Difference between revisions of "Reactive gastropathy"

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Reactive gastropathy (view source)

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#redirect [[Stomach#Reactive_gastropathy]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Reactive_gastropathy_--_intermed_mag.jpg
| Width      =
| 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
| Subtypes  =
| LMDDx      = [[hyperplastic polyp of the stomach]], [[collagenous gastritis]], [[amyloidosis]], [[chronic gastritis]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[stomach]]
| Assdx      = [[osteoarthritis]] (treated with NSAIDs)
| Syndromes  =
| Clinicalhx = classically [[NSAID]] use or alcohol use
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  = erythema, +/-erosions, +/-bile reflux
| Prognosis  =
| Other      =
| 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]]).
 
''NSAID gastropathy'' redirects to here.
 
==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|Alcohol use (excessive)]].
*Bile (reflux).
**May be seen post-Bilroth II (distal gastrectomy).
*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.
**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 - 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
|-
| [[NSAID]]s
| common cause
| pain, reduce cardiovascular risk
|-
| Corticosteroids
| synergistic effect with NSAIDs
| rheumatologic diseases + others
|-
| Potassium (KCl)
| 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
| 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]]
|}
 
===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 -- 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>
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)
</gallery>
 
==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>
STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH REACTIVE GASTROPATHY, SEE COMMENT.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- 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>
 
====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>
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 HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
 
COMMENT:
These findings are suggestive of a reactive gastropathy; however, gland
corkscrewing is not evident.
</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>
STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH PROMINENT SMOOTH MUSCLE, OTHERWISE WITHIN NORMAL
LIMITS.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
==See also==
*[[Stomach]].
*[[Alcoholism]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Stomach]]
Michael
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