Difference between revisions of "Reactive gastropathy"
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| 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 = | ||
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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''' ([[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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==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> | ||
===RG and mild chronic gastritis=== | ====RG and mild chronic gastritis==== | ||
<pre> | <pre> | ||
STOMACH, BIOPSY: | STOMACH, BIOPSY: | ||
- ANTRAL-TYPE GASTRIC MUCOSA WITH REACTIVE GASTROPATHY AND MILD CHRONIC | - ANTRAL-TYPE GASTRIC MUCOSA WITH REACTIVE GASTROPATHY AND MILD CHRONIC | ||
INACTIVE INFLAMMATION. | INACTIVE INFLAMMATION. | ||
- 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> | ||
===Not well-developed=== | ====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=== | ====Not well-developed with minimal inflammation==== | ||
<pre> | <pre> | ||
STOMACH, BIOPSY: | STOMACH, BIOPSY: | ||
- ANTRAL-TYPE GASTRIC MUCOSA WITH SMOOTH MUSCLE HYPERPLASIA, RARE GLAND TORTUOSITY | - ANTRAL-TYPE GASTRIC MUCOSA WITH SMOOTH MUSCLE HYPERPLASIA, RARE GLAND TORTUOSITY | ||
AND MINIMAL CHRONIC INACTIVE INFLAMMATION, SEE COMMENT. | AND MINIMAL CHRONIC INACTIVE 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> | ||
====Isolated smooth muscle prominence==== | =====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> | ||
Latest revision as of 17:47, 17 June 2016
| Reactive gastropathy | |
|---|---|
| Diagnosis in short | |
 Reactive gastropathy. H&E stain. | |
|
| |
| Synonyms | chemical gastritis, chemical gastropathy, NSAID gastropathy (if due to a NSAID) |
|
| |
| LM | foveolar hyperplasia - esp. tortuosity of glands in the "neck" region (S shaped glands), smooth muscle hyperplasia, scant inflammatory cells, +/-edema, +/-erosions |
| LM DDx | hyperplastic polyp of the stomach, collagenous gastritis, amyloidosis, chronic gastritis |
| Site | stomach |
|
| |
| Associated Dx | osteoarthritis (treated with NSAIDs) |
| Clinical history | classically NSAID use or alcohol use |
| Endoscopy | erythema, +/-erosions, +/-bile reflux |
| Clin. DDx | gastritis |
| Reactive gastropathy | |
|---|---|
| External resources | |
| EHVSC | 10177 |
| Wikipedia | reactive gastropathy |
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).
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.[2]
Etologic factors - associated with:[3]
- Excess acid.
- Alcohol use (excessive).
- Bile (reflux).
- May be seen post-Bilroth II (distal gastrectomy).
- Drugs.[1]
Notes:
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 | congestive heart failure[6] |
| 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:[7]
- 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 - very low mag. (WC/Nephron)
RG - low mag. (WC/Nephron)
RG - low mag. (WC/Nephron)
RG - intermed. mag. (WC/Nephron)
RG - intermed. mag. (WC/Nephron)
RG - high mag. (WC/Nephron)
RG - low mag. (WC/Nephron)
RG - intermed. mag. (WC/Nephron)
RG - high mag. (WC/Nephron)
Sign out
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.
Block letters
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.
RG and mild chronic gastritis
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.
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 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.
Not well-developed with minimal inflammation
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.
Isolated smooth muscle prominence
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.
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.
- ↑ URL: http://www.cmej.org.za/index.php/cmej/article/view/2316/2190. Accessed on: June 17, 2016.
- ↑ Wolf, EM.; Plieschnegger, W.; Schmack, B.; Bordel, H.; Höfler, B.; Eherer, A.; Schulz, T.; Vieth, M. et al. (Dec 2014). "Evolving patterns in the diagnosis of reactive gastropathy: data from a prospective Central European multicenter study with proposal of a new histologic scoring system.". Pathol Res Pract 210 (12): 847-54. doi:10.1016/j.prp.2014.08.009. PMID 25238940.
- ↑ Weir, MR.; Espaillat, R. (Jun 2015). "Clinical perspectives on the rationale for potassium supplementation.". Postgrad Med 127 (5): 539-48. doi:10.1080/00325481.2015.1045814. PMID 25960118.
- ↑ 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.