Gastritis （胃炎）

Department of Gastroenterology, the 1st

Affiliated Hospital of Zhengzhou University
CHEN Xiangyu
郑州大学一附院消化科 陈香宇
 Gastritis

Acute Gastritis
Gastritis is
an inflammation of
the lining of the stomach

Chronic Gastritis
 Acute Gastritis

Definition 定义

Type 分类

Etiology 病因

Clinical manifestation 临床表现

Diagnose 诊断

Treatment 治疗
Acute Gastritis

Definition 定义
This involves an
acute inflammatory
reaction at the superficial
mucosa, with the
infiltration of neutrophils.

Type ？ 分型 ？
 Type 分型

Acute simple gastritis 急性单纯性胃炎

Acute erosive/hemorrhagic 急性糜烂 / 出血性

gastritis 胃炎

Acute corrosive gastritis 急性腐蚀性胃炎

Acute phlegmonous gastritis 急性化脓性胃炎

 Acute Gastritis

Definition 定义

Type 分类

Etiology ？ 病因 ？
Clinical manifestation 临床表现

Diagnose 诊断

Treatment 治疗
 Etiology 1 （病因 1 ）

acute infection and pathogen’s toxin

急性感染及病原体毒素

bacteria Viruses parasites toxin

细菌 病毒 寄生虫 毒素

Acute phlegmonous
gastritis Acute simple gastritis
急性单纯性胃炎
急性化脓性胃炎

Special type (rare) Common type

特殊类型（少见） 常见类型
Etiology 2—physicochemical factor
病因 2— 理化因素

COX PGE
Nonsteroidal
anti-inflammatory
drugs （ NSAID） Destroy epithelium
非甾类抗炎药 直接破坏上皮

Alcohol Irritate mucosa

刺激黏膜
乙醇

anticancer drugs inhibit

抗癌药 epithelium regeneration
抑制上皮再生
 COX PGE

Destroy epithelium
直接破坏上皮 Acute
erosive/hemorrhagic
Irritate mucosa gastritis
刺激黏膜 急性糜烂出血性胃炎

inhibit
epithelium regeneration
抑制上皮再生
 Etiology 2—physicochemical factor
病因 2— 理化因素

reflux of bile
or enzymes of pancreas reflux gastritis
反流性胃炎
胆汁胰液反流
 Etiology 3 -- Stress
病因 3 — 应 激
severe injury 严重创伤
severe infections 严重感染 Mucosa ischemia and
major surgery 大手术 oxygen lack
黏膜缺血缺氧
fire burn 烧伤
（ Curling ulcer)
cerebral accident 脑血管意外
H +
inverse diffusion
(Cushing ulcer) H+ 逆弥散

Shock 休克
Severe organ failure 严重脏器
功能衰竭
Mucosa ischemia and Acute
oxygen lack erosive/hemorrhagic
黏膜缺血缺氧 gastritis
急性糜烂出血性胃炎

H+ inverse diffusion
H+ 逆弥散
Stress ulcer
应激性溃疡
Clinical manifestations 临床表现

Acute simple gastritis 急性单纯性胃炎

Acute erosive/hemorrhagic 急性糜烂出血性胃炎

gastritis
Acute simple gastritis 急性单纯性胃炎

1 infection is the main 1 感染多见，起病 急，

cause, it often occurs 病程常为自限
urgently, course of 性
disease is self-limited

2 pain -- acute upper 2 痛 -- 急性上腹痛、

abdominal pain, 压痛

tenderness
 Acute simple gastritis 急性单纯性胃炎

3 吐 -- 恶心、呕吐
3 nausea 、 vomiting

4 diarrhea 4 泻

5 severe cases may appear 5 严重者发热、脱

fever, shock or acidosis 水、 休克、酸中
毒
Acute simple gastritis
should be differentiated 急性单纯性胃炎应
from these diseases 注意与下列疾病鉴别

peptic ulcer 消化性溃疡

Acute pancreatitis 急性胰腺炎
Acute appendicitis 急性阑尾炎
Acute myocardial 急性心肌梗死
infarction
Clinical manifestations 临床表现

Acute simple gastritis 急性单纯性胃炎

Acute erosive/hemorrhagic 急性糜烂出血性胃炎

gastritis
Acute 急性糜烂出血性胃炎
erosive/hemorrhagic 是急性上消化道出血
gastritis is the common
的常见原因（占 10%-
cause of acute upper
gastrointestinal 30% ），仅次于溃疡病
bleeding （ 10%~30
%）

Main manifestations 主要表现为呕血

are vomiting blood, 黑便
dark stools
 Characteristic of 急性糜烂出血性胃炎
Acute erosive/ 出血的特点
hemorrhagic gastritis

volume of bleeding generally 出血量一般不大

is small （ in a few cases, it （少数量大甚至休克）
may be very large ）

intermittent bleeding--- 间歇性发作

because erosion may appear in -- 糜烂病灶可分批出现
batch

Self-limited---erosion can heal 可为自限性

after 24~48h --24-48h 糜烂病灶可愈合
 Diagnose--- 诊 断

clinical manifestation
临床表现

Primary disease + emergency

endoscope examination
基础疾病
急诊胃镜
Oral drug history
服药史
 emergency endoscope 急诊胃镜：
examination ：

means endoscope examination 出血发生后 24-48h 之内

be carried out in 24~48h after 进行的胃镜检查
bleeding.

This test profit early diagnosis 有利于早期诊断和内

and treatment 镜下治疗
 appearance under
内镜下表现：
endoscope ：

Gastric mucosa is
胃黏膜充血、水肿、
congestive, hydropic,
erosive, hemorrhagic 糜烂、出血、

and full of multiple 多发性浅表溃疡

superficial ulcer
 Bleeding -- 出
Erosion -- 糜烂 血
multiple bleeding focus
胃黏膜多发性出血灶
Acute erosive gastritis ： take Peracetic Acid wrongly
急性腐蚀性胃炎：误服过氧乙酸
 Treatment 治 疗
Acute simple gastritis 急性单纯性胃炎

1 remove motivation 应祛除诱因

2 Stop vomiting, relieve pain 止吐、 止痛

3 Antibiotics should be used if 细菌感染者应用

there exist bacterial infection 抗生素

4 Correct disturbance of acid- 纠正电解质和酸碱

base balance, electrolyte and 平衡紊乱
water
 Treatment 治 疗
Acute erosive/
急性糜烂出血性胃炎
hemorrhagic gastritis
Inhibit gastric acid 抑制胃酸分泌：
secretion ： PPI 、 H2RA
PPI 、 H2RA

protective agent for 胃粘膜保护剂：

gastric mucosa ： 硫糖铝
Ulcerlmin, Algeldrate 氢氧化铝凝胶
PPI: proton pump inhibitor
H2RA: H2 receptor antagonist
 Treatment 治 疗
Acute erosive/
急性糜烂出血性胃炎
hemorrhagic gastritis

stop bleeding with 胃镜下止血

endoscope

actively treat primary 积极治疗原发病

disease
 Gastritis

Acute Gastritis
Gastritis is
an inflammation of
the lining of the stomach

Chronic Gastritis
 Chronic gastritis 慢性胃炎
Definition 定义
Epidemiology 流行病学
Classification of Chronic gastritis 分类
Etiology and Pathogenesis 病因和发病机理
Pathology 病 理
clinical manifestation 临床表现
Laboratory examination 实验室和其他检查
and other findings
Diagnosis 诊断
Treatment 治疗
Chronic gastritis 慢性胃炎

Definition: 定义

Chronic inflammatory 胃粘膜的

changes in the gastric 慢性炎症性病变
mucosa
 Chronic gastritis 慢性胃炎
Definition 定义
Epidemiology 流行病学
Classification of Chronic gastritis 分类
Etiology and Pathogenesis 病因和发病机理
Pathology 病 理
clinical manifestation 临床表现
Laboratory examination 实验室和其他检查
and other findings
Diagnosis 诊断
Treatment 治疗
 Epidemiology 流行病学

Helicobacter pylori
（ Hp ） infection 幽门螺杆菌感染是
is the main cause of chronic 慢性胃炎的主要病
gastritis （ 80~95% ） 因（ 80-95% ）。

Infection rate of Hp in 人群中的 Hp 感染

population roughly be 率大致相当于慢性
equivalent to the sickness 胃炎的患病率。
rate of chronic gastritis
infection rate of Hp in 人群中的 Hp 感染
population is 40~70% 率为 40%-70%

In China, infection rate of 中国人群中 Hp 感

Hp is high, and acquire Hp 染率较高，获得感
infection at a young age 染时的年龄较轻
 Chronic gastritis 慢性胃炎
Definition 定义
Epidemiology 流行病学
Classification of chronic gastritis 分类
Etiology and Pathogenesis 病因和发病机理
Pathology 病 理
clinical manifestation 临床表现
Laboratory examination 实验室和其他检查
and other findings
Diagnosis 诊断
Treatment 治疗
 Classification of Chronic gastritis: New Sydney system
慢性胃炎的分类：新悉尼系统

non-atrophic
非萎缩性
Multi-focus atrophic
多灶萎缩性
Chronic gastritis Atrophic
慢 性 胃 炎 萎缩性
Autoimmunity
自身免疫性
Specific forms
特殊类型
 Specific forms 特殊类型

Infections gastritis 感染性

— Viral, Fungal, Tuberculosis — 病毒、真菌、結
核
radioaction-induced gastritis 放射性
— radiographic inspection — 射线损伤
 Specific forms 特殊类型

Lymphocytic 淋巴细胞性
gastritis
— gastritis verrucosa

Non- infection 非感染性

gastritis
— Crohn’s disease
 Chronic gastritis 慢性胃炎
Definition 定义
Epidemiology 流行病学
Classification of Chronic gastritis 分类
Etiology and Pathogenesis 病因和发病机理
Pathology 病 理
clinical manifestation 临床表现
Laboratory examination 实验室和其他检查
and other findings
Diagnosis 诊断
Treatment 治疗
 Etiology
病因和发病机理
and Pathogenesis

 Hp infection 幽门螺杆菌感染

 Autoimmunity and 自身免疫和遗传因素

Genetic factor

 Other factors 其他因素

Helicobacter pylori, Hp 幽门螺杆菌

In 1893, 早在 1893 年
some scholars reported that 就有学者报道在狗的
a helical organism was found 胃腺内观察到一种螺
旋状微生物
in dog’s stomach gland
 1983 年
由澳大利亚学者
In 1983,
Australia’s scholars Warren Warren
and Marshall began 和 Marshall 首先开始
to investigate Hp ， and
对
found there was a
closely relationship Hp 进行系统研究，并阐
between Hp and chronic 明 Hp 与慢性胃炎和溃
gastritis, peptic ulcer.
疡
Because of their
contribution, they won the 病有密切关系。他们因
Nobel prize of 2005 此获得了 2005 年度诺
The finding of Hp is a
milestone of medical HP 的发现是 20 世纪

research in 20th 医学研究，特别是胃

century, especially of 肠道疾病研究的一个
the gastrointestinal 里程碑！
disease research ！
Four arguments approve 幽门螺杆菌符合
that chronic gastritis 病原体的 Koch 四原
is due to Hp 则

1 Hp is present in almost 1 病原体几乎存在

all patients . 于所有患者中

2 感染被清除后胃
2 The gastritis resolves 炎消失
once the infection is cured
3 Gastritis has been induced 3 口服 Hp 可导致慢
in a few subjects by self- 性胃炎
administration of Hp

4 Hp 和慢性胃炎的流
4 The epidemiologic and
行病学、地理分布特
geographic patterns for the 征是一致的
occurrence of Hp and
gastritis are identical
Mechanism of Hp infection Hp 感染引起慢性胃炎的
cause chronic gastritis 机制

1 Hp 1 幽门螺杆菌

2 Autoimmunity 2 自身免疫和
and Genetic factor 遗传因素

3 Other factors 3 其他因素

Mechanism of Hp infection Hp 感染引起慢性胃炎的
cause Chronic gastritis 机制

1 Hp toxins directly 1 Hp 毒素直接损伤胃黏

injure gastric mucosa 膜上皮细胞

2 Hp induce endothelial
2 Hp 诱导胃黏膜上皮细
cells to release 胞释放促炎性细胞因
proinflammatory 子
cytokines
Mechanism of Hp infection Hp 感染引起慢性胃炎的
cause Chronic gastritis 机制

3 Immune reaction 3 Hp 诱发的免疫

induced by Hp can’t clean 反应不能有效清除
up Hp effectively ， Hp ，使感染慢性化
which make the infection
become chronic
4 Hp’s virulence 4 Hp 的毒力
factors 因子

 field setting and

 定植与粘附作用
adhesive attraction
 Vacuole toxin protein  空泡毒素蛋白：
： vacuolar
degeneration of cells 细胞空泡变性

 cytotoxin-associated  细胞毒素相关基因蛋
gene protein ：
inflammatory reaction 白：炎症反应
 Hp 的毒力因
Hp’s virulence factor 子

 Mucus enzyme ： dissolve  粘液酶：溶解粘液

mucus
 cell wall of Hp ： induce  菌体胞壁：作为抗原产
immune reaction
生免疫反
应
 Lipopolysaccharide (LPS)
： ruin the gastric
 脂多糖：破坏胃粘膜
mucosal barrier
屏障
 Persistent Hp infection result  长期 Hp 感染引起
in atrophy of gastric mucosa
胃
and intestinal
metaplasia ， The latter have a 黏膜萎缩和肠上皮化，
closely relationship with 后者与胃癌的发生有密
gastric cancer
切关系
Mechanism of autoimmunity 自身免疫、遗传因素引
and genetic factor cause 起慢性胃炎的机制
Chronic gastritis

1 Hp 1 幽门螺杆菌

2 Autoimmunity 2 自身免疫和
and Genetic factor 遗传因素

3 Other factors 3 其他因素

 Autoimmunity and 自身免疫和
Genetic factor 遗传因素

atrophy dominantly 胃体萎缩为主的

in body of stomach 慢性胃炎

Autoimmunity
gastritis 自身免疫性胃炎
 Autoantibody--- 自身抗体

parietal cell antibody intrinsic factor antibody

（ PCA ） （ IFA ）
壁细胞抗体 内因子抗体

destroy
proton pump of parietal malabsorption of Vit-B12
Vit- B12 吸收障碍
cell 壁细胞质子泵破坏

Acid secretion decrease Addison’s anemia

泌酸减少或缺如 恶性贫血
Mechanism of other factors 其他因素引起慢性胃炎
cause chronic gastritis 的机制

1 Hp 1 幽门螺杆菌

2 Autoimmunity 2 自身免疫和
and Genetic factor 遗传因素

3 Other factors 3 其他因素

1 reflux of duodenal juice ： 1 十二指肠液反流：
bile, pancreatic fluid 胆汁、胰液反流入胃
reflow into stomach

2 damage factor to gastric 2 胃黏膜损伤因子：

mucosa: irritative food,
刺激性食物、乙醇、
alcohol, drugs
药物
 Chronic gastritis 慢性胃炎
Definition 定义
Epidemiology 流行病学
Classification of Chronic gastritis 分类
Etiology and Pathogenesis 病因和发病机理
Pathology 病 理
clinical manifestation 临床表现
Laboratory examination 实验室和其他检查
and other findings
Diagnosis 诊断
Treatment 治疗
 Pathology 病 理

1 Inflammation: 胃粘膜损伤与修复过程，
infiltration of lymphocyte 主要特点：
and plasma cell in lamina
1. 炎症 : 粘膜固有层
propria
中以淋巴细胞和浆细胞
2 atrophy: 为主的炎症细胞浸润
amount of gland in lamina 2. 萎缩 : 指固有层腺
propria decrease ， mucosa
体的数量减少，粘膜变
become thin
薄
 Pathology 病 理

3 metaplasia ：
3. 化生：
intestinal gland metaplasia, 肠腺化生、幽门腺化生、
pyloric gland metaplasia , 不典型增生
atypical hyperplasia
 Chronic gastritis 慢性胃炎
Definition 定义
Epidemiology 流行病学
Classification of Chronic gastritis 分类
Etiology and Pathogenesis 病因和发病机理
Pathology 病 理
clinical manifestation 临床表现
Laboratory examination 实验室和其他检查
and other findings
Diagnosis 诊断
Treatment 治疗
 clinical
临床表现
manifestation

Most patients have no 大部分患者无症状

symptoms
 clinical
临床表现
manifestation
Some present non-specific 有些表现为非特异性的
dyspepsia, include: 消化不良症状：
abdominal distention , 上腹饱胀、隐痛、
vague pain, belching, 嗳气、反酸、烧灼
water brash, heartburn, 感、食欲不振、恶心
poor appetite, nausea and 呕吐、厌食、消瘦、
vomiting, loss of appetite, 贫血等
become thin, anemia.
 clinical
临床表现
manifestation

Usually there is not obvious 无明显体征

sign for patients
 Chronic gastritis 慢性胃炎
Definition 定义
Epidemiology 流行病学
Classification of Chronic gastritis 分类
Etiology and Pathogenesis 病因和发病机理
Pathology 病 理
clinical manifestation 临床表现
Laboratory examination 实验室和其他检查
and other findings
Diagnosis 诊断
Treatment 治疗
 Laboratory
examination and other 实验室和其他检查
findings

 Endoscopy and biopsy  胃镜及活组织检查

 detect Hp  HP 检测
 X-ray examination  X 线检查
 gastric analysis  胃液分析
 serologic examination  血清学检查
 Vit-B12 absorption test  维生素 B12 吸收试验
 Sydney classification of
胃镜诊断的悉尼分类
endoscope diagnosis

 Congestive/exudative gastritis  充血渗出性胃炎

 Flat erosive gastritis

 Raised erosive gastritis  平坦糜烂性胃炎

 Atrophic gastritis  隆起糜烂性胃炎

 Hemorrhagic gastritis

 Reflux gastritis  萎缩性胃炎

 出血性胃炎
Endoscope 胃镜 检查
examination
 superficial gastritis 浅表性胃炎

Congestion, edema, exfiltration, 粘膜充血、水肿、

red alternating with white 渗出、红白相间（花斑
(piebald). Sometimes, there is 样、麻疹样）以红为主
bleeding of superficial erosion. 可有浅表 糜烂出血
 atrophic gastritis 萎缩性胃炎
The mucosa shows signs of 粘膜薄、白、血管网显露
inflammation, at the same time 皱壁细、平、消失
the mucosal layer is thinner 红白相间，以白为主，
and appears to be more 外观颗粒状小结节
transparent.
 Hemorrhagic gastritis

This is the condition where there are pinpoint

hemorrhages on the surface lining of the
stomach.
 Exudative gastritis

In this form of gastric inflammation, the mucosal

defects are covered with mucus and fibrin.
 Raised erosive gastritis

there are areas of polypoid, but also erosive

changes of the gastric mucosa
 Flat erosive gastritis

 erosive gastritis are mucosal lesions , which do not

penetrate the muscular layer of the mucosa.
 The erosions, sometimes - like in this photo -
covered with hematin.
 Bile reflux gastritis

 Gastritis secondary to reflux of bile acids. In this

form of gastritis, a reflux of bile through the pylorus
is evident and causes inflammatory changes of the
gastric mucosa.
Hp detecting Hp 检测
 Hp detecting Hp 检测

Invasive test: 侵入性试验：

快速尿素酶实验
Rapid urease testing
Staining test under microscope 粘膜涂片染色镜检
Histology test 组织学检查

Culture
微需氧培养
Polymerase chain reaction 聚合酶链反应
Non-invasive test: 非侵入性试验：

13
C or 14C urea breath test C 或
13
C 尿素呼气试
14

Detecting of Hp’s antibody/

antigen HP 抗体 / 抗原检测
 Chronic gastritis 慢性胃炎
Definition 定义
Epidemiology 流行病学
Classification of Chronic gastritis 分类
Etiology and Pathogenesis 病因和发病机理
Pathology 病 理
clinical manifestation 临床表现
Laboratory examination 实验室和其他检查
and other findings
Diagnosis 诊断
Treatment 治疗
 Diagnosis 诊 断

Endoscopy 胃镜检查

Mucosa biopsy 粘膜活检

 Chronic gastritis 慢性胃炎
Definition 定义
Epidemiology 流行病学
Classification of Chronic gastritis 分类
Etiology and Pathogenesis 病因和发病机理
Pathology 病 理
clinical manifestation 临床表现
Laboratory examination 实验室和其他检查
and other findings
Diagnosis 诊断
Treatment 治疗
 Treatment 治疗
1 Life-style modifications ： 1 一般治疗：

avoid coarse, irritating or 避免粗糙、刺激、

overheating diet 过热等饮食

避免损害胃粘膜的
avoid taking drugs that
damage gastric mucosa 药物

戒烟、酒
Tobacco and alcohol
consumption should be avoided
 Treatment 治 疗

2 Drugs for inhibit acid secretion 2 抑酸药物

3 Protective agent for mucosa 3 粘膜保护剂

4 Prokinetic Agents 4 促胃动力药

5 Eradicating Hp 5 根除 Hp 治
疗
 5 Eradicating Hp 5 、根除 Hp 治疗
Indication: 适应症：
 Hp associated gastritis  Hp 相关性胃炎伴
accompanied with
明显异常
mucosa erosion
胃黏膜糜烂
moderate to severe atrophy
中 - 重度萎缩
moderate to severe intestinal
metaplasia 中 - 重度肠化
atypical hyperplasia 不典型增生

 Have gastric cancer family history  有胃癌家族史者

 Treatment plan for 治疗方案
eradicating Hp

Bismuth + 2 antibiotics 铋剂 + 两种抗生素

proton pump inhibitor (PPI) 质子泵抑制剂 (PPI)

+ 2 antibiotics + 两种抗生素

1 Bismuth + Amoxicillin 500mg 1 铋剂 + 阿莫西林 50

0mg
Arilin 400mg
甲硝唑
bid, 2w 400mg,
bid, 2w
2 Bismuth + Tetracycline 500mg 2 . 铋剂 + 四环素
Arilin 400mg 500mg
bid, 2w 甲硝唑
400mg,
3 Bismuth+Clarithromycin 250mg
bid, 2w
Arilin 400mg
bid, 1w
3. 铋剂 + 克拉霉素
250mg
甲硝唑
400mg,
bid, 1w
proton pump inhibitor (PPI) 质子泵抑制剂 (PPI)
+ 2 antibiotics + 两种抗生素

1. PPI+ 克拉霉素 500mg

1. PPI + Clarithromycin 500mg
阿莫西林 1000mg
Amoxicillin 1000mg
bid, 1w
bid, 1w
2. PPI + Amoxicillin 1000mg 2. PPI+ 阿莫西林 1000mg
甲硝唑 400mg
arilin 400mg
bid, 1w
bid, 1w
3. PPI + Clarithromycin 250mg 3. PPI+ 克拉霉素 250mg
甲硝唑 400mg
arilin 400mg
bid, 1w
bid, 1w
 Autoimmunity 自身免疫性胃炎
gastritis

Without radical cure method 无特殊治疗

-- 恶性贫血可注射
Addison's anemia can inject 维生素 B12
vit-B12
肠化及不典型增生
Intestinal metaplasia and
Atypical hyperplasia -- 维生素 C 、 E 、
— vit-C, vit-E, 叶酸、锌、硒、
folacin, et al 胡罗卜素
Thank
you!