conditions throughout the gastrointestinal tract.". Aliment Pharmacol Ther. doi:10.1111/apt.12031. PMID 22928604.

[3] ALS. 5 February 2009.

[4] Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 69. ISBN 978-0443066573.

[5] El-Zimaity. 18 October 2010.

[Ref_GLP69-6] Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 69. ISBN 978-0443066573.

[1]

[2]

[3]

[4]

[5]

[6]

@@ Line 1: / Line 1: @@
-#redirect [[Stomach#Reactive_gastropathy]]
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = Reactive_gastropathy_-_low_mag.jpg
+| Width      =
+| Caption    = Reactive gastropathy. [[H&E stain]].
+| Micro      = Foveolar hyperplasia - esp. tortuosity of glands in the "neck" region (S shaped glands), smooth muscle hyperplasia, scant inflammatory cells, +/-edema, +/-erosions
+| Subtypes   =
+| LMDDx      =
+| Stains     =
+| IHC        =
+| EM         =
+| Molecular  =
+| IF         =
+| Gross      =
+| Grossing   =
+| Site       = [[stomach]]
+| Assdx      =
+| Syndromes  =
+| Clinicalhx = classically NSAID use or alcohol use
+| Signs      =
+| Symptoms   =
+| Prevalence =
+| Bloodwork  =
+| Rads       =
+| Endoscopy  = erythema, +/-erosions, +/-bile reflux
+| Prognosis  =
+| Other      =
+| ClinDDx    = [[gastritis]]
+}}
+'''Reactive gastropathy''', abbreviated '''RG''', a relatively common pathology of the [[stomach]]. It is also known as ''chemical gastropathy'',<ref name=pmid16939055>{{Cite journal  | last1 = Genta | first1 = RM. | title = Differential diagnosis of reactive gastropathy. | journal = Semin Diagn Pathol | volume = 22 | issue = 4 | pages = 273-83 | month = Nov | year = 2005 | doi =  | PMID = 16939055 }}</ref> and incorrectly referred to as ''chemical gastritis'' (see below).
+===General===
+*May be seen in the context of a previous resection/surgical reconstruction, e.g. Billroth II.
+====Epidemiology====
+General assocations:
+*Increases with age.<ref name=pmid22928604>{{Cite journal  | last1 = Maguilnik | first1 = I. | last2 = Neumann | first2 = WL. | last3 = Sonnenberg | first3 = A. | last4 = Genta | first4 = RM. | title = Reactive gastropathy is associated with inflammatory conditions throughout the gastrointestinal tract. | journal = Aliment Pharmacol Ther | volume =  | issue =  | pages =  | month = Aug | year = 2012 | doi = 10.1111/apt.12031 | PMID = 22928604 }}</ref>
+Etologic factors - associated with:<ref>ALS. 5 February 2009.</ref>
+*Excess acid.
+*[[EtOH]].
+*Bile.
+*[[H. pylori]].
+*Drugs:<ref name=pmid16939055>{{Cite journal  | last1 = Genta | first1 = RM. | title = Differential diagnosis of reactive gastropathy. | journal = Semin Diagn Pathol | volume = 22 | issue = 4 | pages = 273-83 | month = Nov | year = 2005 | doi =  | PMID = 16939055 }}</ref>
+**Iron (brown pigment on histology).
+**[[NSAID]]s - synergistic effect with corticosteroids.
+Drugs that cause erosions and/or ulcers -- adapted from ''Genta'':<ref name=pmid16939055>{{Cite journal  | last1 = Genta | first1 = RM. | title = Differential diagnosis of reactive gastropathy. | journal = Semin Diagn Pathol | volume = 22 | issue = 4 | pages = 273-83 | month = Nov | year = 2005 | doi =  | PMID = 16939055 }}</ref>
+{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
+! Drug
+! Comment
+! Indication for Rx
+|-
+| NSAIDs
+| common cause
+| pain, reduce cardiovascular risk
+|-
+| Corticosteroids
+| synergistic effect with NSAIDs
+| rheumatologic diseases + others
+|-
+| Potassium (KCl)
+| common cause
+| renal failure
+|-
+| Bisphophonates
+| uncommon cause
+| [[osteoporosis]]
+|-
+| Ferrous sulfate
+| very common if symptomatic
+| iron deficiency anemia
+|-
+| Chloroquine
+| uncommon
+| only in the context of [[malaria]]
+|-
+| Sodium polystyrene sulfonate (Kayexalate)
+| rare
+| renal failure patients
+|}
+====Relation to gastritis====
+*May mimic a (true) gastritis symptomatically and visually in an endoscopic examination.
+*"Chemical gastritis" is misnomer. Etymologically, the ''-itis'' in ''gastritis'', implies an inflammatory process.  Chemical gastropathy is not (predominantly) an inflammatory process.
+**This type of confusion is not uncommon. [[Steatohepatitis]] is another example of this; it is not a process with significant inflammation yet, confusingly, carries the ''-itis'' ending.
+===Gross/endoscopic===
+Features:<ref>{{Ref GLP|69}}</ref>
+*Antral erythema +/- erosions.
+*+/-Bile.
+===Microscopic===
+Features - triad:<ref>El-Zimaity. 18 October 2010.</ref><ref name=pmid16939055/>
+#Foveolar hyperplasia.
+#*Tortuosity of glands in the "neck" region of the gastric glands.
+#*Associated with "mucin depletion" - cytoplasm not clear -- as is usual.
+#Smooth muscle fibre hyperplasia.
+#*Abundant eosinophilic lamina propria.
+#Scant acute & chronic inflammatory cells.
+Additional features.
+*+/-Edema.
+*+/-Erosions.
+Notes:
+*Triad rarely present; mild inflammation common.
+DDx:
+*[[Amyloidosis]].
+*[[Collagenous gastritis]].
+*[[Hyperplastic polyp of the stomach]].<ref name=Ref_GLP69>{{Ref GLP|69}}</ref>
+====Images====
+<gallery>
+Image: Reactive_gastropathy_-_low_mag.jpg | RG - low mag. (WC/Nephron)
+Image: Reactive_gastropathy_-_high_mag.jpg | RG - high mag. (WC/Nephron)
+</gallery>
+===Sign out===
+<pre>
+STOMACH, BIOPSY:
+- ANTRAL-TYPE GASTRIC MUCOSA WITH REACTIVE GASTROPATHY, SEE COMMENT.
+- NEGATIVE FOR INTESTINAL METAPLASIA.
+- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
+- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
+COMMENT:
+This nonspecific finding may be due to a number of causes, including
+medications (especially NSAIDs), alcohol and bile reflux.
+</pre>
+====Not well-developed====
+<pre>
+STOMACH, BIOPSY:
+- BODY-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS.
+- ANTRAL-TYPE GASTRIC MUCOSA WITH SMOOTH MUSCLE HYPERPLASIA,
+  RARE GLAND TORTUOSITY AND NO SIGNFICANT INFLAMMATION, SEE COMMENT.
+- NEGATIVE FOR INTESTINAL METAPLASIA.
+- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
+- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
+COMMENT:
+These findings are suggestive of a reactive gastropathy; however, gland
+corkscrewing is not evident.
+</pre>
+<pre>
+STOMACH, BIOPSY:
+- ANTRAL-TYPE GASTRIC MUCOSA WITH PROMINENT SMOOTH MUSCLE, OTHERWISE WITHIN NORMAL
+LIMITS.
+- NEGATIVE FOR INTESTINAL METAPLASIA.
+- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
+- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
+</pre>
+==See also==
+*[[Stomach]].
+==References==
+{{Reflist|2}}
 [[Category:Diagnosis]]
+[[Category:Stomach]]