The term "hemorrhagic gastritis" is frequently applied to the subepithelial hemorrhages seen at endoscopy in alcoholic patients without a clear understanding of the histologic nature of these lesions. We prospectively screened 125 actively drinking alcoholic patients undergoing upper endoscopy for gastrointestinal bleeding. Gastric subepithelial hemorrhages were found in 20 of these patients. Biopsy specimens of hemorrhagic lesions and nonhemorrhagic mucosa 1 and 3 cm away were taken with a "jumbo" forceps. Gastric biopsy specimens from 12 patients with Barrett's esophagus served as controls for biopsy-induced trauma. Biopsy slides from the patients and controls were coded before histologic scoring. Mean hemorrhage scores (range, 0-4) for the target lesions (2.9 +/- 0.3) were significantly greater than scores for the adjacent mucosa (1 cm, 1.0 +/- 0.2; 3 cm, 1.1 +/- 0.2) or control biopsy specimens (0.8 +/- 0.1). Hemorrhage was superficial, occurring primarily in the foveolar region. Mucosal edema (score range, 0-4) was a prominent feature in the adjacent, nonhemorrhagic mucosa (target lesion, 0.7 +/- 0.2; 1 cm, 1.9 +/- 0.4; 3 cm, 2.0 +/- 0.3; controls, 0.8 +/- 0.1). Edema extended into the deeper gland zones in 11 of 20 patients but in none of the 12 controls (p less than 0.05). Inflammatory cell infiltrates were mild and scores did not vary significantly among the three biopsy sites in alcoholic patients. We conclude that subepithelial hemorrhages seen at endoscopy in alcoholic patients represent localized hemorrhage of the foveolar region with edema in the surrounding mucosa but without prominent inflammatory cell infiltration. Rather than use the term "hemorrhagic gastritis," endoscopists should simply describe these lesions as subepithelial hemorrhages.