Gastritis

Gastritis

（胃炎）

Department of Gastroenterology, the 1st Affiliated Hospital of Zhengzhou University CHEN Xiangyu

郑州大学一附院消化科

陈香宇

Gastritis Acute Gastritis Gastritis is an inflammation of the lining of the stomach

Chronic Gastritis

Acute Gastritis Definition

定义

Type

分类

Etiology

病因

Clinical manifestation

临床表现

Diagnose

诊断

Treatment

治疗

Acute Gastritis

Definition

定义

This involves an acute inflammatory reaction at the superficial mucosa, with the infiltration of neutrophils. Type

？

分型

？

Type

分型

Acute simple gastritis Acute erosive/hemorrhagic gastritis Acute corrosive gastritis Acute phlegmonous gastritis

急性糜烂 / 出血性 胃炎

Acute Gastritis Definition

定义

Type

分类

Etiology

？

病因

？

Clinical manifestation

临床表现

Diagnose

诊断

Treatment

治疗

Etiology 1 （ 病因 1

）

acute infection and pathogen’s toxin 急性感染及病原体毒素

bacteria 细菌

Viruses 病毒

Acute phlegmonous gastritis 急性化脓性胃炎

parasites

toxin

寄生虫

毒素

Acute simple gastritis 急性单纯性胃炎

Special type (rare)

Common type

特殊类型（少见）

常见类型

Etiology 2—physicochemical factor 病因 2— 理化因素 Nonsteroidal anti-inflammatory drugs （ NSAID） 非甾类抗炎药

Alcohol 乙醇

anticancer drugs 抗癌药

COX

PGE

Destroy epithelium 直接破坏上皮

Irritate mucosa 刺激黏膜

inhibit epithelium regeneration 抑制上皮再生

COX

PGE

Destroy epithelium 直接破坏上皮

Irritate mucosa 刺激黏膜

inhibit epithelium regeneration 抑制上皮再生

Acute erosive/hemorrhagic gastritis 急性糜烂出血性胃炎

Etiology 2—physicochemical factor 病因 2— 理化因素

reflux of bile or enzymes of pancreas 胆汁胰液反流

reflux gastritis 反流性胃炎

Etiology 3 -- Stress 病因 3 — 应 激 severe injury

严重创伤

severe infections

严重感染

major surgery

大手术

Mucosa ischemia and oxygen lack 黏膜缺血缺氧

fire burn 烧伤 （ Curling ulcer) cerebral accident (Cushing ulcer)

脑血管意外

Shock

休克

Severe organ failure 严重脏器 功能衰竭

H+ inverse diffusion H+ 逆弥散

Mucosa ischemia and oxygen lack 黏膜缺血缺氧

Acute erosive/hemorrhagic gastritis 急性糜烂出血性胃炎

H+ inverse diffusion H+ 逆弥散

Stress ulcer 应激性溃疡

Clinical manifestations

Acute simple gastritis Acute erosive/hemorrhagic gastritis

临床表现

急性单纯性胃炎

急性糜烂出血性胃炎

Acute simple gastritis 1 infection is the main cause, it often occurs urgently, course of disease is self-limited 2 pain -- acute upper abdominal pain, tenderness

急性单纯性胃炎 1 感染多见，起病 急，病程常为自限 性

2 痛 -- 急性上腹痛 、 压痛

Acute simple gastritis 3 nausea 、 vomiting

急性单纯性胃炎 3 吐 -- 恶心、呕吐

4 diarrhea

4 泻

5 severe cases may appear fever, shock or acidosis

5 严重者发热、脱 水、 休克、酸 中毒

Acute simple gastritis should be differentiated from these diseases

急性单纯性胃炎应 注意与下列疾病鉴别

peptic ulcer

消化性溃疡

Acute pancreatitis

急性胰腺炎

Acute appendicitis

急性阑尾炎

Acute myocardial infarction

急性心肌梗死

Clinical manifestations

Acute simple gastritis Acute erosive/hemorrhagic gastritis

临床表现

急性单纯性胃 炎 急性糜烂出血性胃炎

Acute erosive/hemorrhagic gastritis is the common cause of acute upper gastrointestinal bleeding （ 10%~30% ） Main manifestations are vomiting blood, dark stools

急性糜烂出血性胃炎 是急性上消化道出血 的常见原因（占 10%-30% ），仅次于 溃疡病

主要表现为呕血 黑便

Characteristic of Acute erosive/ hemorrhagic gastritis

急性糜烂出血性胃炎 出血的特点

volume of bleeding generally 出血量一般不大 is small （ in a few cases, it （少数量大甚至休克） may be very large ） intermittent bleeding--间歇性发作 because erosion may appear in -- 糜烂病灶可分批出现 batch

Self-limited---erosion can heal可为自限性 after 24~48h --24-48h 糜烂病灶可愈合

Diagnose--- 诊

断

clinical manifestation 临床表现 Primary disease 基础疾病 Oral drug history 服药史

+

emergency endoscope examination 急诊胃镜

emergency endoscope examination ：

急诊胃镜：

means endoscope examination 出血发生后 24-48h 之内 be carried out in 24~48h after bleeding.

进行的胃镜检查

This test profit early diagnosis and treatment

有利于早期诊断和内 镜下治疗

appearance under endoscope ：

Gastric mucosa is congestive, hydropic, erosive, hemorrhagic and full of multiple superficial ulcer

内镜下表现：

Erosion -- 糜烂

Bleeding -- 出 血

multiple bleeding focus 胃黏膜多发性出血灶

Acute erosive gastritis ： take Peracetic Acid wrongly 急性腐蚀性胃炎：误服过氧乙酸

Treatment

治

疗

Acute simple gastritis 1 remove motivation 2 Stop vomiting, relieve pain

应祛除诱因 止吐、 止痛

3 Antibiotics should be used if there exist bacterial infection

细菌感染者应用 抗生素

4 Correct disturbance of acidbase balance, electrolyte and water

纠正电解质和酸碱 平衡紊乱

Treatment

治

疗

Acute erosive/ hemorrhagic gastritis Inhibit gastric acid secretion ： PPI 、 H2RA protective agent for gastric mucosa ： Ulcerlmin, Algeldrate PPI: proton pump inhibitor H2RA: H2 receptor antagonist

抑制胃酸分泌： PPI 、 H2RA 胃粘膜保护剂： 硫糖铝 氢氧化铝凝胶

Treatment

治

疗

Acute erosive/ hemorrhagic gastritis stop bleeding with endoscope

胃镜下止血

actively treat primary disease

积极治疗原发病

Gastritis Acute Gastritis Gastritis is an inflammation of the lining of the stomach

Chronic Gastritis

Chronic gastritis

慢性胃炎

Definition

定义

Epidemiology

流行病学

Classification of Chronic gastritis

分类

Etiology and Pathogenesis

病因和发病机理

Pathology

病

clinical manifestation Laboratory examination and other findings Diagnosis

临床表现

Treatment

理

实验室和其他检查 诊断 治疗

Chronic gastritis Definition:

慢性胃炎 定义

Chronic inflammatory

胃粘膜的

changes in the gastric

慢性炎症性病变

mucosa

Chronic gastritis

慢性胃炎

Definition

定义

Epidemiology

流行病学

Classification of Chronic gastritis

分类

Etiology and Pathogenesis

病因和发病机理

Pathology

病

clinical manifestation Laboratory examination and other findings Diagnosis

临床表现

Treatment

理

实验室和其他检查 诊断 治疗

Epidemiology

流行病学

Helicobacter pylori （ Hp ） infection is the main cause of chronic gastritis （ 80~95% ）

幽门螺杆菌感染 是慢性胃炎的主 要病因（ 8095% ）。

Infection rate of Hp in population roughly be equivalent to the sickness rate of chronic gastritis

人群中的 Hp 感染 率大致相当于慢 性胃炎的患病率 。

infection rate of Hp in population is 40~70%

人群中的 Hp 感 染率为 40%-70%

In China, infection rate of Hp is high, and acquire Hp infection at a young age

中国人群中 Hp 感染率较高，获 得感染时的年龄 较轻

Chronic gastritis

慢性胃炎

Definition

定义

Epidemiology

流行病学

Classification of chronic gastritis

分类

Etiology and Pathogenesis

病因和发病机理

Pathology

病

clinical manifestation Laboratory examination and other findings Diagnosis

临床表现 实验室和其他检 查

Treatment

理

诊断 治疗

Classification of Chronic gastritis: New Sydney system 慢性胃炎的分类：新悉尼系统

non-atrophic 非萎缩性

Chronic gastritis 慢

性

胃

炎

Atrophic 萎缩性

Specific forms 特殊类型

Multi-focus atrophic 多灶萎缩性 Autoimmunity 自身免疫性

Specific forms Infections gastritis

特殊类型 感染性 — 病毒、真菌、結

— Viral, Fungal, Tuberculosis 核

radioaction-induced gastritis — radiographic inspection

放射性 — 射线损伤

Specific forms

特殊类型

Lymphocytic gastritis — gastritis verrucosa Non- infection — Crohn’s disease gastritis

非感染性

Chronic gastritis

慢性胃炎

Definition

定义

Epidemiology

流行病学

Classification of Chronic gastritis

分类 病因和发病机 理 病 理

Etiology and Pathogenesis Pathology clinical manifestation Laboratory examination and other findings Diagnosis Treatment

临床表现 实验室和其他检 查 诊断 治疗

Etiology and Pathogenesis

病因和发病机 理



Hp infection

幽门螺杆菌感染



Autoimmunity and Genetic factor

自身免疫和遗传因素



Other factors

其他因素

Helicobacter pylori, Hp In 1893, some scholars reported that a helical organism was found in dog’s stomach gland

幽门螺杆菌 早在 1893 年 就有学者报道在狗的 胃腺内观察到一种螺 旋状微生物

1983 年 由澳大利亚学者 In 1983, Australia’s scholars Warren and Marshall began to investigate Hp ， and found there was a closely relationship between Hp and chronic gastritis, peptic ulcer. Because of their contribution, they won the Nobel prize of 2005

Warren 和 Marshall 首先开 始对 Hp 进行系统研究，并 阐 明 Hp 与慢性胃炎和溃 疡 病有密切关系。他们 因此获得了 2005 年度

The finding of Hp is a milestone of medical

HP 的发现是 20 世

research in 20th

纪医学研究，特别

century, especially of

是胃肠道疾病研究

the gastrointestinal

的一个里程碑！

disease research ！

Four arguments approve that chronic gastritis is due to Hp

幽门螺杆菌符合 病原体的 Koch 四原 则

1 Hp is present in almost all patients .

1 病原体几乎存 在于所有患者 中

2 The gastritis resolves once the infection is cured

2 感染被清除后 胃炎消失

3 Gastritis has been induced in a few subjects by selfadministration of Hp

3

4 The epidemiologic and geographic patterns for the occurrence of Hp and gastritis are identical

4 Hp 和慢性胃炎的流 行病学、地理分布 特征是一致的

口服 Hp 可导致慢 性胃炎

Mechanism of Hp infection cause chronic gastritis

1

Hp

Hp 感染引起慢性胃炎 的机制

1 幽门螺杆菌

2 Autoimmunity and Genetic factor

2 自身免疫和 遗传因素

3 Other factors

3 其他因素

Mechanism of Hp infection cause Chronic gastritis

1 Hp toxins directly injure gastric mucosa 2 Hp induce endothelial cells to release proinflammatory cytokines

Hp 感染引起慢性胃炎 的机制

1 Hp 毒素直接损伤胃黏 膜上皮细胞

2 Hp 诱导胃黏膜上皮细 胞释放促炎性细胞 因子

Mechanism of Hp infection cause Chronic gastritis

Hp 感染引起慢性胃炎 的机制

3 Immune reaction

3 Hp 诱发的免疫

induced by Hp can’t clean

反应不能有效清

up Hp effectively ， which make the infection become chronic

除 Hp ，使感染慢性 化

4 Hp’s virulence factors

4 Hp 的毒 力因子

 field

 定植与粘附作用

 Vacuole

 空泡毒素蛋白：

setting and adhesive attraction toxin protein ： vacuolar degeneration of cells

 cytotoxin-associated

gene protein ： inflammatory reaction

细胞空泡变性

 细胞毒素相关基因 蛋白：炎症反应

Hp 的毒力因 子

Hp’s virulence factor  Mucus

enzyme ： dissolve  粘液酶：溶解粘液

mucus  cell

wall of Hp ： induce immune reaction

 菌体胞壁：作为抗原 产 生免疫

 Lipopolysaccharide

(LPS) ： ruin the gastric mucosal barrier

反应

 脂多糖：破坏胃粘膜

 Persistent

Hp infection result  长期 Hp 感染引 in atrophy of gastric mucosa 起胃 and intestinal metaplasia ， The latter have a 黏膜萎缩和肠上皮化， closely relationship with 后者与胃癌的发生有密 gastric cancer 切关系

Mechanism of autoimmunity and genetic factor cause Chronic gastritis

1

Hp

自身免疫、遗传因素引 起慢性胃炎的机制

1 幽门螺杆菌

2 Autoimmunity and Genetic factor

2 自身免疫和 遗传因素

3 Other factors

3 其他因素

Autoimmunity and Genetic factor

自身免疫和 遗传因素

atrophy dominantly in body of stomach

胃体萎缩为主的 慢性胃炎

Autoimmunity gastritis

自身免疫性胃炎

Autoantibody--- 自身抗体 parietal cell antibody （ PCA ） 壁细胞抗体

intrinsic factor antibody （ IFA ） 内因子抗体

destroy proton pump of parietal cell 壁细胞质子泵破坏

malabsorption of Vit-B12 Vit- B12 吸收障碍

Acid secretion decrease 泌酸减少或缺如

Addison’s anemia 恶性贫血

Mechanism of other factors cause chronic gastritis

1

Hp

其他因素引起慢性胃炎 的机制

1 幽门螺杆菌

2 Autoimmunity and Genetic factor

2 自身免疫和 遗传因素

3 Other factors

3 其他因素

1 reflux of duodenal juice ： bile, pancreatic fluid reflow into stomach

1 十二指肠液反流：

2 damage factor to gastric mucosa: irritative food, alcohol, drugs

2 胃黏膜损伤因子：

胆汁、胰液反流入

刺激性食物、乙醇 药物

Chronic gastritis

慢性胃炎

Definition

定义

Epidemiology

流行病学

Classification of Chronic gastritis

分类

Etiology and Pathogenesis

病因和发病机理

Pathology

病

clinical manifestation Laboratory examination and other findings Diagnosis

临床表现

Treatment

理

实验室和其他检查 诊断 治疗

病

Pathology 1 Inflammation: infiltration of lymphocyte and plasma cell in lamina propria

理

胃粘膜损伤与修复过程 ， 主要特点： 1. 炎症 :

粘膜固有层

中以淋巴细胞和浆细

2 atrophy:

胞

amount of gland in lamina propria decrease ， mucosa become thin

为主的炎症细胞浸润 2. 萎缩 :

指固有层腺

体的数量减少，粘膜

Pathology

metaplasia ：

estinal gland metaplasia,

loric gland metaplasia ,

ypical hyperplasia

病 理 3. 化生： 肠腺化生、幽门腺化生 、 不典型增生

Chronic gastritis

慢性胃炎

Definition

定义

Epidemiology

流行病学

Classification of Chronic gastritis

分类

Etiology and Pathogenesis

病因和发病机理

Pathology

病

clinical manifestation Laboratory examination and other findings Diagnosis

临床表现

Treatment

理

实验室和其他检查 诊断 治疗

clinical manifestation

Most patients have no symptoms

临床表现

大部分患者无症状

clinical manifestation Some present non-specific dyspepsia, include: abdominal distention , vague pain, belching,

临床表现 有些表现为非特异性的 消化不良症状： 上腹饱胀、隐痛、 嗳气、反酸、烧灼 感、食欲不振、恶心

water brash, heartburn,

呕吐、厌食、消瘦、

poor appetite, nausea and

贫血等

vomiting, loss of appetite, become thin, anemia.

clinical manifestation

临床表现

Usually there is not obvious

无明显体征

sign for patients

Chronic gastritis

慢性胃炎

Definition

定义

Epidemiology

流行病学

Classification of Chronic gastritis

分类

Etiology and Pathogenesis

病因和发病机理

Pathology

病

clinical manifestation Laboratory examination and other findings Diagnosis

临床表现

Treatment

理

实验室和其他检查 诊断 治疗

Laboratory examination and other findings

实验室和其他检查

 Endoscopy and biopsy



 detect Hp



HP 检测

 X-ray examination



X 线检查

 gastric analysis



胃液分析

 serologic examination



血清学检查

 Vit-B12 absorption test



维生素 B12 吸收试验

胃镜及活组织检查

Sydney classification of endoscope diagnosis  Congestive/exudative gastritis

胃镜诊断的悉尼分 类 

充血渗出性胃炎

 Raised erosive gastritis



平坦糜烂性胃炎

 Atrophic gastritis



隆起糜烂性胃炎



萎缩性胃炎



出血性胃炎

 Flat erosive gastritis

 Hemorrhagic gastritis  Reflux gastritis

Endoscope examination

胃镜 检查

superficial gastritis Congestion, edema, exfiltration, red alternating with white (piebald). Sometimes, there is bleeding of superficial erosion.

浅表性胃炎 粘膜充血、水肿、 渗出、红白相间（花斑 样、麻疹样）以红为主 可有浅表 糜烂出血

atrophic gastritis The mucosa shows signs of inflammation, at the same time the mucosal layer is thinner and appears to be more transparent.

萎缩性胃炎 粘膜薄、白、血管网显 露 皱壁细、平、消失 红白相间，以白为主， 外观颗粒状小结节

Hemorrhagic gastritis

This is the condition where there are pinpoint hemorrhages on the surface lining of the stomach.

Exudative gastritis

In this form of gastric inflammation, the mucosal defects are covered with mucus and fibrin.

Raised erosive gastritis

there are areas of polypoid, but also erosive changes of the gastric mucosa

Flat erosive gastritis

 erosive gastritis are mucosal lesions , which do not

penetrate the muscular layer of the mucosa.  The erosions, sometimes - like in this photo covered with hematin.

Bile reflux gastritis

 Gastritis secondary to reflux of bile acids. In this

form of gastritis, a reflux of bile through the pylorus is evident and causes inflammatory changes of the gastric mucosa.

Hp detecting

Hp 检测

Hp detecting

Invasive test: Rapid urease testing Staining test under microscope Histology test Culture Polymerase chain reaction

Hp 检测 侵入性试验： 快速尿素酶实验 粘膜涂片染色镜检 组织学检查 微需氧培养 聚合酶链反应

Non-invasive test: 13

C or 14 C urea breath test

Detecting of Hp’s antibody/ antigen

非侵入性试验： 13

C 或 试验

14

C 尿素呼气

HP 抗体 / 抗原检测

Chronic gastritis

慢性胃炎

Definition

定义

Epidemiology

流行病学

Classification of Chronic gastritis

分类

Etiology and Pathogenesis

病因和发病机理

Pathology

病

clinical manifestation Laboratory examination and other findings Diagnosis

临床表现

Treatment

理

实验室和其他检查 诊断 治疗

Diagnosis

诊

断

Endoscopy

胃镜检查

Mucosa biopsy

粘膜活检

Chronic gastritis

慢性胃炎

Definition

定义

Epidemiology

流行病学

Classification of Chronic gastritis

分类

Etiology and Pathogenesis

病因和发病机理

Pathology

病

clinical manifestation Laboratory examination and other findings Diagnosis

临床表现

Treatment

理

实验室和其他检查 诊断 治疗

Treatment 1 Life-style modifications ： avoid coarse, irritating or overheating diet avoid taking drugs that damage gastric mucosa

治疗 1 一般治疗： 避免粗糙、刺激、 过热等饮食 避免损害胃粘膜的 药物 戒烟、酒

Tobacco and alcohol consumption should be avoided

Treatment

治 疗

2 Drugs for inhibit acid secretion

2

抑酸药物

3 Protective agent for mucosa

3

粘膜保护剂

4 Prokinetic Agents

4

促胃动力药

5 Eradicating Hp

5

根除 Hp 治 疗

5 、根除 Hp 治 疗

5 Eradicating Hp Indication: 

Hp associated gastritis accompanied with mucosa erosion moderate to severe atrophy moderate to severe intestinal metaplasia atypical hyperplasia

 Have

适应症：



Hp 相关性胃炎伴 明显异常 胃黏膜糜烂 中 - 重度萎 缩 中 - 重度肠 化 不典型增生



有胃癌家族史者

gastric cancer family history

Treatment plan for eradicating Hp

治疗方案

Bismuth + 2 antibiotics

铋剂 + 两种抗生素

proton pump inhibitor (PPI) + 2 antibiotics

质子泵抑制剂 (PPI) + 两种抗生素

1 Bismuth + Amoxicillin 500mg Arilin 400mg bid, 2w

1 铋剂 + 阿莫西林 500mg 甲硝唑 400mg, bid, 2w

2 Bismuth + Tetracycline 500mg 2 . 铋剂 + 四环素 Arilin 400mg 500mg bid, 2w 甲硝唑 400mg,

3 Bismuth+Clarithromycin 250mg Arilin 400mg bid, 1w

bid, 2w

3. 铋剂 + 克拉霉素 250mg 甲硝唑 400mg,

bid, 1w

proton pump inhibitor (PPI) + 2 antibiotics 1. PPI + Clarithromycin 500mg Amoxicillin 1000mg bid, 1w 2. PPI + Amoxicillin 1000mg arilin 400mg bid, 1w 3. PPI + Clarithromycin 250mg arilin 400mg bid, 1w

质子泵抑制剂 (PPI) + 两种抗生素 1. PPI+ 克拉霉素 500mg 阿莫西林 1000mg bid, 1w 2. PPI+ 阿莫西林 1000mg 甲硝唑 400mg bid, 1w 3. PPI+ 克拉霉素 250mg 甲硝唑 400mg bid, 1w

Autoimmunity gastritis Without radical cure method

自身免疫性胃炎 无特殊治疗 -- 恶性贫血可注射 维生素 B12

Addison's anemia can inject vit-B12 肠化及不典型增生 Intestinal metaplasia and Atypical hyperplasia — vit-C, vit-E, folacin, et al

-- 维生素 C 、 E 、 叶酸、锌、硒、 胡罗卜素

Thank you!