Rappel S, Müller H, Stolte M
Institut für Pathologie, Klinikum Bayreuth, 95445 Bayreuth.
Pathologe. 2001 Jan;22(1):19-24. doi: 10.1007/s002920000442.
Helicobacter pylori infection sometimes leads to an antigastric autoimmunity that ultimately develops into complete atrophy of the glands of the gastric mucosal glands. It has been found that the "classical" parietal cell antibody positive and H. pylori induced autoimmune gastritis share common aspects of histomorphology, stages, and pathomechanisms. Healing of H. pylori associated active preatrophic autoimmune gastritis by eradication treatment has been confirmed both in case reports and in prospective and retrospective studies. This leads to a general practice-oriented four-step concept for diagnosis and treatment in daily routine: (a) Histological work-up on the basis of: lymphocytic infiltration of the glands of the corpus and fundic mucosa, focal destruction in individual corpus glands, reactive hypertrophy of the parietal cells, and search for H. pylori. (b) Additional serological work-up if histological evidence of H. pylori is lacking: determination of H. pylori and parietal cell antibodies in the serum. (c) Initiation of an established H. pylori eradication therapy if histology and/or serology is positive for H. pylori. (d) Histological and serological follow-up for 9-12 months to monitor the results of treatment.
幽门螺杆菌感染有时会引发抗胃自身免疫，最终发展为胃黏膜腺体的完全萎缩。研究发现，“经典”壁细胞抗体阳性与幽门螺杆菌诱导的自身免疫性胃炎在组织形态学、阶段和发病机制方面有共同之处。病例报告以及前瞻性和回顾性研究均证实，根除治疗可治愈幽门螺杆菌相关的活动性萎缩前期自身免疫性胃炎。这就形成了日常诊疗中以实践为导向的四步诊断和治疗理念：（a）基于以下方面进行组织学检查：胃体和胃底黏膜腺体的淋巴细胞浸润、个别胃体腺的局灶性破坏、壁细胞的反应性肥大以及查找幽门螺杆菌。（b）若缺乏幽门螺杆菌的组织学证据，则进行额外的血清学检查：测定血清中的幽门螺杆菌和壁细胞抗体。（c）若组织学和/或血清学检测显示幽门螺杆菌呈阳性，则启动既定的幽门螺杆菌根除治疗。（d）进行9至12个月的组织学和血清学随访，以监测治疗效果。
