Genta R M
Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA.
Aliment Pharmacol Ther. 1998 Feb;12 Suppl 1:17-23. doi: 10.1111/j.1365-2036.1998.00003.x.
Epidemiological and biological evidence indicates that atrophic gastritis represents an important risk factor for gastric adenocarcinoma of the intestinal type. To estimate an individual subject's risk of gastric cancer, pathologists should be able to diagnose correctly and reliably assess gastric atrophy. However, both anecdotal evidence and recent studies suggest that pathologists have a low level of agreement on gastric atrophy. Moreover, the terms 'gastric atrophy' and 'atrophic gastritis' remain imprecisely defined, further adding confusion to the histopathological imprecision. The use of visual analogue scales proposed in the recently updated Sydney System for the classification and grading of gastritis may eventually help pathologists achieve a greater degree of interobserver agreement on the histopathological features of gastritis. However, this cannot be achieved in the absence of a stringent and widely accepted definition of atrophy. The purpose of this article is to review briefly the possible pathogenetic pathways leading to the development of atrophic changes in the gastric mucosa, explore the issue of its reversibility, and propose a working definition that could contribute to improved diagnostic reproducibility.
流行病学和生物学证据表明，萎缩性胃炎是肠型胃腺癌的一个重要危险因素。为了评估个体患胃癌的风险，病理学家应能够正确诊断并可靠地评估胃萎缩情况。然而，轶事证据和近期研究均表明，病理学家对胃萎缩的诊断一致性较低。此外，“胃萎缩”和“萎缩性胃炎”这两个术语的定义仍不精确，这进一步加剧了组织病理学诊断的不准确性。最近更新的悉尼胃炎分类和分级系统中提出的视觉模拟量表的使用，最终可能有助于病理学家在胃炎的组织病理学特征上达成更高程度的观察者间一致性。然而，在缺乏严格且被广泛接受的萎缩定义的情况下，这一目标无法实现。本文的目的是简要回顾导致胃黏膜萎缩性改变的可能发病机制，探讨其可逆性问题，并提出一个有助于提高诊断可重复性的实用定义。
