慢性萎缩性胃窦炎与生长抑素水平降低的关系探讨

目的 探讨人慢性萎缩性胃窦炎与生长抑素(SST)水平降低、胃黏膜适应性保护的关联.方法 收集慢性萎缩性胃窦炎患者的胃黏膜活检标本,采集外周血样.放射免疫法测定组织标本和血样的SST水平.光镜下观察组织学变化.透射电镜观察超微结构变化.免疫组化法检测SST在胃窦黏膜中的分布并予半定量分析.结果 慢性萎缩性胃窦炎患者胃窦D细胞数量明显减少,黏液上皮细胞胞质内线粒体肿胀,线粒体嵴断裂,粗面内质网扩张,黏原颗粒减少,细胞内核膜消失,染色质聚集.放射免疫法显示,慢性萎缩性胃窦炎患者血、上皮+隐窝部SST水平[(10.50±7.59)pg/100μl、(1.28±1.57)pg/μg蛋白]均较正常者[(21.16±12.79)pg/100 μl、(4.77±9.52)Pg/μg蛋白]显著降低.免疫组化法显示,慢性萎缩性胃窦炎患者隐窝SST水平(6780±3140)亦较正常者(36840±15230)显著降低.67.7%的慢性萎缩性胃窦炎患者血SST水平低于10 pg/100 μl.结论 在无全身炎性反应状态下,人幽门腺D细胞产生SST能力降低,与慢性萎缩性胃窦炎及胃黏膜适应性保护削弱有关.     

Ultrastructural observation of the gastric mucosa in chronic gastritis patients treated by traditional Chinese medicine

AIM: To demonstrate the relationship between the ultrastructural changes of the gastric mucosa and the syndrome differentiation in chronic gastritis.METHODS: Sixteen chronic gastritis patients with Piweixuhan (PXG, the cold of insufficiency syndrome of the spleen and the stomach) and fifteen chronic gastritis patients with Ganweibuhe (GBG, incoordination syndrome of the liver and the stomach) were treated with Jianpiwenwei decoction (JWD, invigorating the spleen and warming the stomach) or Shuganhewei decoction (SHD, dispersing the stagnated Liver Qi and regulating the stomach), respectively for three months. Before and after treatment, a gastroscopy was performed and the gastric mucosa was collected from the lesser curvature of the antrum of each patient. The ultrasections were observed and photographed under the JEM-100C X electron microscope.RESULTS: The common ultrastructural anomalies of the two types of chronic gastritis were the plasmacyte infiltration and the lesions of the mucosal epithelial cells, chief cells and antral mucous cells. There were obvious differences between the two types. In PXG, the predominant lesion of the chief cells was swelling of the mitochondria, while in GBG the rough endoplasmic reticulum was enlarged in the chief cells and the plasmacytes. After treatment, most cases of the ultrastructural lesions reverted to normal or improved.CONCLUSION: There was a close relationship between the ultrastructural changes of gastric mucosa and the syndrome differentiation of chronic gastritis. JWD and SHD could significantly improve the ultrastructural lesions of the gastric mucosa.     

Lymph and blood capillaries of the human gastric mucosa. A morphologic basis for metastasis in early gastric carcinoma

The distribution of lymph and blood capillaries has been studied by light and transmission electron microscopy in 16 endoscopic and surgical specimens of human gastric mucosa and submucosa. Four specimens were completely normal, seven showed mild gastritis, and five showed severe gastritis. On light microscopy, no definite distinction could be made between small mucosal lymph and blood capillaries. The distinction was achieved only by transmission electron microscopy where lymph capillaries could be identified by the presence of anchoring filaments and the demonstration of open gaps and overlapping endothelial cell processes, as well as by the absence of a basement membrane and "fenestrations" typical of the endothelial cells of blood capillaries. Although large lymph vessels were observed in the submucosa, lymph capillaries were found only in the deep lamina propria adjacent to and within the muscularis mucosae. The upper and middle levels of the lamina propria of the gastric mucosa contained no lymph capillaries. The entire mucosa showed a rich supply of blood capillaries, many of which were adjacent to the basal lamina of gastric glands and the surface epithelium. These morphologic findings correlate with clinicopathologic observations on early gastric cancer. The particularly low incidence of lymph node metastases in the subtype of early gastric cancer that remains confined to the mucosa may be explained by the rarity of lymph capillaries in the mucosa. The high percentage of blood-borne metastases in recurrent early gastric cancer may be related to the rich vascularity of gastric mucosa.     

Gastric Plasmacytoma: An Early Lesion Diagnosed with the Aid of Immunoperoxidase and Immunogold Techniques

A case of gastric plasmacytoma in a 34-yr-old woman has been presented. The demonstration of monotypic intracytoplasmic immunoglobulin of IgM-kappa type in biopsy specimens by immunoperoxidase technique contributed the confident histological diagnosis. In the resected stomach, IgM-kappa monoclonal proliferation of plasmacytic tumor cell was also demonstrated in the lamina propria and in the perivascular space of the submucosa, which was distinct from plasma cells of polyclonal nature diffusely infiltrating in the adjacent mucosa. The double immunogold staining confirmed the presence of immunoglobulin IgM-kappa type in the distended rough endoplasmic reticulum of the tumor cell.     

Ultrastructural research on chronic gastritis treated by traditional Chinese medicine

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Experimental reactivation of chronic gastric lesions exposed to different aggressive conditions.

Experimental reactivation of chronic gastric lesions induced by acetic acid injection to the rat stomach was produced after exposure of the animals to different secondary damaging conditions. On day 18 after the initial injury, animals (n = 100) were distributed in five groups. One of them was used as control and the remainder were subjected to absolute ethanol, stress, pyloric ligation or aspirin. Measurements of gastric acid secretion were performed. Pyloric ligation resulted in the maximal rate of acid secretion. Computerized morphometric analysis of the gastric injuries showed a significant association (70%, p less than 0.01) of hemorrhagic lesions with the primary site of chronic injury in animals subjected to pyloric ligation. No significant association was observed after absolute ethanol (30%), aspirin (30%) or stress (35%). The presence of hemorrhage associated with the original gastric lesions was more dependent on the disorganization of the lamina propria and proliferation of chief cells in the margins of the mucosal scar than on the severity of extent of the chronic lesions. These results indicate that local conditions at the level of gastric mucosa together with an increased presence of acid in the gastric lumen provide favorable conditions for the reactivation of primary chronic lesions in the rat.     

Surface electron microscopical changes of the gastric mucosa in experimental porcine stress ulceration.

Gastric mucosal changes in 8 piglets subjected to a transient hypovolaemic shock were studied using scanning electron microscopy (SEM). The mucosal lesions during the shock were characterized by progressive degenerative changes in the mucous membrane of the stomach. These surface changes included flattening or swelling of the individual cells. The flattening of the mucous membrane was later connected with red cell diapedesis through it. These changes were most typical in the areas of haemorrhagic gastritis and preceded the ulcer formation. Following retransfusion, the affected epithelial lining appeared greatly distended over the oedematous lamina propria, with almost complete loss of structural detail. Masses of red blood cells were seen to emerge through the epithelium as an indication of subepithelial haemorrhage. It is possible that the injured epithelium is actually broken down by the pressure of the underlying mucosal haemorrhage and oedema. At later stages, the ulcerated areas showed complete loss of epithelial cells and thus the underlying structureless lamina propria, covered by necrotic cell remnants, blood cells and fibrin, was denuded.     

Campylobacter pyloric, chronic gastritis, gastric ulcer and duodenal ulcer

After the initial report of Marshall and Warren, several publications have also demonstrated the presence of pyloric campylobacter in an elevated percentage of cases of chronic gastritis and peptic ulcer. We present our experience studying 672 patients examined by esophagogastroduodenoscopy after referral to clinical because of upper gastrointestinal symptoms. We used an Olympus GIF-K2 panendoscope taking two biopsies from the gastric antrum. Specimens were stained with hematoxilin-eosin and silver. In our experience these methods have given us the best results in detecting this bacteria. Diagnosis of gastric and duodenal ulcer was made by endoscopic criteria and chronic gastritis diagnosed by histology. Chronic gastritis was categorized into active and inactive based in the invasion of polymorphonuclear into mucosa. We have also quantitated damage of the mucin producing cells as well as the degree of bacterial colonization. We have found pyloric campylobacter in 91.8% of patients suffering from chronic active gastritis, 72.7% of patients with diagnosis of gastric ulcer and 84.2% of cases of duodenal ulcer. Our results agree with the ones reported by other authors. We conclude that pyloric campylobacter is not an opportunist microorganism within the stomach because it produces inflammatory changes as well as damage of the mucin producing cells. Its presence may play some role in the etiology of gastritis and peptic ulcer disease.     

IL-18 与幽门螺杆菌感染的关系及其致病作用研究进展

白细胞介素-18(IL-18)是一种重要的细胞免疫调节因子,幽门螺杆菌(H.pylori)能促进胃上皮细胞和黏膜固有层单核细胞分泌IL-18,参与包括慢性胃炎、消化性溃疡、胃癌和胃黏膜相关淋巴组织(MALT)淋巴瘤等多种胃十二指肠疾病的发生。本文就IL-18与H.pylori感染的关系及其致病作用研究进展作一综述。     

Isoenzymes of lactate dehydrogenase in human gastric mucosa and gastric carcinoma tissue

Lactate dehydrogenase (LDH) isoenzymes were demonstrated electrophoretically in human fundic and pyloric gastric mucosae and in gastric carcinoma tissue. Fundic gastric mucosa consistently displayed a pattern with predominance of LD1, LD2, and LD3. Pyloric gastric mucosa and cancer tissue consistently had identical patterns with a predominance of LD2, LD3, and LD4, differing significantly from the LDH isoenzyme pattern of fundic mucosa. The LDH isoenzyme pattern characteristic of fundic mucosa extended very close to the histological junction between body and pyloric gastric mucosa and was not affected by the presence of gastritis in the stomach. These results serve to demonstrate yet another difference between mucosa from the acid-secreting and the pyloric areas of the human stomach.     

Scanning electron microscopy of intestinal metaplasia of the human stomach

Biopsy samples of gastric mucosa were obtained at endoscopy from patients suspected of having intestinal metaplasia. These samples were prepared for light microscopy and scanning electron microscopy. Observations of the luminal surface of the gastric mucosa in the scanning electron microscope revealed distinct topographic differences in the intestinalized and nonintestinalized regions. The latter area showed features consistent with those described in chronic gastritis, i.e., the exaggeration of the "cobblestone relief" appearance of the luminal surface of the stomach and the presence of numerous short, stubby, bulbous microvilli which project from the free border of the surface mucous cells toward the lumen of the stomach. The intestinalized region revealed a plush microvillous (striated) border periodically interrupted by apical openings of goblet cells. The scanning electron microscope is a useful research aid for examination of cell membrane expressions of the surface cells of the gastric mucosa not totally appreciated by light microscopy and transmission electron microscopy.     

Pathological characteristics of gastric leiomyoblastoma

AIM: To determine the pathological characteristics of gastric leiomyoblastoma. METHODS: All tissues were obtained during surgery or gastroscopy. Tissue specimens for examination by light microscope were 1 cm x 1 cm x 1 cm in size, fixed in 40 g/L neutral buffered formaldehyde, embedded in paraffin, and stained with hematoxylin and eosin. The fresh tissues obtained for electron microscopy were 1 mm x 1 mm x 1 mm in size, and fixed in phosphate buffered 30 g/L glutaraldehyde, postfixed in 10 g/L osmium tetroxide and dehydrated in graded alcohol, embebbed in Epon 812. Ultrathin sections of 50 nm were stained with uranyl acetate and lead citrate and examined under a JEM-2000 EX transmission electron microscope. RESULTS: The most important histopathological feature of leiomyoblastoma was the predominance of large, rounded or polygonal cells with characteristic perinuclear clear zone in cytoplasms. The tumor cells arranged in patch, cell junction or junctional complex could be found occasionally between cells under electron microscope. Most of the neoplastic cytoplasms were filled with myofilaments, dense bodies, and dense patches. Rough endoplasmic reticulum dilatated as lakes, and large quantities of protein secretions of intermediate electron density were found in the dilated cisternae. Intracisternal segregation could also be found. The nuclei were round or oval, and anomalous nuclei were found in part of cells. CONCLUSION: The diagnosis of gastric leiomyoblastoma can be confirmed by electron microscopy. The clear appearance of tumor cells is due to the dilation of rough endoplasmic reticulum, not fat droplets, glycogens or mucus in cytoplasm.     

Gastric plasmacytoma with cylindrical crystalline inclusions

An 81 year-old female case of extramedullary plasmacytoma of the stomach is reported. Immunohistochemically, the tumor cells contained IgM-lambda immunoglobulin. Electron micrographs of the tumor cells showed centrally located nuclei with nuclear inclusions and cytoplasm filled with crystalline inclusions in the rough endoplasmic reticulum. IgM-lambda producing gastric plasmacytoma with cylindrical inclusions is rare.     

Accumulation of mast cells and macrophages in focal active gastritis of patients with Crohn's disease

BACKGROUND/AIMS: Recent studies have shown that focal active gastritis seems to be the typical gastric pathology in Crohn's disease. The aim of this study was to compare the incidence of focal active gastritis, Helicobacter pylori infection and distribution of gastric mast cells and macrophages in patients with Crohn's disease, ulcerative colitis and H. pylori gastritis without inflammatory bowel disease. METHODOLOGY: Patients with histologically confirmed Crohn's disease (n = 25) or ulcerative colitis (n = 25) and control patients without inflammatory bowel disease (n = 25) were included in this study. Biopsy specimens were obtained from the antrum and corpus of each patient, and stained with hematoxylin and eosin and immunostained using antibodies to tryptase (AA1) and CD68. The number of mast cells and macrophages located in the lamina propria was determined. RESULTS: Focal active gastritis was detected in 54% of H. pylori-negative patients with Crohn's disease, but it was not found in patients with ulcerative colitis nor in the control group. The density of mast cells and macrophages in the lamina propria of H. pylori-positive patients was significantly higher than in H. pylori-negative patients in all groups. In the Crohn's disease group, the number of mast cells (antrum; 83 +/- 11, body; 89 +/- 11/mm2) and macrophages (antrum; 94 +/- 22, body; 92 +/- 17/mm2) in the lamina propria of H. pylori-negative patients with focal active gastritis was halfway between that in H. pylori-positive and H. pylori-negative patients. In focal active gastritis, mast cells accumulated at the border of focal active gastritis, whereas macrophages accumulated in the center of such lesions. CONCLUSIONS: Our findings indicated that the diagnosis of focal active gastritis, using immunostain for mast cells and macrophages, is the histological hallmark of gastric Crohn's disease. Macrophages might be associated with the formation of focal active gastritis in patients with Crohn's disease.     

Collagenous gastritis

Subepithelial fibrosis has previously been reported in the small intestine (collagenous sprue) and colon (collagenous colitis). We report a 15-yr-old girl with chronic gastritis and subepithelial fibrosis of the gastric corpus who presented with recurrent abdominal pain and acute upper gastrointestinal bleeding. Nodularity and erythema of the gastric corpus were persistent endoscopic findings. Biopsies revealed patchy chronic active gastritis with a striking focal thick band of collagen immediately beneath the surface epithelial cells that did not extend to deeper portions of the lamina propria. Contrast radiography demonstrated an abnormal mucosa of the gastric corpus with a mosaiclike surface pattern. Numerous studies have failed to elucidate the etiology. Despite treatment with ranitidine, sucralfate, and furazolidone, there has been no clinical or pathologic improvement. The pathogenesis and prognosis of collagenous gastritis, and its relationship to collagenous sprue and collagenous colitis, remain to be defined.     

Clinical characteristics of bile reflux gastritis

Thirty patients with bile reflux gastritis, proven by gastroscopy and Milk 99mTc-EHIDA Test, were studied and their clinical features were compared with those of patients with non-bile reflux gastritis. The symptoms were similar in both groups of patients, whereas histologically in bile reflux gastritis there were more hyperemia of mucosa, more obvious edema in lamina propria and more polymorphonuclear infiltration. Furthermore, in bile reflux gastritis the histological changes were more severe in the antrum and decreased in severity toward the cardia. Acid secretion was significantly lower in patients with bile reflux gastritis than in patients with non-bile reflux gastritis while the serum gastrin level was significantly higher in the former than in the latter group. The authors suggest that there may be a vicious cycle among duodenogastric reflux, low level of gastric acidity and high level of serum gastrin. When duodenogastric reflux occurs, not only the bile salts damage the gastric mucosa and subsequently cause the back diffusion of hydrogen ion but also the alkaline duodenal juice neutralizes the gastric acid, resulting in decrease of gastric acidity. The bile salts and low acidity can stimulate the release of serum gastrin which antagonizes the effects of cholecystokinin and secretin on pyloric tone and aggravates the duodenogastric reflux.     

Immunological aspects of lymphocytic gastritis

Diffuse and corporeal varioliform gastritis represent the usual endoscopic expression of lymphocytic gastritis. Referring to the work of other authors on varioliform gastritis, immunocytochemical studies have been made on the plasma cells of the lamina propria in two comparative series of lymphocytic and chronic atrophic gastritis. We could not demonstrate any significant variation in the number of IgE plasma cells between the two types of gastritis. In another study, the lymphocytic populations of the lamina propria and of the epithelium were characterized by peroxidase immunocytochemical methods on frozen sections. In agreement with other authors we confirmed that, in lymphocytic gastritis, the intraepithelial lymphocytes belong to the T group with a predominance of the T8 subgroup. In the lamina propria, the lymphocytes were mostly T with a slight preponderance of the T4 subgroup. B lymphocytes were scarce. The distribution of B and T lymphocytes was the same as that observed in coeliac disease.