Lee Sun-Young
Korean J Helicobacter Up Gastrointest Res. 2023 Jun;23(2):108-117. doi: 10.7704/kjhugr.2023.0015. Epub 2023 Jun 12.
The gastric cancer risk varies based on the etiology and severity of gastritis, which depends on a history of infection and the secretory capacity of the stomach. Type A gastritis is associated with reverse atrophy of the corpus and type B with progressive atrophy extending from the antrum to the corpus. Diffuse or spotty redness in the corpus together with high serum pepsinogen (PG) II levels and a low PG I/II ratio are observed in patients with infection when secretory capacity of the stomach is intact. Diffuse-type gastric cancer may develop near the gastric folds, which is a rare site of atrophy. Low serum PG I levels are associated with progressive gastric corpus atrophy and intestinal metaplasia in patients with chronic and previous infections. This clinical scenario predisposes patients to intestinal-type gastric cancer, which originates in the atrophic and metaplastic gastric mucosa. Conversely, a high PG I/II ratio is observed in patients without infection. Serum PG I levels and the PG I/II ratio are high in patients with acute -negative gastritis, including drug-induced gastritis but are significantly low in autoimmune gastritis. Gastric neuroendocrine tumors may develop in patients with autoimmune gastritis or in those with long-term acid suppressant use. Fasting serum gastrin levels and the risk of neuroendocrine tumors are high in both cases. In this review, types of gastritis are summarized along with evaluation performed to determine the secretory capacity of the background gastric mucosa.
胃癌风险因胃炎的病因和严重程度而异，而胃炎的病因和严重程度取决于感染史和胃的分泌能力。A型胃炎与胃体部的逆向萎缩有关，B型胃炎则与从胃窦部延伸至胃体部的进行性萎缩有关。当胃的分泌能力完好时，感染患者会出现胃体部弥漫性或斑点状发红，同时血清胃蛋白酶原（PG）II水平升高，PG I/II比值降低。弥漫型胃癌可能在胃皱襞附近发生，这是一个罕见的萎缩部位。血清PG I水平低与慢性和既往感染患者的胃体部进行性萎缩及肠化生有关。这种临床情况使患者易患肠型胃癌，其起源于萎缩性和化生的胃黏膜。相反，未感染患者的PG I/II比值较高。急性幽门螺杆菌阴性胃炎患者（包括药物性胃炎）的血清PG I水平和PG I/II比值较高，但自身免疫性胃炎患者的该比值则显著降低。自身免疫性胃炎患者或长期使用抑酸剂的患者可能会发生胃神经内分泌肿瘤。在这两种情况下，空腹血清胃泌素水平和神经内分泌肿瘤的风险都很高。在本综述中，总结了胃炎的类型以及为确定背景胃黏膜分泌能力而进行的评估。
