內(nèi)科學(xué)胃炎(英文)

Gastritis1DefinitionGastritisA

wide

variety

of

inflammatory

or

hemorrhagicconditions

of

gastric

mucosa:Damage

Inflammation

RegenerationGastropathyEpithelial

cell

damage

and

regeneration

withoutassociated

inflammation2Anatomical

siteCARDIA

賁門MUCOUS

SECRETINGENDOCRINEBODY

胃體SPECIALISED

SECRETORYPARIETAL

–

ACIDCHIEF

-

PEPSINOGENENDOCRINE：D

cell：HISTAMINEMastocyte：SOMATOSTATINANTRUM

胃竇MUCOUS

SECRETINGENDOCRINE：

GASTRIN,5

Hydroxyl

Tryptamine3Gastritis

is

defined

as

microscopic

inflammation

of

the

stomachand

represents

a

histological

not

a

clinical

entity,

as

themajority

of

persons

with

gastric

inflammation

are

completelyasymptomatic.

-Chronic

referring

to

long

standing

forms-Chronic

referring

to

mononuclear

cellinfiltrate

especially

lymphocyte

and

macrophagesGrosshistologicGastritis

is

mostly

a

histological

term

thatneeds

biopsy

to

be

confirmed4Helicobacter

pylori-induced

gastritis,Classification5Acute

GastritisChronic

gastritis–Acute

referring

toshort

terminflammation–Acute

referring

toneutrophilicinfiltrate-Chronic

referring

to

lonstanding

forms-Chronic

referring

tomononuclear

cell

infiltraespecially

lymphocyte

andmacrophagesAcute

Gastritis6Developing

shortly

exposure

to

variousinjurious

substances

or

followingdepression

in

mucosal

blood

flowAcute

Gastritis7Erosive

&

Hemorrhagic

gastritisHelicobacter

pylori-induced

gastritisInfectious

gastritis

(excluding

H.

pylori)Etiologyand

Pathogenesis8g

StressShock

;Sepsis

;Burn;CNS

Trauma

or

SurgeryRenal,

Hepatic

or Respiratory

Failureg

Chemical

injuryNSAIDsAlcoholg

Bacteria

andToxin(Helicobacter

pylori)g

Mucosa

ischemia

;thromboxane

A2

,

leukotriene

C4g

Inhibition

of

epithelial renewal

;g

Impairment

of

gastric

mucosa

barrier

;g

Hydrogen

ion

back-diffusion

;g

Free

radicals9Stress

Related

Gastric

Mucosa

Damageg

NSAIDs

and

GastritisInhibiting

synthesis

of

prostaglandinsinhibiting

cyclooxygenase

(COX,環(huán)氧合酶)Chemical

injury10g

Alcohol

and

GastritisAlcohol

is

lipid-solubleHigh

concentration

of

ethanol

transversesgastric

mucosa

and

results

in

mucosa

damage11Chemical

injuryClinical

Manifestations12Acute

Erosive

&

Hemorrhagic

Gastritisg

Upper

GI

BleedingHematemesis;Melena;Occult

Blood

in

StoolClinical

Manifestations13g

Epigastric

Pain

or

discomfortg

Anorexiag

Nausea

and

VomitingDefinite

Diagnosis:

Emergency

Endoscop14ACUTE

GASTRITIS

-

MORPHOLOGYMucosal

congestion,oedema,

inflammation

&ulceration15Two

Special

Terms

in

Acute

Erosive

&Hemorrhagic

Gastritis16g

Cushing

UlcerErosions

and

ulcers

associated

with

CNStrauma

or

surgeryg

Curling

UlcerErosions

and

ulcers

associated

with

burg

Remove

offending

agentsg

Treat

predisposing

conditionsg

Symptomatic

treatmentg

Protect

gastric

mucosa:

Sucralfate17Treatmentg

Inhibit

or

neutralize

gastric

acid

:AntiacidsH2-receptor

antagonists

(H2-RAs)Cimetidine,

Ranitidine

,

FamotidineProton

pump

Inhibitors

(PPIs)Omaprazole,

Lansoprazole,Pantoprazole,

Rabeprazole,Esoprazole18Treatmentg

Avoid

offending

agentsg

Prophylactic

use

of

acid-inhibitor

mucosa-protecting

drugs:Sucralfate;H2-receptor

antagonistsPPIs19PreventionChronic

Gastritis20Chronic

Gastritis21Chronic

referring

to

long

standing

forms

Chronic

referring

to

mononuclear

cell

inespecially

lymphocyte

and

macrophagesGastritis

is

defined

as

microscopic

inflammation

of

the

stomach

and

rea

histological

not

a

clinical

entity,

as

the

majority

of

persons

with

ginflammation

are

completely

asymptomatic.1.

Whitehead

(1972)SuperficialChronic

GastritisAtrophicClassification222.

Strickland

(1973)Type

AAtrophic

GastritisType

B2324Classification

of

CAG

by

StricklandFeaturesType

AType

Bg

Morphologyantrumnormalatrophycorpusdiffusemultifocalhypoacidig

Serum

gastring

Gastric

acid

secretiong

Gastric

autoantibodiesanacidity90%10%90%

10%g

Frequency

inpernicious

anemiag

proposed

etiologicalautoimmunityfactors

genetic

componentmucosairrit25ants3.

Sydney

System

(1990)4.

Updated

Sydney

System

(1996)The

most

widely

used

method

for

classification

of

gastritClassifing

chronic

gastritis

based

on

topography,

morphand

etiology26281.

重慶共識(shí)

（1982）g

Superficialg

Atrophicg

(Hypertrophic)Location:

antrum,

corpus

or

pan-;Severity:

mild,

moderate,

severe;Activity:

active,

quiescent;Metaplasia:

intestinal,

pseudopyloric井岡山共識(shí)（2000）上海共識(shí)（2006）(Sydney

System）上海共識(shí)（2012）295.

National

consensusEtiology

and

Pathogenesi301.

Helicobacter

pylori

Infection:31(Koch’s

postulates)g

High

prevalence

of

Hp

infection

in

patientwith

chronic

active

gastritis

(80-95%).g

Hp

infection

is

associated

with

gastric

muinflammation.Same

distributionInflammation

subsides

after

eradicationgStudies

in

volunteer

and

animal

models.3233Antigenic

MimicryGastric

Epithelium,G

cells,Canaliculi

of

Parietal

CeH+,

K+-ATPaseAntibodyLipopolysaccharideHeat

Shock

Protein342.

Immunological

Factorsg

Parietal

cell

antibody

(PCA)and

intrinsic

factorantibody

(IFA)

are

in

90%

of

patients

with

typeA

atrophic

gastritis

and

pernicious

anemia.g

Pernicious

anemia

is

also

associated

with

otherautoimmune

diseases:Hashimoto’s

thyroiditis;Diabetes

mellitus;Vitiligo白癲風(fēng)353.

Duodenal-Gastric

Reflux(a)

Dysfunction

of

pyloric

sphincter(b)

After

Partial

Gas36BilePancreaticEnzymesLecithin卵磷脂Lysolecithin溶血卵磷脂Damage

of

Gastric

Mucosal

BarrierMechanisms

of

Gastric

Mucosal

Damageby

Duodenal

Contents37Asymptomatic

in

majority

of

patients;g

Some

have

dyspeptic

symptoms:Epigastric

pain

or

discomfortBelchingRegurgitation

Loss

of

appetiteNausea

and

vomitingg

Some

may

develop

symptomatic

complication:Anemia;

Peptic

ulcer;Gastric

polyp;

Gastric

carcinoma38Clinical

ManifestationNon-Atrophic

Gastritis:g

Infiltration

of

plasmacell,

lymphocytes

andneutrophils

in

laminapropria.g

Surface

cells

damageHistology

of

Chronic

Gastritis39Atrophic

Gastritis:g

Inflammatory

cells

infiltrationg

Atrophy

of

gastric

glandsg

Metaplasia:Intestinal

MetaplasiaPseudopyloric

Metaplasiag

Dysplasia40Histology

of

Chronic

Gastriti4142Two

Types

of

Metaplasiain

Gastric

MucosaLined

by

intestinal-type

absorptive

cells,cells

and

Peneth

cells

—

Intestinal

MetaplLined

by

mucus-secretingcells

similar

to

those

in

amucosa

—Pseudopylori

Metaplasia43Gastric

Precancerous

Changes(Dysplasia)Precancerous

ConditionPrecancerous

lesion

g

Atrophic

Gastritisg

Gastric

Polypg

Gastric

Ulcerg

Gastric

Stumpg

Menetrier’s

DiseaseWHO,

19784445Laboratory

Examinations46g

Detection

of

H.

pylori

infectiongGastric

Secretory

TestLow

acid

or

no

acid

in

type

A

gastritisg

Serology

TestsGastrinA:IFA(intrinsic

factor

Ab)A:PCA

(parietal

cell

Ab)Vitamin

B12

level

(300-900ng/L)g

Gastroscopyg

HistologyNon-Atrophic

gastritisg

Edema;g

Hyperemia;g

Exudate;g

ErosionThe

definitive

diagnosis

is

made

onlygastroscopy

and

biopsy

of

gastric

mucos47Atrophic

gastritis48g

Vissible

blood

vessels;g

Thinning

of

gastric

mucosaRapid

urease

test49HistologyCultureDirect

smearPCR13C-

Breath

testDetection

of

H.

pylori

InfectionH&E

StainCresyl

violet

stainWarthin

-Starry

StainAcridine

orange

sta50in51Diagnosisg

No

any

symptom

in

most

of

patientsg

Symptoms

are

non-specificg

Definitive

diagnosis

is

made

onlyby

endoscopy

and

biopsy52g

Remove

offending

agents;g

Symptomatic

treatment;g

Eradication

of

Hp;g

Prevention

of

Duodenal-gastric

reflux;g

Supplement

with

anti-oxidants

for

CAG;g

Follow-up

for

CAG

with

high

risk

of

gastrcancer53Treatmentg

Preventionof

Duodenal-gastric

Reflu54Prokinetic:Metoclopramide

胃復(fù)安;Domperidone

多潘立酮;Mosapride

莫沙比利Bile-binding

agents

:–

Cholestyramineg

Supplement with

Anti-oxidants

:Vitamin

CVitamin

E-carotene,Selenium硒Role

of

Anti-oxidants

in

Preventiof

Gastric

CancerAnti-oxidantsNitrateNitroso

CompoundsInflammationDamage

of

epitheliumDNA

mutationFree

Radicals

(–)55(–)Nitriteg

Follow-up56Atrophic

gastritis

is

one

of

precancerouconditions,

the

annual

risk

for

gastric

cis

about

0.5%.Patients

with

severe

atrophic

gastritisdysplasia

should

be

closely

followed

upendoscopy.Bacteria

other

than

H.

pyloriVirusesFungiParasitesSynonymous

termsChronic

superficialgastritisDiffuse

antral

gastritisChronic

antral

gastritisType

B

gastritisType

A

gastritisDiffuse

corporal

gastritisPernicious

anemia-associated

gastritisType

B

or

type

AB

gastritisAtrophic

pangastritisReactive

gastropathyReflux

gastropathyCeliac

disease-associatedVarioliformIsolated

granulomatous

gastritisAllergicPhlegmonous

gastritisEmphysematous

gastritisCytomegalovirusAnisakiasisSpecial

forms

of

gastritis57Chemical

(reactive)

gastropathy(NSAID

and

bile

reflux)Other

infectious

gastritis

(excluding

H.Menetrier’s

DiseaseBacteria

other

than

H.

pyloriVirusesFungiParasitesSynonymous

termsChronic

superficialgastritisDiffuse

antral

gastritisChronic

antral

gastritisType

B

gastritisType

A

gastritisDiffuse

corporal

gastritisPernicious

anemia-associated

gastritisType

B

or

type

AB

gastritisAtrophic

pangastritisReactive

gastropathyReflux

gastropathyCeliac

disease-associatedVarioliformIsolated

granulomatous

gastritisAllergicPhlegmonous

gastritisEmphysematous

gastritisCytomegalovirusAnisakiasisSpecial

forms

of

gastritis58Chemical

(reactive)

gastropathy(NSAID

and

bile

reflux)Epithelial

cell

damage

and

regenerationWithout

associated

inflammationBacteria

other

than

H.

pyloriVirusesFungiParasitesSynonymous

termsChronic

superficialgastritisDiffuse

antral

gastritisChronic

antral

gastritisType

B

gastritisType

A

gastritisDiffuse

corporal

gastritisPernicious

anemia-associated

gastritisType

B

or

type

AB

gastritisAtrophic

pangastritisReactive

gastropathyReflux

gastropathyCeliac

disease-associatedVarioliformIsolated

granulomatous

gastritisAllergicPhlegmonous

gastritisEmphysematous

gastritisCytomegalovirusAnisakiasisSpecial

forms

of

gastritis59Other

infectious

gastritis

(excluding

H.Bacteria

other

than

H.pylori

Phlegmonous

gastritis(蜂窩織性胃炎）Viruses

:

CytomegalovirusFungi：Parasites：Anisakiasis（異尖線蟲病