Reflux gastritis in gastroesophageal reflux disease: A histopathological study

Ann Diagn Pathol. 1999 Oct;3(5):281-6. doi: 10.1016/s1092-9134(99)80023-9.


Increased intragastric alkaline reflux has been documented in patients with reflux esophagitis; however, the effect on gastric histology has not been investigated in this population. We examined gastric biopsies from 72 non-acid-suppressed patients with gastroesophageal reflux disease (GERD) for changes of reflux gastritis or other forms of gastritis. In the Helicobacter pylori-negative GERD patients (n = 52) using the Dixon scoring system for reflux gastritis with a threshold score of >/=11, reflux gastritis was found in 15% (three of 20) of GERD patients with erosions and in no GERD patients without erosions. When the reflux gastropathy threshold score was changed to more than 8, 90% (18 of 20) of GERD patients with erosions and 19% (six of 32) of GERD patients without erosions were classified as having reflux gastritis. Regardless of the reflux gastritis threshold used, only 14% (seven of 52) of the H pylori-negative GERD patients exhibited normal gastric histology. Inactive chronic gastritis or nonspecific reactive changes were histologic findings in those gastric biopsies not classified as reflux gastritis or normal. All H pylori-positive GERD patients (n = 20) had active chronic gastritis. We conclude that most GERD patients will exhibit some form of gastric pathology: either reflux gastritis, chronic gastritis, or nonspecific reactive changes, depending on what reflux threshold score is applied and the presence of H pylori. Studies to define the intragastric alkaline content in conjunction with gastric histopathology need to be performed to further define those reflux esophagitis patients with reflux gastritis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Bile Reflux / complications
  • Bile Reflux / metabolism
  • Bile Reflux / pathology*
  • Female
  • Gastric Juice / metabolism
  • Gastric Mucosa / metabolism
  • Gastric Mucosa / microbiology
  • Gastric Mucosa / pathology
  • Gastritis / etiology
  • Gastritis / metabolism
  • Gastritis / pathology*
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / metabolism
  • Gastroesophageal Reflux / pathology*
  • Gastroscopy
  • Helicobacter Infections / complications
  • Helicobacter Infections / pathology
  • Helicobacter pylori / isolation & purification
  • Humans
  • Male
  • Middle Aged
  • Stomach Ulcer / microbiology
  • Stomach Ulcer / pathology