Gastric pathology in Meckel's diverticulum. Review of cases resected between 1965 and 1995.

One hundred forty-nine case files of Meckel's diverticulum resected at our hospital between 1965 and 1995 were reviewed for the presence of heterotopic gastric mucosa. Of these, 140 cases were evaluated, and 25 demonstrated ectopic gastric mucosa. Six of these heterotopic tissue specimens contained no assessable surface mucosa; therefore only 19 were evaluated for gastric histopathologic changes. "Gastritis" was present in all reviewed cases, but the predominant pattern was that of reflux-type gastritis or gastropathy, which had not previously been documented at this location. This gastropathy was demonstrated in 58% of the cases and could also account for some of the symptoms that prompted removal of appendixes without inflammation. Chronic and chronic active gastritis were also demonstrated in a minority of cases, and those with moderate or severe activity were associated with peptic ulceration. No Helicobacter pylori-like organisms were detected with either modified Giemsa stain or hematoxylin-and-cosin (H&E) stain. Findings were inconclusive with regard to erosive gastritis related to nonsteroidal anti-inflammatory drugs in Meckel's diverticulum. That the proportion of ectopic gastric mucosa found in several studies (including this one) is about half that suggested in textbooks indicates a need for a better workup of resected Meckel's diverticulum and a search for all types of gastric disease if gastric heterotopia is present. Emphasis must be placed on identification of reflux-type chemical gastritis and gastropathy, which are often documented as normal mucosa.