Schaub N, Wegmann W
Medizinische Klinik, Kantonsspital Bruderholz.
Schweiz Med Wochenschr. 1990 Sep 22;120(38):1369-84.
Based on clinical and histopathological features, three different types of chronic gastritis can be distinguished: gastritis A is confined to the proximal stomach and is the result of an autoimmunological process with antibodies against parietal cells and intrinsic factor. It is a rare disorder and may lead to pernicious anaemia. Distal, antral gastritis B is caused by an infection of the gastric mucosa with Helicobacter pylori (HP). Its incidence increases with age (greater than 50% above age 50). Gastritis C may be caused by drugs and alcohol but is mainly found in gastric remnants after partial resection as a consequence of biliary reflux. Gastritis A rarely causes symptoms. A relationship between gastritis B and C and non-ulcer dyspepsia (NUD) is highly controversial. Gastritis B is very closely associated with peptic ulcer disease. HP-positive antral gastritis seems to be the prerequisite for ulcer formation. All 3 types of gastritis carry an increased risk of malignancy, which seems to be positively correlated with hypoacidity, the chronicity of the inflammation and the histopathological feature of intestinal metaplasia. Noninvasive diagnostic tests (serology, breath tests, scintigraphy) are available, but the diagnosis of gastritis is still mainly based on endoscopy and biopsy. Treatment of gastritis A is not possible. Gastritis B can be healed by eradication of HP using bismuth salts and antibiotics but only combinations of 2-3 compounds seem to afford long-term positive results. Further clinical trials are needed to determine whether such treatment is justified in patients with gastritis and NUD. In patients with chronic recurrent peptic ulcers eradication of HP prevents relapses and heals ulcer disease. Gastritis C complicated by severe symptoms or ulcer can only be successfully treated by a biliary diversion, i.e. Roux-Y-gastrojejunostomy. The discovery that gastritis B is caused by HP improves our understanding of peptic ulcer disease and will change therapeutic concepts.
根据临床和组织病理学特征，可区分出三种不同类型的慢性胃炎：A型胃炎局限于胃近端，是一种自身免疫过程的结果，会产生抗壁细胞和内因子的抗体。这是一种罕见的疾病，可能导致恶性贫血。远端胃窦B型胃炎是由幽门螺杆菌（HP）感染胃黏膜引起的。其发病率随年龄增长而增加（50岁以上人群中发病率超过50%）。C型胃炎可能由药物和酒精引起，但主要见于部分切除术后的胃残余部分，是胆汁反流的结果。A型胃炎很少引起症状。B型和C型胃炎与非溃疡性消化不良（NUD）之间的关系极具争议。B型胃炎与消化性溃疡病密切相关。HP阳性的胃窦胃炎似乎是溃疡形成的前提条件。所有这三种类型的胃炎发生恶性肿瘤的风险均增加，这似乎与胃酸缺乏、炎症的慢性化以及肠化生的组织病理学特征呈正相关。有非侵入性诊断测试（血清学、呼气试验、闪烁扫描），但胃炎的诊断仍主要基于内镜检查和活检。A型胃炎无法治疗。B型胃炎可通过使用铋盐和抗生素根除HP来治愈，但只有2 - 3种化合物的组合似乎能带来长期的积极效果。需要进一步的临床试验来确定这种治疗方法对胃炎和NUD患者是否合理。对于慢性复发性消化性溃疡患者，根除HP可预防复发并治愈溃疡病。C型胃炎并发严重症状或溃疡时，只能通过胆汁改道手术，即Roux - Y式胃空肠吻合术成功治疗。B型胃炎由HP引起这一发现增进了我们对消化性溃疡病的理解，并将改变治疗观念。
