17 chronic gastritis gao

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17 chronic gastritis gao

  1. 1. Chronic Gastritis Dr. GAO Xiang Department of Gastroenterology The First Affiliated Hospital
  2. 2. <ul><li>The chronic inflammation </li></ul><ul><li>of gastric mucosa. </li></ul>Definition
  3. 6. Chronic gastritis
  4. 7. <ul><li> Helicobacter pylori infection </li></ul>Etiology
  5. 9. Helicobacter pylori
  6. 10. <ul><li> auto-immunologic fator </li></ul><ul><li> high positive rate (90%) of serum anti- </li></ul><ul><li>parietal cell antibody (APCA) </li></ul><ul><li> animal model: gastritis induced by </li></ul><ul><li>injecting APCA repeatedly </li></ul><ul><li>  high positive rate (75%) of serum </li></ul><ul><li> anti-intrinsic factor antibody </li></ul>Etiology
  7. 11. <ul><li> reflux of duodenal juice </li></ul><ul><li>incompetence of pyloric sphincter </li></ul><ul><li>post operate stomach </li></ul><ul><li> alcohol </li></ul><ul><li> heavy salty foods </li></ul><ul><li> aging </li></ul><ul><li> portal hypertension </li></ul><ul><li> … ... </li></ul>Other factors
  8. 12. Classification of chronic gastritis <ul><li> Chronic antral gastritis </li></ul><ul><li> (Type B gastritis) </li></ul><ul><li>H. Pylori infection (90%) </li></ul><ul><li>NSAIDs </li></ul><ul><li>alcohol </li></ul><ul><li>… ... </li></ul>
  9. 13. <ul><li> Chronic corpus gastritis </li></ul><ul><li> (Type A gastritis) </li></ul><ul><li> auto-immunologic factors </li></ul><ul><li>Chronic pangastritis </li></ul>Classification of chronic gastritis
  10. 14. Histology <ul><li>Chronic superficial gastritis </li></ul><ul><li>Chronic inflammation without </li></ul><ul><li>glandular atrophy </li></ul>
  11. 15. Chronic superficial gastritis
  12. 16. Chronic atrophic gastritis <ul><li>Chronic inflammation with </li></ul><ul><li>glandular atrophy </li></ul>
  13. 17. Chronic atrophic gastritis
  14. 18. Chronic gastritis <ul><li>Active stage: </li></ul><ul><li>with polymorhpy nuclear neutrophils infiltration </li></ul><ul><li>Quiescent stage: </li></ul><ul><li>without polymorhpy nuclear neutrophils </li></ul><ul><li>infiltration </li></ul>
  15. 19. Chronic gastritis <ul><li>With </li></ul><ul><li> Metaplasia : intestinal </li></ul><ul><li>Psueodopyloric </li></ul>
  16. 20. Intestinal metaplasia
  17. 21. chronic gastritis with Dysplasia <ul><li>mild , </li></ul><ul><li>moderate , </li></ul><ul><li>severe </li></ul>
  18. 22. Chronic gastritis with dysplasia
  19. 23. Clinical Manifestations <ul><li> Most of patients are asymptomatic </li></ul><ul><li> Dyspepsia: upper abdominal pain or </li></ul><ul><li> discomfort (bloating, belching, nausea </li></ul><ul><li> vomiting) </li></ul><ul><li> The symptoms are not specific </li></ul><ul><li> No typical physical sign found </li></ul>
  20. 24. Laboratory and other examinations <ul><li> Endoscopy examination with mucosal </li></ul><ul><li> biopsy </li></ul><ul><li> the most reliable method for diagnosis </li></ul>
  21. 25. Endoscopy examination <ul><li> superficial gastritis </li></ul><ul><li> edema, erythema, exudate, erosion </li></ul>
  22. 26. Edema erythema
  23. 27. <ul><li> Atrophic gastritis </li></ul><ul><li>grey, reduced mucosa folds, </li></ul><ul><li>submucosal visible vessels </li></ul>
  24. 28. Visible vessels
  25. 29. <ul><li>Note </li></ul><ul><li>imperfect co-relations between endoscopic appearances and histological classification, the final diagnosis should be made by histological examination. </li></ul>
  26. 30. Detection of H. pylori <ul><li> Urease test </li></ul><ul><li> Histology </li></ul><ul><li> Microbiological culture </li></ul><ul><li> Breath test: 13 C-urea 14 C-urea </li></ul><ul><li> Serology: IgG </li></ul>
  27. 31. Gastric acid secretion and serology tests <ul><li>Type A gastritis </li></ul><ul><li> serum anti-parietal cell antibody: (+) </li></ul><ul><li> serum anti-intrinsic factor antibody: (+) </li></ul><ul><li> serum gastrin: </li></ul><ul><li> basic and maximal (pengastrin stimulated) gastric acid secretion : </li></ul>
  28. 32. <ul><li>Type B gastritis </li></ul><ul><li> usually in normal range of above tests </li></ul><ul><li> gastrin and gastric acid secretion decreased when severe atrophy occurred </li></ul>
  29. 33. <ul><li> Type A Type B </li></ul><ul><li>Etiology auto immunity H.p. </li></ul><ul><li> Environment factors </li></ul><ul><li>Topography corpus antrum </li></ul><ul><li>BAO & MAO  -- or   </li></ul><ul><li>gastrin  -- </li></ul><ul><li>APCA + -- </li></ul><ul><li>Associated pernicious anemia peptic ulcer </li></ul><ul><li>disease </li></ul>
  30. 34. Treatment <ul><li> Exclusion of causative factors </li></ul><ul><li>smoking, alcohol, NSAIDs, salty food </li></ul><ul><li> Medication </li></ul><ul><li> relief of pain: antacid, H 2 -RA, PPI </li></ul><ul><li> prokinetic agents: to enhance gastric motility, promote gastric empty </li></ul>
  31. 35. <ul><li> Anti-microbiotic therapy </li></ul><ul><li>There are still some arguments </li></ul><ul><li> No a effective, low side-effect and low price medicine available </li></ul><ul><li> Eradication of Hp is not means improvement of symptoms </li></ul>
  32. 36. How should we do? <ul><li>Eradication of H.p. </li></ul><ul><li> When the patient’s symptom is intractable </li></ul><ul><li> When the patient from the high risk area of gastric cancer </li></ul><ul><li> When the patient wishes to be treated </li></ul>
  33. 37. Surgery <ul><li>Only in chronic gastrits with severe dysplasia , because of dysplasia is regarded as precancerous lesion and it is hard to distinguish severe dysplasia and early gastric cancer </li></ul>
  34. 38. Prognosis <ul><li>Normal mucosa  CSG  CAG  GC </li></ul><ul><li>There is a risk from atrophic gastritis (especially with moderate to severe dysplasia) developing to gastric cancer . </li></ul>?
  35. 39. Summary <ul><li> Chronic gastritis is a common disease </li></ul><ul><li> Type A : auto immunity </li></ul><ul><li> Type B : H. Pylori infection </li></ul><ul><li> Symptom : dyspepsia </li></ul><ul><li> Diagnosis : endoscopy with histology </li></ul><ul><li> Treatment : symptoms relief </li></ul><ul><li> Prognosis </li></ul>

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