慢性胃炎的病理诊断
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摘要
慢性胃炎的病理诊断参照了新悉尼系统的直观模拟评分法和中国慢性胃炎共识意见(2017,上海),包括对慢性胃炎的炎症、活动性、萎缩、肠化和幽门螺杆菌进行半定量评价,并给予总结性分类。虽然幽门螺杆菌感染是最常见的原因,但是也不能忽视其他类型的慢性胃炎。病理评估时应尽可能提供病因学依据和线索。慢性胃炎的两个风险评估系统可操作的与肾癌风险联系的肾炎评估(OLGA)和可操作的与肾癌风险联系的肠化生评估(OLGIM)可以有效对胃癌的发生风险进行分层,建议纳入病理评估。完善的慢性胃炎病理诊断系统不仅可以指导临床治疗,也有利于慢性胃炎患者的管理、随访策略的制定以及早癌的筛查。
The pathologic diagnosis of chronic gastritis referred to the updated Sydney system and Chinese consensus on chronic gastritis(2017, Shanghai) which included the semiquantitative evaluation of inflammation, activity, atrophy, intestinal metaplasia, H.pylori infection and gave the related classification. Although H.pylori infection is the most common cause, other types of chronic gastritis should not be ignored. Furthermore, the pathologic assessment should try to provide evidences or clues pointing to the etiology. OLGA and OLGIM were two effective systems to evaluate the risk to gastric cancer that were recommended as a part in the pathologic assessment. Complete pathologic diagnosis system could not only guide the clinical treatment, but also facilitate the management of the chronic gastritis patients, development of the follow-up strategy and early gastric cancer screening.
The pathologic diagnosis of chronic gastritis referred to the updated Sydney system and Chinese consensus on chronic gastritis(2017, Shanghai) which included the semiquantitative evaluation of inflammation, activity, atrophy, intestinal metaplasia, H.pylori infection and gave the related classification. Although H.pylori infection is the most common cause, other types of chronic gastritis should not be ignored. Furthermore, the pathologic assessment should try to provide evidences or clues pointing to the etiology. OLGA and OLGIM were two effective systems to evaluate the risk to gastric cancer that were recommended as a part in the pathologic assessment. Complete pathologic diagnosis system could not only guide the clinical treatment, but also facilitate the management of the chronic gastritis patients, development of the follow-up strategy and early gastric cancer screening.
引文
[1] 中华医学会消化病学分会.中国慢性胃炎共识意见(2017,上海)[J].胃肠病学,2017,22(11):670-87.
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[5] Rugge M,Meggio A,Pennelli G,et al.Gastritis staging in clinical practice:the OLGA staging system[J].Gut,2007,56(5):631-636.
[6] Rugge M,Fassan M,Pizzi M,et al.Operative link for gastritis assessment vs operative link on intestinal metaplasia assessment[J].World J Gastroenterol,2011,17(41):4596-4601.
[7] Yun CY,Kim N,Lee J,et al.Usefulness of OLGA and OLGIM system not only for intestinal type but also for diffuse type of gastric cancer,and no interaction among the gastric cancer risk factors[J].Helicobacter,2018,23(6):e12542.
[8] Yue H,Shan L,Bin L.The significance of OLGA and OLGIM staging systems in the risk assessment of gastric cancer:a systematic review and meta-analysis[J].Gastric Cancer,2018;21(4):579-587.
[9] Campana D,Ravizza D,Ferolla P,et al.Risk factors of type 1 gastric neuroendocrine neoplasia in patients with chronic atrophic gastritis.A retrospective,multicentre study[J].Endocrine,2017,56(3):633-638.
[10] Corey B,Chen H.Neuroendocrine tumors of the stomach[J].Surg Clin North Am,2017,97(2):333-343.
[11] Koutri E,Papadopoulou A.Eosinophilic gastrointestinal diseases in childhood[J].Ann Nutr Metab,2018,73 (Suppl 4):18-28.
[12] Broide E,Sandbank J,Scapa E,et al.The immunohistochemistry profile of lymphocytic gastritis in celiac disease and helicobacter pylori infection:interplay between infection and inflammation[J].Mediators Inflamm,2007,2007:81838.
[13] Joo M.Rare gastric lesions associated with Helicobacter pylori infection:a histopathological review[J].J Pathol Transl Med,2017,51(4):341-351.
[14] Yip RHL,Lee LH,Schaeffer DF,et al.Lymphocytic gastritis induced by pembrolizumab in a patient with metastatic melanoma[J].Melanoma Res,2018,28(6):645-627.
[15] Gabrieli D,Ciccone F,Capannolo A,et al.Subtypes of chronic gastritis in patients with celiac disease before and after gluten-free diet[J].United European Gastroenterol J,2017,5(6):805-810.
[16] Pimentel AM,Rocha R,Santana GO.Crohn's disease of esophagus,stomach and duodenum[J].World J Gastrointest Pharmacol Ther,2019,10(2):35-49.
[2] Fang JY,Du YQ,Liu WZ,et al.Chinese consensus on chronic gastritis (2017,Shanghai)[J].J Dig Dis,2018,19(4):182-203.
[3] Tajalli R,Nobakht M,Mohammadi-Barzelighi H,et al.The immunohistochemistry and toluidine blue roles for Helicobacter pylori detection in patients with gastritis[J].Iran Biomed J,2013,17(1):36-41.
[4] Petrolla AA,Katz JA,Xin W.The clinical significance of focal enhanced gastritis in adults with isolated ileitis of the terminal ileum[J].J Gastroenterol,2008,43(7):524-530.
[5] Rugge M,Meggio A,Pennelli G,et al.Gastritis staging in clinical practice:the OLGA staging system[J].Gut,2007,56(5):631-636.
[6] Rugge M,Fassan M,Pizzi M,et al.Operative link for gastritis assessment vs operative link on intestinal metaplasia assessment[J].World J Gastroenterol,2011,17(41):4596-4601.
[7] Yun CY,Kim N,Lee J,et al.Usefulness of OLGA and OLGIM system not only for intestinal type but also for diffuse type of gastric cancer,and no interaction among the gastric cancer risk factors[J].Helicobacter,2018,23(6):e12542.
[8] Yue H,Shan L,Bin L.The significance of OLGA and OLGIM staging systems in the risk assessment of gastric cancer:a systematic review and meta-analysis[J].Gastric Cancer,2018;21(4):579-587.
[9] Campana D,Ravizza D,Ferolla P,et al.Risk factors of type 1 gastric neuroendocrine neoplasia in patients with chronic atrophic gastritis.A retrospective,multicentre study[J].Endocrine,2017,56(3):633-638.
[10] Corey B,Chen H.Neuroendocrine tumors of the stomach[J].Surg Clin North Am,2017,97(2):333-343.
[11] Koutri E,Papadopoulou A.Eosinophilic gastrointestinal diseases in childhood[J].Ann Nutr Metab,2018,73 (Suppl 4):18-28.
[12] Broide E,Sandbank J,Scapa E,et al.The immunohistochemistry profile of lymphocytic gastritis in celiac disease and helicobacter pylori infection:interplay between infection and inflammation[J].Mediators Inflamm,2007,2007:81838.
[13] Joo M.Rare gastric lesions associated with Helicobacter pylori infection:a histopathological review[J].J Pathol Transl Med,2017,51(4):341-351.
[14] Yip RHL,Lee LH,Schaeffer DF,et al.Lymphocytic gastritis induced by pembrolizumab in a patient with metastatic melanoma[J].Melanoma Res,2018,28(6):645-627.
[15] Gabrieli D,Ciccone F,Capannolo A,et al.Subtypes of chronic gastritis in patients with celiac disease before and after gluten-free diet[J].United European Gastroenterol J,2017,5(6):805-810.
[16] Pimentel AM,Rocha R,Santana GO.Crohn's disease of esophagus,stomach and duodenum[J].World J Gastrointest Pharmacol Ther,2019,10(2):35-49.