Genta R M
Department of Pathology, Veterans Affairs Medical Center, Houston, TX 77030, USA.
Am J Surg Pathol. 1996;20 Suppl 1:S23-30. doi: 10.1097/00000478-199600001-00004.
The Sydney System is a novel classification of gastritis that attempts to incorporate etiologic, topographic, and morphologic criteria into a clinically relevant scheme. In September of 1994, a group of 20 gastric pathologists from various parts of the world gathered in Houston, Texas, U.S.A., to reappraise the Sydney System 4 years after its introduction and to attempt to reach a broad consensus on gastritis. One of the most controversial issues at the Houston Workshop was the concept of atrophy. Several factors converge to foment confusion and disagreement. "Normal" is imprecisely defined; the loss of glands occurs with distinct patterns and has different functional significance in antrum and corpus; inflammatory infiltrate and lymphoid follicles in the lamina propria may alter the architecture of the gastric mucosa, particularly in the antrum, making loss especially arduous to discern from mere displacement; the relationship between atrophy and intestinal metaplasia remains incompletely understood; and finally, and perhaps most important, the topographic patterns of distribution and the genesis and evolution of atrophic gastritis have been among the most divisive predicaments in the tumultuous arena of gastritis. This article explores some of the difficulties surrounding the concept of atrophy, summarizes the resolutions made at the Houston Workshop, and presents a novel approach to the histopathologic evaluation of atrophic gastritis.
悉尼系统是一种新型的胃炎分类方法，它试图将病因、部位和形态学标准纳入一个具有临床相关性的方案中。1994年9月，来自世界各地的20位胃病理学家齐聚美国得克萨斯州休斯敦，在悉尼系统推出4年后对其进行重新评估，并试图就胃炎问题达成广泛共识。休斯敦研讨会上最具争议的问题之一是萎缩的概念。有几个因素导致了混淆和分歧。“正常”的定义不精确；腺体丧失呈现出不同的模式，在胃窦和胃体具有不同的功能意义；固有层中的炎性浸润和淋巴滤泡可能会改变胃黏膜的结构，尤其是在胃窦，这使得从单纯的移位中辨别萎缩变得尤为困难；萎缩与肠化生之间的关系仍未完全明了；最后，或许也是最重要的一点，萎缩性胃炎的分布部位模式以及发生和演变一直是胃炎这一纷繁领域中最具分歧性的难题。本文探讨了围绕萎缩概念的一些难点，总结了休斯敦研讨会做出的决议，并提出了一种评估萎缩性胃炎组织病理学的新方法。
