Difference between revisions of "Reactive gastropathy"
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| Caption = Reactive gastropathy. [[H&E stain]]. | | Caption = Reactive gastropathy. [[H&E stain]]. | ||
| Micro = | | Micro = foveolar hyperplasia - esp. tortuosity of glands in the "neck" region (S shaped glands), smooth muscle hyperplasia, scant inflammatory cells, +/-edema, +/-erosions | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = | | LMDDx = | ||
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'''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). | '''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. | *May be seen in the context of a previous resection/surgical reconstruction, e.g. Billroth II. | ||
===Epidemiology=== | |||
General assocations: | 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> | *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> | ||
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===Relation to gastritis=== | |||
*May mimic a (true) gastritis symptomatically and visually in an endoscopic examination. | *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. | *"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. | **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> | Features:<ref>{{Ref GLP|69}}</ref> | ||
*Antral erythema +/- erosions. | *Antral erythema +/- erosions. | ||
*+/-Bile. | *+/-Bile. | ||
==Microscopic== | |||
Features - triad:<ref>El-Zimaity. 18 October 2010.</ref><ref name=pmid16939055/> | Features - triad:<ref>El-Zimaity. 18 October 2010.</ref><ref name=pmid16939055/> | ||
#Foveolar hyperplasia. | #Foveolar hyperplasia. | ||
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*[[Hyperplastic polyp of the stomach]].<ref name=Ref_GLP69>{{Ref GLP|69}}</ref> | *[[Hyperplastic polyp of the stomach]].<ref name=Ref_GLP69>{{Ref GLP|69}}</ref> | ||
===Images=== | |||
<gallery> | <gallery> | ||
Image: Reactive_gastropathy_-_low_mag.jpg | RG - low mag. (WC/Nephron) | Image: Reactive_gastropathy_-_low_mag.jpg | RG - low mag. (WC/Nephron) | ||
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</gallery> | </gallery> | ||
==Sign out== | |||
<pre> | <pre> | ||
STOMACH, BIOPSY: | STOMACH, BIOPSY: | ||
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</pre> | </pre> | ||
===Not well-developed=== | |||
<pre> | <pre> | ||
STOMACH, BIOPSY: | STOMACH, BIOPSY: | ||
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- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | ||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | ||
COMMENT: | COMMENT: | ||
Revision as of 08:10, 26 July 2013
| 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 |
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
- 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.
See also
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.