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Gastritis Department of Digestive Disease
Shanghai Institute of Digestive Disease Zheng Qing
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Gastritis Definition: A wide variety of inflammatory or hemorrhagic
conditions of gastric mucosa. Gastritis is mostly a histological term that needs biopsy to be confirmed
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Classification Acute Gastritis Chronic gastritis Simple Superficial
Erosive & Hemorrhagic Phlegmonous Corrosive Chronic gastritis Superficial Atrophic (Hypertrophic) Acute vs. chronic Acute referring to short term inflammation Acute referring to neurophilic infiltrate Chronic referring to long standing forms Chronic referring to mononuclear cell infiltrate especially lymphocyte and macrophages
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Anatomical site CARDIA 贲门 MUCOUS SECRETING ENDOCRINE BODY 胃体
SPECIALISED SECRETORY PARIETAL – ACID CHIEF - PEPSINOGEN ENDOCRINE HIST, SOMASTATIN ANTRUM 胃窦 MUCOUS SECRETING ENDOCRINE GASTRIN, 5HT
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Acute Gastritis Developing shortly exposure to various
injurious substances or following depression in mucosal blood flow
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Etiology and Pathogenesis
Stress Shock ; Sepsis ; Burn; CNS Trauma or Surgery Renal, Hepatic or Respiratory Failure Alcohol NSAIDs (non-steroidal anti-inflammatory drugs) Bacteria and Toxin (Helicobacter pylori)
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Stress Related Gastric Mucosa Damage
Mucosa ischemia ; thromboxane A2 , leukotriene C4 Inhibition of epithelial renewal ; Impairment of gastric mucosa barrier ; Hydrogen ion back-diffusion ; Free radicals
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Alcohol is lipid-soluble, high concentration
Alcohol and Gastritis Alcohol is lipid-soluble, high concentration of ethanol transverses gastric mucosa and results in mucosa damage. NSAIDs and Gastritis Inhibiting synthesis of prostaglandins
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Clinical Manifestations
Acute Simple Gastritis Epigastric Pain or discomfort Anorexia Nausea and Vomiting
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Clinical Manifestations
Acute Erosive & Hemorrhagic Gastritis Upper GI Bleeding Hematemesis; Melena; Occult Blood in Stool
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Definite Diagnosis: Emergency Endoscopy
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ACUTE GASTRITIS - MORPHOLOGY
Mucosal congestion, oedema, inflammation & ulceration
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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
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Treatment Remove offending agents Treat predisposing conditions
Symptomatic treatment Protect gastric mucosa: Sucralfate
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Treatment Inhibit or neutralize gastric acid : Antacids
H2-receptor antagonists (H2-RAs) Cimetidine, Ranitidine , Famotidine Proton pump Inhibitors (PPIs) Omaprazole, Lansoprazole, Pantoprazole, Rabeprazole, Esoprazole
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Prevention Avoid offending agents Prophylactic use of acid-inhibiting
or mucosa-protecting drugs: Sucralfate; H2-RAs; PPIs
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Chronic Gastritis
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Classification 1. Whitehead (1972) Superficial Chronic Gastritis
Atrophic
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2. Strickland (1973) Type A Atrophic Gastritis Type B
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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 % % Frequency in % % pernicious anemia proposed etiological autoimmunity mucosa factors genetic component irritants
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3. Sydney System (1990) 4. Updated Sydney System (1996)
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National consensus Superficial Atrophic (Hypertrophic)
重庆共识 (1982) Superficial Atrophic (Hypertrophic) Location: antrum, corpus or pan-; Severity: mild, moderate, severe; Activity: active, quiescent; Metaplasia: intestinal, pseudopyloric 井冈山共识 (2000) 上海共识 (2006)
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Etiology and Pathogenesis
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1. Helicobacter pylori Infection:
(Koch’s postulates) High prevalence of Hp infection in patients with chronic active gastritis (80-95%). Hp infection is associated with gastric mucosal inflammation. Distribution Inflammation subsides after eradication of Hp Studies in volunteer and animal models.
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Antigenic Mimicry Antibody Lipopolysaccharide Heat Shock Protein
Gastric Epithelium, G cells, Canaliculi of Parietal Cells, H+, K+-ATPase Antibody
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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: Hashimoto’s thyroiditis; Diabetes mellitus; Vitiligo 白癫风
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3. Duodenal-Gastric Reflux
(a) Dysfunction of pyloric sphincter (b) After Partial Gastrectomy
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Mechanisms of Gastric Mucosal Damage
by Duodenal Contents Bile Pancreatic Enzymes Lecithin 卵磷脂 Lysolecithin 溶血卵磷脂 Damage of Gastric Mucosal Barrier
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