Gastroscopy in follow-up studies of patients with chronic atrophic gastritis and diagnosis of early gastric cancer

Visual assessment of gastric mucosa and histological findings in biopsies from the lesions were compared for 1806 patients with chronic atrophic gastritis. The spectrum of the focal lesions appeared wide. Morphological examinations determined basic comparable structural elements typical for atrophic gastritis. 85 patients were diagnosed to have early gastric cancer. All the cancer patients suffered from chronic atrophic gastritis and developed in 88% of cases intestinal metaplasia, in 32% severe epithelial dysplasia. Focal changes in the mucosa characteristic for early gastric cancer in 64% of cases could be considered as variants of chronic atrophic gastritis. In 52 patients cancer was identified during the follow-up, new-onset macroscopic alterations emerging in the last year in 62% cancer subjects. The rest of them had long-lasting macroscopic lesions, among them severe dysplasia of the epithelium in 65% of cases, believed to be histological variants of atrophic gastritis. Early cancer is suggested to develop in the presence of previous lesions rapidly and discretely.     

脱氧核糖核酸倍体多参数分析联合胃镜病理学对早期胃癌及癌前病变的诊断意义

目的 对胃镜及普通病理诊断为慢性萎缩性胃炎癌前病变的病例,进行DNA倍体多参数测定,探讨其结果对早期胃癌及癌前病变的诊断意义,并验证胃镜下取材的准确性及可靠性.②研究DNA倍体多参数在慢性浅表性胃炎、慢性萎缩性胃炎、肠上皮化生、不典型增生、胃癌过程中的变化规律,揭示胃癌的发生机制.方法 ①用苏木精-伊红染色法(hematoxylin-eosin staining,HE)对胃镜下表现为浅表性胃炎、慢性萎缩性胃炎并可疑癌前病变的胃黏膜组织及胃癌术后标本做出病理诊断.②用流式细胞术对上述标本进行DNA倍体、DNA含量(DI值)、S期指数(SPF)、增殖指数(PI)分析.结果 ①胃镜下慢性萎缩性胃炎并可疑癌前病变65例;病理结果:萎缩性胃炎伴肠上皮化生27例,伴不典型增生18例,病理证实癌前病变率69.1%.②DNA异倍体、DI值、PI、SPF阳性率在慢性浅表性胃炎、慢性萎缩性胃炎、肠上皮化生、不典型增生、胃癌,均呈增高趋势,胃癌组与其他各组差异均有统计学意义(P＜0.05或P＜0.01),不典型增生与肠上皮化生、慢性萎缩性胃炎、慢性浅表性胃炎差异有统计学意义(P＜0.05或P＜0.01).结论 ①DNA含量和倍体变化在慢性萎缩性胃炎即已出现,其出现率随胃黏膜病变的加重而升高②DNA含量和倍体变化出现在病理形态学改变之前,可做为早期胃癌及癌前病变的预警性指标,弥补胃镜及普通病理诊断的不足.     

蓝激光成像技术微放大分型对慢性胃炎萎缩性病灶的诊断价值

目的 评估蓝激光成像技术（BLI）微放大分型对慢性胃炎萎缩性病灶的诊断价值。方法 2017年12月－2019年6月随机对解放军总医院第四医学中心420例慢性胃炎患者使用BLI微放大检查（放大40～60倍），计算其诊断慢性胃炎萎缩性病灶的敏感度、特异度、阳性预测值和阴性预测值，评估其诊断价值。结果 共发现慢性萎缩性胃炎231例，非萎缩性胃炎189例。共活检822处病灶。其中，萎缩性病灶376处，非萎缩性病灶446处；根据团队以往经验，将慢性胃炎BLI微放大分为四型：菊花绒毛型（共106处）、结节绒毛型（共203处）、鱼鳞型（共20处）和规则型（共493处）。106处菊花绒毛型病灶中，萎缩性病灶88处，非萎缩性病灶18处，诊断萎缩性病灶的阳性预测值为83.0%（88/106）；203处结节绒毛型病灶中，萎缩性病灶170处，非萎缩性病灶33处，诊断萎缩性病灶的阳性预测值为83.7%（170/203）；20处鱼鳞型病灶中，萎缩性病灶18处，非萎缩性病灶2处，诊断萎缩性病灶的阳性预测值为90.0%（18/20）；493处规则型病灶中，萎缩性病灶100处，非萎缩性病灶393处，诊断非萎缩性病灶的阳性预测值为79.7%（393/493）。菊花绒毛型、结节绒毛型和鱼鳞型三型联合诊断萎缩性病灶的敏感度为73.4%，特异度为88.1%，阳性预测值为83.9%，阴性预测值为79.7%，准确度为81.4%，诊断中重度萎缩性病灶的敏感度可提升至85.7%。结论 BLI微放大分型有助于提高慢性胃炎萎缩性病灶的内镜识别度及诊断率，尤其是中重度萎缩性病灶。     

慢性胃炎胃镜下形态与组织学改变的比较

目的；探讨慢性胃炎胃镜下形态与胃粘膜病理组织学改变的关系。方法：对1958例慢性胃炎患者的胃镜资料进行相关对照研究。结果：1958例患者胃镜诊断慢性浅表性胃炎(CSG)1543例，慢性萎缩性胃炎(CAG)415例；病理结果CSGl664例，CAAG294例。伴肠上皮化生(IM)341例，伴不典型增生(Dys)92例，伴总性活动性炎症563例；对CSG和CAG的诊断，胃镜结果与病理学结果比较，其灵敏度分别为87．62%(1458／1664)、71．09％(209／294)。结论：单一的胃镜下表现对病理组织学诊断的灵敏度不甚理想，但是某些特定的胃镜表现有助于某些病理组织学诊断。     

幽门螺旋杆菌感染与胃黏膜癌前病变中bcl-2蛋白表达的关系

目的研究幽门螺杆菌(Hp)感染的胃黏膜癌前病变bcl-2蛋白表达的变化,探讨HP在胃癌发生发展过程中的作用。方法应用石蜡切片及免疫组化方法,对58例慢性胃炎、42例慢性胃炎伴肠化生、36例异型增生进行比bcl-2蛋白表达及HP检测研究。结果 胃黏膜化生组及异型增生组的Hp感染率及bcl-2蛋白阳性表达率均明显高于慢性胃炎组p<0.05;84例Hp阳性者bcl-2蛋白表达34例,阳性率40.5％,52例HP阴性者bcl-2蛋白表达11例,阳性率21％,两者比较,差异显著p<0.05。结论 肠上皮化生、异型增生的胃黏膜HP的感染及bcl-2蛋白的表达水平同步增高,说明Hp感染在胃癌发生、发展过程中起一定作用。     

阿莫西林联合果胶铋治疗慢性萎缩性胃炎的临床效果及对血清炎症因子的影响

目的探讨阿莫西林联合果胶铋治疗慢性萎缩性胃炎的临床效果及对血清炎症因子的影响。方法将我院收治的40例慢性萎缩性胃炎患者根据随机数字表法分为对照组与观察组,各20例。对照组采用阿莫西林治疗,观察组采用阿莫西林联合果胶铋治疗。比较两组的治疗效果。结果观察组的治疗总有效率显著高于对照组(P<0.05)。治疗后,两组的肠上皮化生、异型增生、腺体萎缩、慢性炎症、活动性积分、TNF-α、IL-6、CRP水平均降低,且观察组显著低于对照组(P<0.05)。结论阿莫西林联合果胶铋治疗慢性萎缩性胃炎的临床效果显著,可改善患者的临床症状,降低其血清炎症因子水平。     

胃黏膜癌前病变中bcl-2蛋白表达与幽门螺杆菌感染的关系

目的 观察幽门螺杆菌(HP)感染后胃黏膜癌前病变中bcl—2蛋白表达的特点，探讨服在胃癌发生发展过程中的作用。方法 应用免疫组织化学SP法及Warthin-Starry嗜银染色(WS染色)，对56例慢性胃炎、46例慢性胃炎伴肠化生、34例异型增生进行bcl—2蛋白表达及服检测的研究。结果 胃黏膜肠化生组及异型增生组的服感染率及bcl—2蛋白阳性表达率均明显高于慢性胃炎组(P＜0．05)；86例HP阳性者bcl-2蛋白表达39例，阳性率45．3％，50例HP阴性者bcl—2蛋白表达12例，阳性率24％，两者比较，差异显著(P＜0．05)。结论 在慢性胃炎、肠上皮化生、异型增生的进展过程中，bcl—2蛋白的表达水平在增高。HP感染在胃癌发生、发展过程中起一定作用。bcl—2蛋白的表达可能是服致癌的作用机制之一。     

慢性萎缩性胃炎内镜诊断与病理结果比照分析

目的探讨中重度慢性萎缩性胃炎(CAG)胃镜下表现与病理结果的关系。方法对45例中重度CAG的胃镜下诊断及表现与病理学结果进行相关性研究。结果病理诊断中重度CAG为30例,轻度CAG9例,正常6例。肠上皮化生(IM)25例,异型增生28例。中重度CAG的胃镜诊断与病理结果比较肉眼符合率为66.67%。胃镜下表现与病理结果比较,胃黏膜的各种表现对CAG的阳性预测值均达到80%以上,多种表现同时存在对CAG阳性预测值可达90%以上,其阳性率之间比较无显著差异。黏膜变薄等表现对IM及异型增生的阳性预测值均在70%以下。结论中重度CAG的胃镜下诊断符合率较低,但是通过对胃镜下表现的认识,可提高诊断符合率。     

Western blotting of total lysate of Helicobacter pylori in cases of atrophic body gastritis

BACKGROUND: Atrophic body gastritis is considered the first important step in the histogenesis of gastric carcinoma, a multistep process starting from chronic gastritis and progressing through chronic atrophic gastritis, intestinal metaplasia, and dysplasia. Helicobacter pylori is involved in the induction of atrophic body gastritis, but documentation of H. pylori infection is difficult because of the progressive disappearance of the bacterium. Our study aimed to detect past H. pylori infection in patients with atrophic body gastritis. METHODS: We used Western blot analyses of whole bacterial protein lysate of 2 different strains to probe sera from 143 patients. All sera were analyzed by ELISA (Bio-Rad), and results of gastric histology were available for all patients. RESULTS: Among 111 patient sera previously classified as negative for H. pylori infection by ELISA, 106 (95.5%) were positive when assayed by immunoblotting. CONCLUSIONS: Commercial diagnostic reagent sets may fail to detect H. pylori infection. Western blotting of whole bacterial protein extracts could provide the basis of a noninvasive serology tool able to assess previous infection with H. pylori in patients with atrophic body gastritis.     

慢性胃炎镜下病理特点与幽门螺杆菌血清抗体类型的相关性研究

目的探讨不同菌型幽门螺杆菌(Hp)血清抗体类型与慢性胃炎发生率及其病理特点的关系。方法选取该院2014年11月-2016年11月收治疗的上腹部不适的患者650例作为研究对象,所有患者均行胃镜检查,所有患者均行Hp呼气实验检查Hp,并采用酶联免疫吸附法检查患者血清中Hp抗体类型,采用Logistic分析Hp感染与慢性胃炎发生及其病理特点的关系。结果 650例患者中慢性胃炎93例,以Hp(-)为对照组,Hp(+)组患者慢性胃炎风险是Hp(-)患者的1.6倍,Hp(+)Cag A-Ig G+患者慢性胃炎是Hp(-)患者的2.3倍,Hp(+)Cag A-Ig G-患者慢性胃炎是Hp(-)患者的1.8倍。慢性萎缩性胃炎(CAG)患者27例中,以Hp(-)为参照,Hp(+)组患者CAG是Hp(-)患者的2.1倍,Hp(+)Cag A-Ig G-患者CAG是Hp(-)患者的1.9倍,Hp(+)Cag A-Ig G+患者CAG是Hp(-)患者的2.9倍;CAG伴不典型增生(Dys)患者13例中,以Hp(-)为参照,Hp(+)组患者是Hp(-)患者的2.4倍,Hp(+)Cag A-Ig GCAG伴Dys是Hp(-)患者的3.5倍,Cag A-Ig G+的慢性胃炎患者炎症反应程度明显比Hp(-)及Cag A-Ig G-的患者高,且炎症活动度明显更高。结论 Hp(+)Cag A-Ig G+感染加重慢性胃炎患者胃黏膜患者的炎症反应,同时促进慢性胃炎向CAG伴Dys发展。     

慢性胃炎病变黏膜组织HSP70的表达与幽门螺杆菌感染的相关性研究

目的探讨导致慢性胃炎的主要病因幽门螺杆菌（Hp）感染与病变黏膜组织中热休克蛋白70（HSP70）表达的相关性,旨在为临床判定慢性胃炎的严重程度、发展趋势和治疗前景提供依据。方法收集慢性胃炎胃黏膜胃镜活检标本71例,所有标本均经病理证实,其中浅表性胃炎38例,萎缩性胃炎33例。经吉姆萨染色结合临床^14C尿素呼气试验测定Hp,把所有病例分为Hp阳性组和Hp阴性组;用免疫组织化学技术测定黏膜组织中HSP70,计算两组黏膜组织HSP70表达阳性率,经统计学方法比较其差异显著性。结果不论浅表性胃炎还是萎缩性胃炎,Hp阳性组黏膜组织中HSP70表达阳性率（分别为61．5％和76．0％）显著高于Hp阴性组黏膜组织HSP70表达阳性率（分别为25．0％和37．5％）,差异具有显著性（P〈0．05）。结论HSPT0在各型慢性胃炎黏膜组织均有表达,Hp感染使其表达量明显增强。测定HSP70可反映Hp感染的严重程度和疾病的发展趋势及治疗前景。     

胃蛋白酶原与胃泌素检测对慢性萎缩性胃炎的诊断价值探讨

目的探讨胃蛋白酶原(PG)与胃泌素-17(G-17)在慢性萎缩性胃炎中的诊断价值。方法根据组织病理学诊断结果将120例患者分为对照组(50例,病理检查无明显炎症)和慢性萎缩性胃炎组(70例)。患者清晨空腹抽取静脉血3 mL,免疫放射检测方法检测血清中PGⅠ、PGⅡ、G-17水平。比较慢性萎缩性胃炎组患者不同萎缩部位血清PGⅠ、胃蛋白酶原Ⅰ/胃蛋白酶原Ⅱ比值(PGR)、G-17水平。结果慢性萎缩性胃炎组患者血清PGⅠ、PGR、G-17水平明显低于对照组(P<0.01);萎缩性胃窦炎患者血清PGⅠ、PGR水平明显高于萎缩性胃体炎、全胃多灶性萎缩患者(P<0.01);萎缩性胃体炎患者血清G-17水平明显高于萎缩性胃窦炎和全胃多灶性萎缩患者(P<0.01)。结论检测血清PG和G-17可以作为一种无创性的筛查慢性萎缩性胃炎的方法。     

Reverse diffusion of hydrogen ions and its correlation with acid secretion and proliferative activity of gastric mucosal epithelium in patients with variants of chronic gastritis and peptic ulcer

Eighty-one patients with chronic gastritis and 124 patients with peptic ulcer were examined. It was discovered that in chronic gastritis, the concomitant gastritis included, in patients with peptic ulcer, the degree of enhancement of reverse diffusion of hydrogen ions depended on the intensity of atrophy of the fundal and antral mucosa as well as on the extent of gastric lesions. The duodenogastral reflux promoted the increase of reverse diffusion of hydrogen ions. In mediogastral ulcer site, reverse diffusion of hydrogen ions was, at the height of exacerbation, enhanced to a greater degree than in the stage of ulcer healing. In atrophic variants of chronic gastritis and in peptic ulcer patients with an ulcer sited in the stomach, a close positive correlation was noted between reverse diffusion of hydrogen ions and proliferative activity of the gastric mucosa epithelium and a negative correlation between the diffusion and hydrochloric acid secretion. In patients with peptic ulcer of the duodenum without gastritis or the duodenogastral reflux, the characteristics of reverse diffusion of hydrogen ions did not differ from those seen in normal subjects.     

Follow-up study of chronic gastric erosions.

Chronic gastric erosions were detected with a frequency of 4.4% in 8,468 patients over the six year period from 1971 to 1977. The lesions were usually multiple, chain-like or clustered, along the greater curvature. The age group most often afflicted was the 50-60 year olds, and male predominance were three to one. In one-third of the cases, chronic erosions were found in combination with gastric or duodenal ulceration. Longterm observation of 64 patients over a period of four and a half years revealed no change in the condition in 50%, increase, decrease or complete disappearance of the lesions were found in the remaining 50%. In 10% chain-like multiple erosions developed into a persisting fold in the gastric mucosa. No evidence suggesting that erosive lesions lead to chronic ulceration or development of either polyps or malignancy within 4 1/2 years was recorded, nor was there any association with gastric protein loss.     

Relationship between Helicobacter pylori and antral gastritis and gastroduodenitis]

Morphological data on the biopsies obtained from the antral gastric mucosa of 150 chronic gastritis and gastroduodenitis patients provided grounds for recognition of 3 degrees of gastritis activity. Helicobacter pylori (CP) occurred in the antral gastric portion in 100% of the cases. CP presence and mucosa contamination, plasmocytic infiltration, dystrophic changes in the surface and glandular epithelium were found to correlate. Administration of ampiox in a daily dose of 1.0 g for 10 days resulted in a rapid attenuation of painful and dyspepsia syndromes which ceased on treatment day 7. Endoscopically and morphologically, there were more rapid epithelialization of the erosions and inhibited activity of gastritis compared to the control group. In biopsies obtained on treatment week 3-4 CP was not registered in 67% of cases or was present in much less amounts. The control subjects manifested CP universally, the morphological positive trend was unremarkable.     

Potentialities of a serological method in diagnosis of atrophic gastritis

AIM: To analyse diagnostic potential of "serological gastrobiopsy" in patients with various gastroduodenal diseases. MATERIAL AND METHODS: A total of 244 patients with gastroduodenal pathology have been examined. The diagnoses made morphologically were compared with those made by the serological method. The diagnosis of duodenal ulcer, gastric ulcer, atrophic gastritis, nonatrophic gastritis was made in 155, 31, 43 and 15 patients, respectively. The type of chronic gastritis was diagnosed by the levels of gastrin-17, pepsinogen I, pepsinogen II and antibodies to Helicobacter pylori in blood serum. The diagnoses made serologically were compared with those made morphologically. RESULTS: The highest accuracy of a serological diagnosis of mucosal atrophy of the antral stomach was observed in gastric ulcer (80.6%) and duodenal ulcer (71.6%) in high sensitivity and low specificity. The accuracy of the diagnosis of gastric body mucosa atrophy in atrophic gastritis was 60.5%, in gastric ulcer--51.6%, in duodenal ulcer 58.7% in high specificity and low sensitivity. Serological diagnosis of gastric atrophy was accurate in 71.7%. In weak morphological picture of gastric body atrophy false negative serological diagnosis is possible. No false positive results occurred in diagnosis of gastric body mucosal atrophy (specificity 100%). A negative correlation was found between the severity of gastric body atrophy and pepsinogen I serum level (r = -0.380), pepsinogen I to pepsinogen II in blood serum (r = -0.392). No differences were revealed in gastrin-17 levels in the serum in different atrophy severity in the antral mucosa. CONCLUSION: "Serological gastrobiopsy"provides satisfactory accuracy of atrophic gastritis diagnosis in gastroduodenal diseases.     

慢性萎缩性胃炎的临床病理学特点分析

目的探讨慢性萎缩性胃炎(CAG)的病理组织学形态、胃镜下表现与血清学检测特征,以提高诊断准确率。方法对65例CAG和135例慢性非萎缩性胃炎(CNAC)的临床病理资料、血清学检测和幽门螺杆菌(Hp)感染情况予以回顾性分析,并结合相关文献进行讨论。结果 CAG临床主要表现为上腹部饱胀、不适或疼痛,餐后明显,同时伴有其他消化不良症状,持续数天或数月不等。胃镜直视下特征表现为胃黏膜变薄,皱襞变浅或消失,色苍白而平滑,透过变薄的黏膜可见黏膜下小血管;长期严重的病例,还可见胃黏膜(多在幽门部)呈细颗粒状,甚至形成息肉。组织学特点比较复杂,其特征性所见是胃黏膜固有腺体(主要是胃窦的幽门腺和胃体的胃底腺)萎缩、以致消失,上皮再生、增生与化生,炎症细胞的浸润和淋巴小结形成,黏膜肌层增生等。血清学检测显示血清胃蛋白酶原(PG)-I及胃泌素-17(G-17)均明显低于CNAC患者,72.3%的CAG患者中Hp阳性伴血清胃蛋白酶原PG-I/PG-II比值(PGR)明显降低。结论 CAG是临床常见的胃癌癌前状态,尤其是伴有肠上皮化生和(或)异型增生则为重要的癌前病变;对其确诊主要依靠胃镜活检组织病理学检查,联合检测血清PG和G-17水平可用于大规模人群的普查,以及对患者的随访和预后监测。     

Pourquoi et comment surveiller une gastrite chronique?

Stomach cancer remains present in France (6,000 new cases per year).The background is fully known: atrophic gastritis and gastric intestinal metaplasia. This frequent situation, found in 25% of upper tract endoscopies using RUs, is not currently covered by any monitoring recommendations. However, 1.8% of patients showing these histological anomalies develop a gastric adenocarcinoma within the following 10 years. The increased risk factors for atrophic gastritis are also known, mainly severe atrophic gastritis with extension to the stomach as a whole, family antecedents, nicotine dependence, and above all the presence of dysplasia. The results for two large-scale cohorts (in Hong Kong and Europe) strongly suggest that apart from patients showing dysplasia, who obviously have to be monitored, the presence of one of the various increased risk factors associated with atrophic gastritis justifies regular endoscopic and histological monitoring of the persons concerned.     

胃癌组织环氧合酶-2表达与幽门螺杆菌cagA+菌株感染的关系

目的探讨胃癌组织H pylori cagA感染对环氧合酶2(COX2)表达的影响。方法采用原位聚合酶链反应(PCR)及免疫组织化学技术检测60例慢性浅表性胃炎6、0例慢性萎缩性胃炎、64例肠上皮化生6、4例不典型增生、64例胃癌组织中cagA基因及COX2蛋白表达情况。结果COX2在胃癌、异型增生的阳性表达率升高,分别为70.3%、64.1%与肠上皮化生、萎缩性胃炎、浅表性胃炎相比有显著性差异(P<0.05)。在H pyloricagA阳性胃癌组、异型增生组COX2表达率明显高于H pyloricagA阴性组,两组之间有显著性差异(P<0.05);COX2阳性表达与患者性别、年龄、肿瘤大小无关,与患者浸润深度、淋巴转移、H pyloricagA感染有关。结论H pylori可通过诱导COX2表达参与胃癌病变,COX2参与胃癌的发生发展,CagA是H pylori的重要致病因素,与COX2表达上调及胃癌的发生密切相关。     

Gastric hyperplastic polyps causing upper gastrointestinal hemorrhage in a young adult

Here, we report a case of a young man who presented with a significant upper gastrointestinal bleed treated by endoscopic removal of multiple hyperplastic polyps. Gastric hyperplastic polyps are a relatively uncommon cause of overt gastrointestinal bleeding. While most hyperplastic gastric polyps are asymptomatic, they may present with abdominal pain, iron deficiency anemia or gastric outlet obstruction. These polyps are associated with conditions such as Helicobacter pylori gastritis and atrophic autoimmune gastritis, which predispose the epithelium to chronic inflammation and epithelial repair. The patient presented to Northwestern Memorial Hospital in July 2011. The polyps were resected by clip-assisted snare polypectomy. Histopathologic assessment of the resected polyps demonstrated multiple, non-ulcerative hyperplastic polyps measuring 1.3-1.8 cm in size, without evidence of dysplasia or malignancy. This case describes a young adult patient with multiple, large gastric polyps causing overt gastrointestinal bleeding. This is a rare presentation in a young individual, as these polyps are typically identified in patients older than 60 years of age and less commonly, pediatric populations.