Reactive Gastropathy: A Nationwide Patho-epidemiologic Study in the United States

Abstract

Purpose: Reactive gastropathy (RG) is a constellation of histopathologic findings representing the expression of damage inflicted upon the gastric mucosa either directly by chemical substances (bile, alcohol) or indirectly through the suppression of prostaglandin synthesis induced by non-steroidal anti-inflammatory drugs (NSAIDs). Pathologists suspect that its prevalence is increasing, but there are no data to support this hypothesis. This study was designed to evaluate temporal trends in the prevalence of RG in a large national sample of gastric biopsies diagnosed in a single pathology laboratory that applies uniform diagnostic criteria. Methods: We analyzed electronic records from the Caris Database, which includes data from patients from private outpatient endoscopy centers across the U.S. Records include demographic, clinical, and endoscopic information, biopsy location, and histopathologic report. All adults who had an EGD with gastric biopsies between 1/2008 and 12/2010 were included. Our analysis focused on the diagnosis of RG (excluding cases labeled as “mild RG”) and Helicobacter infection in different time periods and in different age groups. We also analyzed the prevalence of RG and H. pylori gastritis in four geographically and ethnically different groups of patients living in: the Great Salt Basin; the Southwest border region; a large urban center in the northeast; and the rural south. Results: There were gastric biopsy specimens from 390,872 unique adults (median age 57 years; 61.7% women). RG was diagnosed in 72,736 patients (median age 61; 65.4% women). There was a steady increase with advancing age (from 11.8% in 18-30 year old to 24.4% in 80-90 year old patients). There was a significant increase in the prevalence of RG from the first 6 months of 2008 (14.4%) and the last 6 months of 2010 (21.5%; p<.0001); during the same period the prevalence of H. pylori declined minimally from 9.7% to 8.9%. No seasonal trends were detected for either condition. As shown in Table 1, the ratio of RG to H. pylori gastritis differed considerably in the four regions.Table 1: . No Caption available.Conclusion: This study shows that histopathologic changes associated with chemical injury to the gastric mucosa are detected in approximately one fifth of adults who have gastric biopsies. RG is slightly more common in women and increases with age. In our laboratory the prevalence of RG has increase by 50% in three years; whether this reflects a true change or evolving histopathologic criteria cannot be determine at this time. The relative prevalence of H. pylori and RG (H. pylori -RG ratio) was strongly in favor of H. pylori in the Southwest border region, strongly in favor of RG in the Great Salt Basin and the rural south and close to 1 in the urban northeast.