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Difference between revisions of "Reactive gastropathy"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Reactive_gastropathy_-_intermed_mag.jpg | | Image = Reactive_gastropathy_--_intermed_mag.jpg | ||
| Width = | | Width = | ||
| Caption = Reactive gastropathy. [[H&E stain]]. | | Caption = Reactive gastropathy. [[H&E stain]]. | ||
| Synonyms = chemical gastritis, chemical gastropathy, NSAID gastropathy (if due to a NSAID) | |||
| Micro = foveolar hyperplasia - esp. tortuosity of glands in the "neck" region (S shaped glands), smooth muscle hyperplasia, scant inflammatory cells, +/-edema, +/-erosions | | 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 = [[hyperplastic polyp of the stomach]], [[collagenous gastritis]], [[amyloidosis]], [[chronic gastritis]] | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
| Line 15: | Line 16: | ||
| Grossing = | | Grossing = | ||
| Site = [[stomach]] | | Site = [[stomach]] | ||
| Assdx = | | Assdx = [[osteoarthritis]] (treated with NSAIDs) | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = classically NSAID use or alcohol use | | Clinicalhx = classically [[NSAID]] use or alcohol use | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
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| Other = | | Other = | ||
| ClinDDx = [[gastritis]] | | ClinDDx = [[gastritis]] | ||
}} | |||
{{ Infobox external links | |||
| Name = {{PAGENAME}} | |||
| EHVSC = 10177 | |||
| pathprotocols = | |||
| wikipedia = reactive gastropathy | |||
| pathoutlines = | |||
}} | }} | ||
'''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''' ([[Reactive gastropathy#Relation to 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''' ([[Reactive gastropathy#Relation to gastritis|see below]]). | ||
''NSAID gastropathy'' redirects to here. | |||
==General== | ==General== | ||
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Etologic factors - associated with:<ref>ALS. 5 February 2009.</ref> | Etologic factors - associated with:<ref>ALS. 5 February 2009.</ref> | ||
*Excess acid. | *Excess acid. | ||
*[[EtOH]]. | *[[EtOH|Alcohol use (excessive)]]. | ||
*Bile. | *Bile (reflux). | ||
* | **May be seen post-Bilroth II (distal gastrectomy). | ||
*Drugs | *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). | **Iron (brown pigment on histology). | ||
**[[NSAID]]s - synergistic effect with corticosteroids. | **[[NSAID]]s - synergistic effect with corticosteroids. | ||
**Steroids.<ref>URL: [http://www.cmej.org.za/index.php/cmej/article/view/2316/2190 http://www.cmej.org.za/index.php/cmej/article/view/2316/2190]. Accessed on: June 17, 2016.</ref> | |||
Notes: | |||
*[[H. pylori]] uncommon in RG.<ref name=pmid25238940>{{Cite journal | last1 = Wolf | first1 = EM. | last2 = Plieschnegger | first2 = W. | last3 = Schmack | first3 = B. | last4 = Bordel | first4 = H. | last5 = Höfler | first5 = B. | last6 = Eherer | first6 = A. | last7 = Schulz | first7 = T. | last8 = Vieth | first8 = M. | last9 = Langner | first9 = C. | title = Evolving patterns in the diagnosis of reactive gastropathy: data from a prospective Central European multicenter study with proposal of a new histologic scoring system. | journal = Pathol Res Pract | volume = 210 | issue = 12 | pages = 847-54 | month = Dec | year = 2014 | doi = 10.1016/j.prp.2014.08.009 | PMID = 25238940 }}</ref> | |||
Drugs that cause erosions and/or ulcers | 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" | {| class="wikitable sortable" style="margin-left:auto;margin-right:auto" | ||
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! Indication for Rx | ! Indication for Rx | ||
|- | |- | ||
| | | [[NSAID]]s | ||
| common cause | | common cause | ||
| pain, reduce cardiovascular risk | | pain, reduce cardiovascular risk | ||
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| Potassium (KCl) | | Potassium (KCl) | ||
| common cause | | common cause | ||
| | | [[congestive heart failure]]<ref name=pmid25960118>{{Cite journal | last1 = Weir | first1 = MR. | last2 = Espaillat | first2 = R. | title = Clinical perspectives on the rationale for potassium supplementation. | journal = Postgrad Med | volume = 127 | issue = 5 | pages = 539-48 | month = Jun | year = 2015 | doi = 10.1080/00325481.2015.1045814 | PMID = 25960118 }}</ref> | ||
|- | |- | ||
| Bisphophonates | | Bisphophonates | ||
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| Ferrous sulfate | | Ferrous sulfate | ||
| very common if symptomatic | | very common if symptomatic | ||
| iron deficiency anemia | | iron deficiency [[anemia]] | ||
|- | |- | ||
| Chloroquine | | Chloroquine | ||
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| Sodium polystyrene sulfonate (Kayexalate) | | Sodium polystyrene sulfonate (Kayexalate) | ||
| rare | | rare | ||
| renal failure | | [[renal failure]] | ||
|} | |} | ||
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===Images=== | ===Images=== | ||
<gallery> | |||
Image: Reactive gastropathy -- very low mag.jpg | RG - very low mag. (WC/Nephron) | |||
Image: Reactive gastropathy -- low mag.jpg | RG - low mag. (WC/Nephron) | |||
Image: Reactive gastropathy - alt -- low mag.jpg | RG - low mag. (WC/Nephron) | |||
Image: Reactive gastropathy -- intermed mag.jpg | RG - intermed. mag. (WC/Nephron) | |||
Image: Reactive gastropathy - alt -- intermed mag.jpg | RG - intermed. mag. (WC/Nephron) | |||
Image: Reactive gastropathy -- high mag.jpg | RG - high mag. (WC/Nephron) | |||
</gallery> | |||
<gallery> | <gallery> | ||
Image: Reactive_gastropathy_-_low_mag.jpg | RG - low mag. (WC/Nephron) | Image: Reactive_gastropathy_-_low_mag.jpg | RG - low mag. (WC/Nephron) | ||
Image: Reactive_gastropathy_-_intermed_mag.jpg | RG - intermed. mag. (WC/Nephron) | |||
Image: Reactive_gastropathy_-_high_mag.jpg | RG - high mag. (WC/Nephron) | Image: Reactive_gastropathy_-_high_mag.jpg | RG - high mag. (WC/Nephron) | ||
</gallery> | </gallery> | ||
==Sign out== | ==Sign out== | ||
<pre> | |||
Stomach, Antrum, Biopsy: | |||
- Antral-type gastric mucosa with reactive gastropathy. | |||
- NEGATIVE for Helicobacter-like organisms. | |||
- NEGATIVE for intestinal metaplasia. | |||
- NEGATIVE for dysplasia and NEGATIVE for malignancy. | |||
</pre> | |||
===Block letters=== | |||
<pre> | <pre> | ||
STOMACH, BIOPSY: | STOMACH, BIOPSY: | ||
- ANTRAL-TYPE GASTRIC MUCOSA WITH REACTIVE GASTROPATHY, SEE COMMENT. | - ANTRAL-TYPE GASTRIC MUCOSA WITH REACTIVE GASTROPATHY, SEE COMMENT. | ||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | - NEGATIVE FOR INTESTINAL METAPLASIA. | ||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | ||
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</pre> | </pre> | ||
===Not well-developed=== | ====RG and mild chronic gastritis==== | ||
<pre> | |||
STOMACH, BIOPSY: | |||
- ANTRAL-TYPE GASTRIC MUCOSA WITH REACTIVE GASTROPATHY AND MILD CHRONIC | |||
INACTIVE INFLAMMATION. | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
====Not well-developed==== | |||
<pre> | <pre> | ||
STOMACH, BIOPSY: | STOMACH, BIOPSY: | ||
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- ANTRAL-TYPE GASTRIC MUCOSA WITH SMOOTH MUSCLE HYPERPLASIA, | - ANTRAL-TYPE GASTRIC MUCOSA WITH SMOOTH MUSCLE HYPERPLASIA, | ||
RARE GLAND TORTUOSITY AND NO SIGNFICANT INFLAMMATION, SEE COMMENT. | RARE GLAND TORTUOSITY AND NO SIGNFICANT INFLAMMATION, SEE COMMENT. | ||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | - NEGATIVE FOR INTESTINAL METAPLASIA. | ||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | ||
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</pre> | </pre> | ||
====Not well-developed with minimal inflammation==== | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- ANTRAL-TYPE GASTRIC MUCOSA WITH SMOOTH MUSCLE HYPERPLASIA, RARE GLAND TORTUOSITY | |||
AND MINIMAL CHRONIC INACTIVE INFLAMMATION, SEE COMMENT. | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
The smooth muscle hyperplasia and rare gland tortuosity are suggestive of a reactive | |||
gastropathy. | |||
</pre> | |||
=====Isolated smooth muscle prominence===== | |||
<pre> | <pre> | ||
STOMACH, BIOPSY: | STOMACH, BIOPSY: | ||
- ANTRAL-TYPE GASTRIC MUCOSA WITH PROMINENT SMOOTH MUSCLE, OTHERWISE WITHIN NORMAL | - ANTRAL-TYPE GASTRIC MUCOSA WITH PROMINENT SMOOTH MUSCLE, OTHERWISE WITHIN NORMAL | ||
LIMITS. | LIMITS. | ||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | - NEGATIVE FOR INTESTINAL METAPLASIA. | ||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | ||
</pre> | </pre> | ||
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==See also== | ==See also== | ||
*[[Stomach]]. | *[[Stomach]]. | ||
*[[Alcoholism]]. | |||
==References== | ==References== | ||