Differential diagnosis of reactive gastropathy

Semin Diagn Pathol. 2005 Nov;22(4):273-83. doi: 10.1053/j.semdp.2006.04.001.


Reactive or chemical gastropathy is the constellation of endoscopic and histological changes caused by chemical injury to the gastric mucosa. Its diagnosis rests on the histopathological demonstration of nonspecific elementary lesions that may occur simultaneously or separately in different degrees and various proportions. These lesions include foveolar hyperplasia, interfoveolar smooth muscle fibers, erosions, edema, and hyperemia, in the absence of significant inflammation. Their respective occurrence in a set of gastric biopsies can be placed on a spectrum of diagnostic certainty that is never absolute because each of such changes can and does occur in other conditions. Although a correlation between histological evidence of chemical gastropathy and clinical manifestations, particularly risk of bleeding, is yet to be documented, reporting the suspicion of drug-induced gastric damage may help clinicians to identify patients that might benefit from change, reduction, or discontinuation of certain medications.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Gastric Mucosa / pathology*
  • Humans
  • Stomach Diseases / chemically induced*
  • Stomach Diseases / diagnosis*


  • Anti-Inflammatory Agents, Non-Steroidal