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chemical gastritis

Thursday 23 February 2012

Reactive Gastritis

The diagnosis of "chemical gastritis" or "reactive gastritis" is indicated by the finding of foveolar hyperplasia, edema, and smooth-muscle proliferation in the lamina propria, together with only normal numbers or a minor increase in chronic inflammatory cells.

Unless there is erosion, neutrophilic polymorphonuclear cells are not seen.

This histological picture suggests an etiological role for some chemical irritant or drug; indeed, the entity was first recognized in patients who had undergone a partial gastrectomy with a gastroenteric anastomosis and who had bile reflux.

Thus, the clinical information might point to a bile-associated chemical gastritis (bile reflux gastritis), whereas a history of NSAID use would indicate a NSAID-associated chemical gastritis.

Some patients with reactive gastritis abuse alcohol, but in most no specific association can be identified.

When such changes are detected in the biopsy specimens from a patient without a suggestive history, pathologists should alert the clinician about the possibility of unrecognized NSAID use.

Although the Sydney Working party favored reactive over chemical gastritis, the Houston meeting remained divided on this issue. Some members have a strong preference for `chemical’ as the term is more explicit.

Likewise, the term gastropathy is favored by those who do not consider the mucosal reaction to be inflammatory.

The choice of terminology is not considered crucial. Wider recognition of this histological entity is much more important.

See also

- Gastritis