内科学胃炎(英文)

Gastritis,Definition,Gastritis A wide variety of inflammatory or hemorrhagic conditions of gastric mucosa: Damage Inflammation Regeneration Gastropathy Epithelial cell damage and regeneration without associated inflammation,Anatomical site,ANTRUM 胃窦,CARDIA 贲门,BODY 胃体,MUCOUS SECRETING ENDOCRINE,SPECIALISED SECRETORY PARIETAL ACID CHIEF - PEPSINOGEN ENDOCRINE： D cell：HISTAMINE Mastocyte：SOMATOSTATIN,MUCOUS SECRETING ENDOCRINE： GASTRIN,5 Hydroxyl Tryptamine,Gross histologic,Gastritis is mostly a histological term that needs biopsy to be confirmed,Classification,Acute Gastritis,Chronic gastritis,Acute referring to short term inflammation Acute referring to neutrophilic infiltrate,-Chronic referring to long standing forms -Chronic referring to mononuclear cell infiltrate especially lymphocyte and macrophages,Acute Gastritis,Developing shortly exposure to various injurious substances or following depression in mucosal blood flow,Acute Gastritis,Erosive & Hemorrhagic gastritis Helicobacter pylori-induced gastritis Infectious gastritis (excluding H. pylori),Etiology and Pathogenesis Stress Shock ; Sepsis ; Burn; CNS Trauma or Surgery Renal, Hepatic or Respiratory Failure Chemical injury NSAIDs Alcohol Bacteria and Toxin (Helicobacter pylori),Mucosa ischemia ; thromboxane A2 , leukotriene C4 Inhibition of epithelial renewal ; Impairment of gastric mucosa barrier ; Hydrogen ion back-diffusion ; Free radicals,Stress Related Gastric Mucosa Damage,NSAIDs and Gastritis Inhibiting synthesis of prostaglandins by inhibiting cyclooxygenase (COX, 环氧合酶),Chemical injury,Alcohol and Gastritis Alcohol is lipid-soluble High concentration of ethanol transverses gastric mucosa and results in mucosa damage,Chemical injury,Clinical Manifestations Acute Erosive Occult Blood in Stool,Clinical Manifestations,Epigastric Pain or discomfort Anorexia Nausea and Vomiting,Definite Diagnosis: Emergency Endoscopy,Mucosal congestion, oedema, inflammation & ulceration,ACUTE GASTRITIS - MORPHOLOGY,Two Special Terms in Acute Erosive & Hemorrhagic Gastritis Cushing Ulcer Erosions and ulcers associated with CNS trauma or surgery Curling Ulcer Erosions and ulcers associated with burn,Remove offending agents Treat predisposing conditions Symptomatic treatment Protect gastric mucosa: Sucralfate,Treatment,Inhibit or neutralize gastric acid : Antiacids H2-receptor antagonists (H2-RAs) Cimetidine, Ranitidine , Famotidine Proton pump Inhibitors (PPIs) Omaprazole, Lansoprazole, Pantoprazole, Rabeprazole, Esoprazole,Treatment,Avoid offending agents Prophylactic use of acid-inhibiting or mucosa-protecting drugs: Sucralfate; H2-receptor antagonists PPIs,Prevention,Chronic Gastritis,Chronic Gastritis,Chronic referring to long standing forms Chronic referring to mononuclear cell infiltrate especially lymphocyte and macrophages Gastritis is defined as microscopic inflammation of the stomach and represents a histological not a clinical entity, as the majority of persons with gastric inflammation are completely asymptomatic.,1. Whitehead (1972) Superficial Chronic Gastritis Atrophic,Classification,2. Strickland (1973) Type A Atrophic Gastritis Type B,Classification of CAG by Strickland Features Type A Type B Morphology antrum normal atrophy corpus diffuse multifocal Serum gastrin Gastric acid secretion anacidity hypoacidity Gastric autoantibodies 90% 10% Frequency in 90% 10% pernicious anemia proposed etiological autoimmunity mucosa factors genetic component irritants,3. Sydney System (1990) Updated Sydney System (1996) The most widely used method for classification of gastritis Classifing chronic gastritis based on topography, morphology, and etiology,1. 重庆共识 （1982） Superficial Atrophic (Hypertrophic) Location: antrum, corpus or pan-; Severity: mild, moderate, severe; Activity: active, quiescent; Metaplasia: intestinal, pseudopyloric 2. 井冈山共识 （2000） 3. 上海共识 （2006）(Sydney System） 4. 上海共识 （2012）,National consensus,Etiology and Pathogenesis,1. Helicobacter pylori Infection: (Kochs postulates) High prevalence of Hp infection in patients with chronic active gastritis (80-95%). Hp infection is associated with gastric mucosal inflammation. Same distribution Inflammation subsides after eradication of Hp Studies in volunteer and animal models.,Antigenic Mimicry,Gastric Epithelium, G cells, Canaliculi of Parietal Cells, H+, K+-ATPase,Antibody,Lipopolysaccharide Heat Shock Protein,2. Immunological Factors Parietal cell antibody (PCA)and intrinsic factor antibody (IFA) are in 90% of patients with type A atrophic gastritis and pernicious anemia. Pernicious anemia is also associated with other autoimmune diseases: Hashimotos thyroiditis; Diabetes mellitus; Vitiligo 白癫风,3. Duodenal-Gastric Reflux,(a)