Weiss A A, Yoshida E M, Poulin M, Gascoyne R D, Owen D A
Department of Medicine and Pathology, Vancouver Hospital and Health Sciences Centre, British Columbia Cancer Agency, Vancouver, B.C., Canada.
J Clin Gastroenterol. 1997 Jul;25(1):354-7. doi: 10.1097/00004836-199707000-00013.
Uncontrolled hemorrhage and multisystem organ failure developed in a patient with celiac sprue, lymphocytic gastritis, and diffuse gastric ulceration. A proximal small bowel biopsy showed villous atrophy and lymphoplasmacytic infiltration consistent with celiac sprue. At autopsy, there were no gross or histologic findings to suggest lymphoma. The intestinal lymphocytic infiltrate was not monoclonal, and gene rearrangements were not detected. Lymphocytic gastritis is a rare cause of upper gastrointestinal hemorrhage, which may be the result of sensitivity to gluten or other luminal antigens. This diagnosis should be considered in cases of diffuse gastric ulceration with bleeding in which the endoscopic appearances are not typical of peptic ulcer disease or drug-induced erosions. Ideally, biopsies of gastric and duodenal mucosa should be performed to establish the diagnosis.
一名患有乳糜泻、淋巴细胞性胃炎和弥漫性胃溃疡的患者出现了无法控制的出血和多系统器官衰竭。近端小肠活检显示绒毛萎缩和淋巴细胞浆细胞浸润，符合乳糜泻表现。尸检时，没有肉眼或组织学发现提示淋巴瘤。肠道淋巴细胞浸润不是单克隆性的，也未检测到基因重排。淋巴细胞性胃炎是上消化道出血的罕见原因，可能是对麸质或其他腔内抗原敏感的结果。对于伴有出血的弥漫性胃溃疡，若内镜表现不符合消化性溃疡病或药物性糜烂的典型特征，则应考虑这一诊断。理想情况下，应进行胃和十二指肠黏膜活检以明确诊断。
