Vieth M, Stolte M
Institut für Pathologie, Klinikum Bayreuth, Preuschwitzer Strasse 101, 95 445 Bayreuth, Germany.
Internist (Berl). 2006 Jun;47(6):578, 580-7. doi: 10.1007/s00108-006-1618-7.
Since the rediscovery of spiral-shaped gastric bacteria in 1983 by Warren and Marshal numerous detailed facts have enlarged our knowledge base for a better understanding of gastritis. The WHO classified Helicobacter as a class 1 carcinogen. Helicobacter plays a role in many diseases of the upper GI tract (gastric and duodenal ulcer, MALT lymphoma, and gastric cancer). Knowledge of the interaction between bacterium and host led to an improvement of the diagnosis of gastritis. Unfortunately endoscopy, histology, and patient's symptoms do not correlate with each other. Therefore, gastritis is a purely histological diagnosis. A histological diagnosis always needs to be accompanied by an etiological cause of the inflammation. Only when this information is given a clinical consequence can be drawn from a histological diagnosis. In Germany the so-called ABCD scheme of gastritis is widely used (A: autoimmune gastritis, B: bacterial gastritis, C: chemical reactive gastritis, D: other forms of gastritis). At least two antrum and two corpus biopsies (matrix diagnostics) are necessary to reach representative tissue with an acceptable probability. If less than these four (minimal standard) biopsies are taken, the histological diagnosis will remain uncertain.
自1983年沃伦和马歇尔重新发现螺旋形胃细菌以来，众多详细事实扩充了我们的知识库，以便更好地理解胃炎。世界卫生组织将幽门螺杆菌列为1类致癌物。幽门螺杆菌在许多上消化道疾病（胃溃疡、十二指肠溃疡、黏膜相关淋巴组织淋巴瘤和胃癌）中起作用。对细菌与宿主之间相互作用的了解促进了胃炎诊断的改进。不幸的是，内镜检查、组织学检查和患者症状之间并不相互关联。因此，胃炎是一种纯粹的组织学诊断。组织学诊断始终需要伴有炎症的病因。只有给出此信息，才能从组织学诊断得出临床结论。在德国，所谓的胃炎ABCD分类法被广泛使用（A：自身免疫性胃炎，B：细菌性胃炎，C：化学性反应性胃炎，D：其他形式的胃炎）。为了以可接受的概率获取具有代表性的组织，至少需要取两块胃窦和两块胃体活检组织（基质诊断）。如果活检组织少于这四块（最低标准），组织学诊断将仍不确定。
