幽门螺杆菌感染与胃不同部位组织学病变的关系

目的 明确幽门螺杆菌(Helicobacter pylori,H,pylori)感染与胃不同部位粘膜组织学病变的关系。方法 在215例胃镜受检者胃窦、角、体三点取材进行组织学检查，Giemsa染色明确H.pylori感染情况，HE染色计量观察组织学病变情况，分析两者的相关关系。结果 从胃窦到胃角、胃体，炎症程度(单个核细胞浸润)、活动度(中性粒细胞浸润)、糜烂及淋巴滤泡形成均递减，H.pylori阳性者积分高于阴性者。在胃窦和胃角部，H.pylori感染更常引起近腔面上皮分泌下降，而在胃体部无此发现，H.pylori感染在三个部位均可引起腺体萎缩。结论 H.pylori感染是胃多部位组织学病变如淋巴细胞、中性粒细胞浸润、糜烂和淋巴滤泡形成与粘膜萎缩的病因，在胃窦和胃角引起的病变重于胃体。     

Gastric morphology and serum gastrin levels in pernicious anaemia.

Mucosal biopsies from multiple sites in the stomachs of 21 patients with pernicious anaemia have been examined. The histological changes almost always involved the entire gastric mucosa, including that of the pyloric antrum. Metaplastic changes were almost universal and consisted of intestinal metaplasia in the body and antrum and pyloric metaplasia in the body. The severity of the pyloric metaplasia was such as to make the distinction between body and antrum on biopsy impossible. No relationship was found between serum gastrin activity and the histological appearances of the gastric antrum or body.     

胃肠道结核的内镜与病理

目的总结胃肠道结核的内镜诊断经验，以引起对这个特殊疾病的重视，减少漏诊和误诊。方法内镜检查发现胃肠道黏膜隆起、结节、红斑、溃疡等病变，行黏膜活检病理。结果7例患者中，胃结核2例，其中溃疡型1例，增殖型1例；肠结核5例，其中增殖型4例，混合型1例。病变部位：胃窦部2例，回肠末端1例，回盲瓣1例，回肠末端和回盲瓣1例，回肠末端及结肠多处病变1例，升结肠1例。内镜诊断：1例结合有浸润型肺结核诊断为肠结核，2例诊断为结肠恶性肿瘤，4例诊断为胃肠黏膜隆起或溃疡性病变性质待定。7例患者活检组织病理均为干酪样坏死肉芽肿，符合结核。结论胃肠道结核病内镜下表现多种多样，与结肠癌、克罗恩病等炎性肠病及胃良恶性溃疡难以鉴别，需依赖黏膜活检病理诊断。     

原发性病理性十二指肠胃反流致病的因素分析

目的 探讨原发性病理性十二指肠胃反流(DGR)胃黏膜病变、幽门螺杆菌(Hp)感染、胆汁反流之间的关系.方法 应用便携式胆汁监测仪监测86例原发性病理性DGR患者胃内24 h胆汁反流情况;另取胃黏膜组织活检,分别行快速尿素酶试验、改良Giemsa染色和HE染色,判断有无Hp感染,并观察胃黏膜慢性炎症、活动性、萎缩、肠化等组织学特征.结果 ①将患者根据有无Hp感染分为Hp阳性组和Hp阴性组,Hp阳性组胃窦部黏膜病理积分、胆红素吸收值≥0.25的时间百分比均显著低于Hp阴性组(P均＜0.05);两组胆红素吸收值≥0.25的时间百分比和胃窦、胃角部黏膜病理积分均呈显著正相关(P均＜0.05).②将患者根据胆汁反流程度分为高反流组和低反流组,高反流组Hp阳性率显著低于低反流组(P＜0.05),胃窦和胃角部黏膜肠上皮化生的检出率、胃窦部黏膜病理积分均显著高于低反流组(P均＜0.05).结论 原发性病理性DGR导致胃窦黏膜损伤的主要因素可能为胆汁反流,随胆汁反流程度加重,胃窦黏膜损伤程度加重;胆汁反流可能抑制Hp在胃窦部定植,Hp感染可能与胆汁反流协同作用导致胃体部黏膜损伤.     

Types of atrophic gastritis in patients with primary Sj?gren's syndrome.

Histological examination of the gastric mucosa was performed in 44 patients with primary Sjögren''s syndrome with extraglandular symptoms (mean age 51.9, range 22-76). Biopsy specimens were taken from each of three separate regions: the antrum, the corpus, and the transitional zone between the antrum and the corpus. The incidence of chronic atrophic gastritis was considerably higher in patients with Sjögren''s syndrome than in the controls. In the young patients with Sjögren''s syndrome atrophic lesions were more common both in the antrum and in the corpus than in the control group. In middle aged patients, however, only the antrum, and in the elderly only the corpus, was much more commonly affected than in the controls. All three types of chronic atrophic gastritis occurred in patients with Sjögren''s syndrome. Decreased gastric acid secretion was associated mainly with atrophic gastritis of types A and AB, whereas hypergastrinaemia occurred almost exclusively in gastritis of type A.     

胃镜检出胃恶性病变3460例分析

目的:探索胃镜检出胃恶性病变患者的发病及胃镜、病理特点。方法:对我院1990～2009年胃镜诊断的3460例胃恶性病变患者按不同年龄分组进行胃镜及病理资料的回顾性分析、总结。结果:3460例胃恶性病变患者中,男性多于女性(2.26∶1),但年龄≤40岁组男女差别不大。50岁以上发病明显增高,特别是60～70岁发病率最高。胃窦部为胃癌的高发部位,年龄≤40岁组以胃体和胃窦为主,而60岁以上患者胃贲门食管连接部癌的发病率显著上升。年龄≤40岁组病理类型以分化差、恶性程度高的低分化腺癌和印戒细胞癌为主,随着年龄增长,病理类型逐渐趋向于以中分化管状腺癌、高分化管状腺癌为主。胃淋巴瘤多发于胃体、胃窦部,胃镜下表现以多发性溃疡病灶为主。结论:胃恶性病变的发病与年龄、性别密切相关,不同年龄组胃癌的发生部位、病理特点各不相同,应引起重视,同时应提高对青年人胃癌的认识,提倡和重视胃镜检查普及,做到早期发现、早期诊断、早期治疗。     

胃肠道异位胰腺60例的诊断与治疗分析

目的 探讨胃肠道异位胰腺的临床特点、诊断及治疗原则.方法 对近10年来经内镜超声检查和病理检查确诊的60例异位胰腺患者的病例资料进行回顾性分析.结果 本组60例,病变位于十二指肠球腔3例,十二指肠降段2例,胃角3例,胃窦、体交界处2例,胃窦部50例.所有病变均经过内镜、内镜超声及病理检查确诊为异位胰腺.其中28例行内镜下高频电切治疗,2例行内镜下黏膜切除术(EMR)治疗,30例行外科手术治疗.所有患者术后疗效满意,未出现手术并发症.结论内镜超声对确诊异位胰腺具有重要价值,对于异位胰腺的内镜下治疗具有重要的指导意义.内镜下微创治疗异位胰腺安全有效,具有重要的临床应用价值.     

Role of lymphoid nodules in pathogenesis of indomethacin-induced gastric lesions in dogs

Pathogenesis of indomethacin-induced gastric lesions in beagles was studied morphologically. While a single oral administration of indomethacin (20 mg/kg) did not induce visible lesions in the stomach of male beagles, repeated administration once daily for 5 or 10 days induced gastric erosions or ulcers, mainly in the antrum. When this compound was given once or repeatedly, histological examination showed that the total number of lymphoid nodules both in the fundus and antrum tended to increase or significantly increased. The number of large nodules (over 350 m in diameter) was significantly increased, particularly in the antrum. Some of these enlarged nodules seen at the surface of the mucosa showed damage at the luminal area, and the lesions were microscopically visible. Indomethacin is known to disrupt the gastric mucosal barrier in dogs, leading to increased back-diffusion of acid. Our findings and those of others suggest that indomethacin may induce lesions in specific portions of the dog stomach, initiated by enlargement of lymphoid nodules followed by damage to some of these nodules, probably due to a corrosive effect of gastric juice through the disrupted mucosal barrier.     

Relationship between location of stress erosive gastritis and brain damage in resuscitated patients]

Patients after resuscitation from cardiopulmonary arrest often show stress erosive gastritis. This study investigated the relationship between the location of gastric mucosal injury and the degree of brain damage. Forty-five resuscitated patients with gastrointestinal bleeding complications were enrolled and were examined by esophagogastric fiberscope after 72 hours of hospitalization. Their brainstem and cerebral functions were evaluated brainstem auditory evoked potential (BAEP) and electrical encephalogram (EEG), respectively. Thirty patients showed complications with acute gastric lesions. Ten patients had gastric mucosal injury in the antrum and they all showed a good response for BAEP (I, III and V waves were positive). In contrast, patients without antral gastric mucosal lesions showed poor response for ABR (defect of III and V waves) and EGG (Hockerday Grade III or IV). These results indicate that fair brainstem function is necessary for stress erosive gastritis in gastric antrum.     

Unusual manifestations of gastric inflammatory fibroid polyp in a child

AIM: Inflammatory fibroid polyp (IFP) is a rare benign lesion that may occur throughout the digestive tract. IFP is more commonly found in the antrum of the stomach in particular. It mostly affects adults at the average age of 60 years. These polyps are able to cause abdominal pain, gastrointestinal bleeding, intestinal obstruction or intussusception. In this paper we report a case of gastric IFP with unusual presenting features. METHODS: A child with gastric IFP was described and the literature was reviewed. RESULTS: A 4-year-old girl presented with fever for 2 months, arthralgia of knees and ankles, iron deficiency anemia, and hypoalbuminemia. Her stool examination was positive for occult blood. The upper gastrointestinal study demonstrated a large lobulated mass at the upper part of gastric body. Partial gastrectomy en bloc with this 5 cm x 8 cm mass was subsequently performed. Pathological examination was consistent with IFP. Following the mass excision, her fever abruptly declined and disappeared together with anemia and arthralgia. She remained asymptomatic and the abdominal ultrasonography performed at the 24-month follow-up demonstrated no recurrence of the tumor. CONCLUSION: The etiopathogenesis of IFP still remains unclear. The presence of IFP throughout the gastrointestinal tract and its variable clinical appearances make it difficult to diagnose. The inflammatory symptoms found in this patient support the hypothesis of inflammatory benign lesions of IFP.     

RETROSPECTIVE STUDY OF ENDOSCOPIC FINDINGS: 250 CASES OF GASTRIC CANCER

Background : The accuracy of endoscopy for detecting gastric cancer is high but failures may occur if the cancer is not visualized or recognized with gastroscopy. The aim of this study was to understand the reasons why gastroscopy may not detect gastric cancer. Methods : Patients with gastric cancer (n = 4053) diagnosed between 1979 and 1996 were studied by linking gastroscopic examinations (n = 111 094). Endoscopic records were reviewed in 250 patients who were diagnosed with gastric cancer but had not been diagnosed as such on the examination within the previous 3 years. Results : In 33 patients (13.2%) gastric cancer was detected at the advanced stage. The percentage of advanced cancer was significantly higher on the cardia and the gastric body than it was on the angulus and the antrum. In 107 patients (42.8%) no lesion was identified after reviewing endoscopic records. In 102 patients (40.8%) marked lesions were present but had not been diagnosed as such. In 41 patients (16.4%) gastric cancer may have been overlooked but due to a lack of photographic documentation in the specific areas, these findings were not confirmed. The percentage of the indeterminate examinations was significantly higher in lesions on the remnant stomach and the cardia than in other areas. Conclusion : In order to reduce the proportion of the advanced gastric cancer to under 20%, repeated endoscopic examinations were recommended within 2 years even if any suspicious lesions could not be detected by the initial examination.     

Risk of ulceration with long-term indomethacin: endoscopic and histological changes in upper gastro-intestinal mucosa.

Twenty patients taking long-term indomethacin were chosen for the study because all had a normal endoscopic examination; biopsies, however, from the oesophagus, gastric antrum and duodenal bulb revealed histological inflammation in all patients in at least one site. After 8 weeks during which indomethacin therapy was continued, a further endoscopy revealed lesions in 5 patients--peptic ulcer in 3 and erosions in 2--but only 1 of these had any change in gastro-intestinal symptoms. Irrespective of whether mucosal lesions are seen on endoscopy in patients established on non-steroidal anti-inflammatory drug therapy, they remain in danger of developing both ulcers and erosions which are likely to be asymptomatic. At no time can one justifiably feel this patient group is not at risk of peptic ulceration.     

Preliminary study of magnetically controlled capsule gastroscopy for diagnosing superficial gastric neoplasia

BackgroundMagnetically controlled capsule gastroscopy (MCCG) is a newly developed non-invasive method designed for gastric examination. Although favorable diagnostic accuracy has been reported, there is little if any data about its ability to diagnose gastric cancer.AimsTo compare the detectability of superficial gastric neoplasia by MCCG and gastroscopy.MethodsThis study was a self-controlled comparison study. Ten subjects diagnosed with superficial gastric neoplasia and scheduled to undergo endoscopic submucosal dissection (ESD) at a tertiary hospital were prospectively invited for an MCCG examination. The diagnostic agreement of MCCG, ESD and pathology were compared, including location, size and endoscopic appearance of the lesions.ResultsOf the 10 enrolled patients, 6 were confirmed as having early gastric cancer/high-grade intraepithelial neoplasia, 2 gastric low-grade intraepithelial neoplasia (LGIN), 1 tubular adenoma with LGIN and 1 neuroendocrine tumor. The per-patient and per-lesion sensitivities of MCCG for superficial gastric neoplasia detection were 100% and 91.7%. Location and size of the lesions were compared favorably to gastroscopy whilst one cardiac lesion was missed. Endoscopic appearances of these lesions observed on MCCG and EGD demonstrated good consistency. No adverse events were observed.ConclusionWith good gastric preparation and careful examination of stomach, MCCG is able to detect superficial gastric neoplasms.     

Primary gastric tuberculosis presenting as non-healing ulcer and mimicking Crohn's disease

A 39-year-old woman was referred to our hospital for treatment of a non-healing gastric ulcer. Esophagogastroduodenoscopy (EGD) revealed an erosion in the pyloric antrum and a longitudinal ulcer on the lesser curvature of the gastric body. The histopathologic examination of biopsy specimens revealed non-caseating epithelioid granulomas. Acid-fast staining did not reveal bacilli. The differential diagnosis included gastric tuberculosis, Crohn's disease, and sarcoidosis and empiric antituberculous therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide was initiated. Gastric lesions were subsequently resolved and non-caseating epithelioid granulomas were not demonstrated on the post-treatment examination. Recurrence was not observed during the follow-up period of 53 months.     

Endoscopic follow-up study of development of gastric antral vascular ectasia associated with liver cirrhosis

Gastric antral vascular ectasia is an important cause of chronic gastrointestinal blood loss. However, its development and progression have not yet been clarified. We investigated its early lesions and progression by reviewing endoscopic films of five patients with gastric antral vascular ectasia followed for liver cirrhosis. In all patients, early findings were prepyloric red spots. In two patients, anemia due to gastrointestinal bleeding was already observed when vascular lesions were confined to the distal antrum. In the other three patients, anemia was observed 1–2 years after they showed a diagnostic pattern of gastric antral vascular ectasia. The vascular lesions gradually thickned and extended throughout the antrum, with the complete picture shown in 1.5–5 years. The pattern of distribution was classified into three types: diffuse spotty, diffuse confluent, and striped. These types could be predicted before the complete formation. Gastric antral vascular ectasia associated with liver cirrhosis started as prepyloric red spots and extended to the proximal antrum in various ways and varying time courses of less than 5 years; this entity may cause hemorrhage even in the early stage.     

胃癌临床诊断影响因素的探讨

目的:探讨影响胃癌临床诊断的因素。方法:对472例胃癌病例的首发症状、内镜、病理组织活检及细胞学刷片检查结果进行回顾性研究,全部病例均行胃镜和组织活检,81例同时行细胞学刷片。结果:病变部位以胃窦(35.4％)和胃体分布(29％)多见,病变主要表现为溃疡(41.8％)、糜烂(16.1％)、菜花样肿物(15.7％)或结节隆起病变(26.5％)。368例(78.1％)在行首次内镜取材活检后确诊,73例(15.5％)需行2次或2次以上的内镜活检,尚有31例(6.5％)需借助其它检查才得以确诊。癌的检出与病灶组织取材量密切相关,每例病灶组织活检量在6块以上时,阳性率可达97.5％,而取材量不足2块时,恶性病变的阳性率仅63.6％。细胞学刷片检查对胃癌检出的阳性率不高(54.3％),但确能在某些组织活检阴性病例中发现恶性细胞。结论:由于胃癌表现的不典型性,对临床就诊病人应注意胃癌的可能。对可疑病变行多块活组织检查(>6块)和同时进行细胞学刷片,对提高胃癌的检出率有重要价值。     

经支气管镜治疗支气管肿瘤

经支气管镜治疗支气管肿瘤张保金，赵忠忱近十几年来经气管镜治疗的方法已有多种，技术亦日益提高，特别对气管支气管肿瘤的治疗更逐步普及，这是重新打开大气道的阻塞和狭窄，迅速缓解患者呼吸困难和濒临窒息的有效方法。一、适应症的选择：支气管肺癌开始均在支气管粘膜...     

Computed virtual chromoendoscopy - enhanced videocapsule endoscopy is of potential benefit in gastric antral vascular ectasia syndrome refractory to endoscopic treatment

Gastric antral vascular ectasia (GAVE) syndrome represents a rare cause of gastrointestinal bleeding. More extensive small-bowel involvement must be excluded in those patients with GAVE syndrome in whom aggressive endoscopic treatment of antral lesions results in lack of control of digestive bleeding, and for this subset of patients videocapsule endoscopy examination should be considered. However, since the dim angioectatic lesions, even if located in the gastric antrum, might be difficult to accurately outline with standard endoscopy, virtual chromoendoscopy techniques have been employed to aid in their detection, and the presented case illustrates how Fujinon intelligent color-enhancement (FICE) technology implemented in videocapsule endoscopy clearly emphasizes the vascular morphology and delineation of antral angioectasias, allowing better targeted endoscopic treatment and improving patient outcome.     

Gastroscopic screening in 80 patients with pernicious anaemia.

We have studied 80 patients with pernicious anaemia. Upper gastrointestinal endoscopy (with biopsy and cytology) showed no lesion other than atrophic gastritis in 34 patients. Thirty three patients, however, had varying degrees of gastric mucosal dysplasia, which was detected more frequently by histology than by cytology. The endoscopic appearance of the mucosa was abnormal in four of the six patients with moderate dysplasia, and in all three patients with severe dysplasia. One patient was found to have a small carcinoma in the gastric antrum, and underwent total gastrectomy; 18 patients had polyps (often multiple); four of these were treated by endoscopic polypectomy. One of the patients with polyps had multiple carcinoid tumours, and an asymptomatic parathyroid adenoma. Seventeen of the patients also underwent barium meal examination; abnormalities were revealed in only three of the seven patients with lesions visible at endoscopy. Our results justify further endoscopic studies in patients with pernicious anaemia, and sequential examinations to establish the natural history of gastric dysplasia.     

Gastric mucosal hexosamine content in various liver diseases.

Since gastric mucosal lesions are frequently encountered in patients with liver disease, we measured the levels of gastric mucosal hexosamine. In chronic hepatitis patients, hexosamine levels were reduced in both the antrum and corpus as compared with those in normal controls, while values in the advanced liver cirrhosis group (total bilirubin greater than 5 mg/dl) were lower than in the less advanced group. Although the presence or absence of esophageal varices had no influence on hexosamine, higher concentrations were found in patients with the red color sign (+) in comparison with those with negative red color sign (-). One month after endoscopic injection sclerotherapy of esophageal varices, hexosamine did not change, but decreases were seen in both the antrum and corpus at 3 months. We observed an increase in gastric mucosal blood flow after treatment with teprenone, a new antiulcerative agent, in normal controls. Gastric mucosal hexosamine increased significantly after teprenone treatment in both chronic hepatitis and liver cirrhosis groups. From these results, we conclude that hexosamine has a defensive action against gastric lesions in various liver diseases.