天津医科大学内科学课件 GASTRITIS.pptVIP

Etiology and pathogenesis Non-atrophic Gastritis Non-atrophic Gastritis Atrophic Gastritis Dysplasia Lab Examination 常用染色剂 Kudo pit pattern classification Kudo pit pattern classification Pattern classification Surface pattern (gastric) Surface pattern (gastric) K. Tanaka et al. J Gastroenterol 2006 non-structured pits branch-like or gyrus-like pits large roundish or tubular pits (larger than type I pits) small roundish or tubular pits (smaller than type I pits) stellar or papillary pits roundish pits Pit pattern characteristics destructive pattern V irregular arrangement and size IV III L gyrus and villous III S slit-like pits II small round pits of uniform size and shape I Surface pattern characteristics Type Hp（W-S Stain） Hp（Giemsa Stain） Hp（HE Stain） Epidemiology China adults 42%-64% children 25%-59% H. Pylori associated diseases * Gastritis * Peptic Ulcer * MALT lymphoma * Gastric Carcinoma “Disease-Specific” Virulence Factors The best studied putative virulence factor is the cytotoxin-associated gene product (Cag) A, the product of one of the genes in the cag pathogenicity island. Subjects infected with H pylori with a functional cag pathogenicity island have elevated mucosal levels of interleukin-8, marked neutrophilic infiltration into the gastric mucosa, and an increased risk of developing a symptomatic outcome such as peptic ulcer or gastric cancer. “Disease-Specific” Virulence Factors Other putative pathogenicity factors include the following: IceA (induced by contact with epithelium), a bacterial restriction enzyme for which no biologic or epidemiologic evidence as a virulence factor in H pylori–related disease has been confirmed; and VacA (vacuolating cytotoxin), which has been subtyped into an s1 genotype and an s2 genotype. Autoimmune Gastritis Autoimmune gastritis is a corpus-restricted chronic atrophic gastritis associated with circulating serum anti–parietal cell and anti–intrinsic factor antibodies