Reflux gastritis: distinct histopathological entity?

Abstract

Infirmary at Leeds, Leeds summARY A total of 98 patients who had either undergone gastric surgery (23) or who had peptic ulcers (56), or who had normal endoscopic findings (19), all underwent gastric biopsy, together with measurement of pH and total bile acid concentration in their fasting gastric juice. The biopsy specimens were graded "blind" for the presence of foveolar hyperplasia; oedema and smooth muscle fibres in the lamina propria; vasodilation and congestion of superficial mucosal capillaries; and a paucity of both acute and chronic inflammatory cells in the belief that these features constituted a distinctive histological picture related to reflux of alkaline duodenal content into the stomach.We found a strong association between severe grades of each of these histological variables and both hypochlorhydria (pH > 4) and increased bile acid concentrations in the stomach. Furthermore, when the individual grades were added together to give a composite "reflux score," there was a significant difference in the incidence of hypochlorhydria (p < 0'01) and raised bile acid concentrations (p < 0'005) between those patients with a reflux score above and below 10. Although we do not claim that reflux is invariably accompanied by a distinctive histological picture, we suggest that recognition of this hitherto poorly documented combination of features as reflux gastritis may assist in the selection of patients for specific treatment and minimise the overdiagnosis of premalignant dysplasia (with which the lesion may be confused) in the postoperative stomach.

Gastritis and Carditis

“…The histopathologic features of reflux gastropathy have been well described by Dixon et al (78). They include foveolar hyperplasia, edema and smooth muscle fibers in the lamina propria, vasodilation and congestion of superficial mucosal capillaries, and a paucity of active and chronic inflammatory cells.…”

“…It has also been referred to as reflux gastritis, chemical gastritis, and Type C gastritis. The condition was originally described in the stomachs of patients who had undergone gastric surgery (62)(63)(64). It was found to be most common after Billroth II gastrectomy but was also encountered after vagotomy and pyloroplasty (64).…”

“…On theoretical grounds, one would expect gastropathy secondary to reflux to be diffuse and located adjacent to the pylorus, and gastropathy secondary to NSAIDs to be more patchy throughout the antrum. There is good evidence for believing that the gastric mucosal changes are secondary to chemically mediated damage at the mucosal surface, producing increased surface exfoliation and epithelial turnover (78).…”

“…These features may each be graded on a 0-3ϩ scale to provide a "reflux score" (maximum, 15). Scores of Ն10 are regarded as highly characteristic of reactive gastropathy (78). In examples of prominent foveolar hyperplasia, there is often a corkscrew appearance of the superficial mucosa (Fig.…”

Induction of peripheral lymph node addressin in human gastric mucosa infected byHelicobacter pylori

“…Biopsy specimens obtained from 20 rheumatoid arthritis patients who had been taking nonsteroidal anti-inflammatory drugs (NSAIDs) were evaluated according to a system (26) modified from Dixon et al (27) for grading of chemical gastritis. Five histological features, which are composed of (i) foveolar hyperplasia, (ii) edema and prominence of muscle fibers in the lamina propria, (iii) vasodilatation and congestion, (iv) inverse scale for polymorphonuclear neutrophil activity, and (v) inverse scale for chronic lymphocyte infiltration, were graded from 0 (normal or absent) to 3 (marked).…”