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reactive gastropathy

Wednesday 3 February 2016

Definition: Reactive gastropathy refers to the constellation of endoscopic and histologic findings caused by chemical injury to the gastric mucosa.

Images

- Reactive gastropathy - chemical gastropathy : prominent foveolar hyperplasia & splayed smooth muscle fibres. NSAID use.

The histologic picture is characterized by foveolar hyperplasia with edema, smooth muscle hyperplasia, and congestion of superficial capillaries in the lamina propria in the absence of significant inflammation.

These features were originally described in biopsy specimens obtained from patients who had undergone gastric surgery and were felt to be specific for bile reflux.

It has since become apparent, however, that the constellation of histologic features seen in reactive gastropathy is a nonspecific response to chemical injury of the gastric mucosa.

Reactive gastropathy has also been referred to as chemical gastropathy, reflux gastritis, and type C gastritis.

The term "chemical gastropathy" was recommended by the Updated Sydney System, because it indicates an underlying chemical injury that is not associated with infection.

Differential diagnosis

- Gastric antral vascular ectasia (GAVE)

  • The presence of fibrin thrombi in the mucosal capillaries is a characteristic feature of GAVE rather than of reactive gastropathy.
  • This finding, along with its distinctive endoscopic appearance (" watermelon stomach "), aids in the differentiation of GAVE from other similar-appearing entities.

- Helicobacter pylori-induced gastritis
- portal hypertensive gastropathy

Links

- http://emedicine.medscape.com/article/1962893-overview