From Sidney to OLGA: an overview of atrophic gastritis.
From Sidney to OLGA: an overview of atrophic gastritis.
复制标题
DOI：
10.23750/abm.v89i8-s.7946
复制
发表时间：
2018-12-17
期刊：
影响因子：
--
通讯作者：
Di Mario, Francesco
中科院分区：
文献类型：
--
作者：
Crafa, Pellegrino;Russo, Michele;Di Mario, Francesco
慢性胃炎是一种长期疾病，可导致适当胃腺的丧失。胃炎这个术语指的是经组织学证实的胃部炎症，有时伴有结构性粘膜变化。在世界范围内，幽门螺杆菌感染作为慢性活动性胃炎的主要病因效应因素发挥着举足轻重的作用。 H.p.是一种对胃粘膜具有选择性趋向性的细菌，能够在敌对环境中生存，以适应除自身以外的生物定植，能够制定生存策略并避免防御机制，引起炎症变化，从无症状的轻度胃炎到更严重的损伤，如消化性溃疡以及癌前病变和恶性肿瘤。胃炎的模式和分布与这些后遗症密切相关，慢性萎缩性胃炎伴肠化生现在被评估为癌前病变，具有向低度和高度上皮内病变演变的明确风险，正如科雷亚级联模型中所预期的那样。事实上，慢性胃炎的主要并发症仍然与胃癌密切相关，胃癌在生物学上与幽门螺杆菌感染有关，现在被称为 I 类致癌物。胃癌的发生是由环境因素以及细菌菌株、宿主反应和胃粘膜微生物群失调引起的。由于个体患者表现出不同的胃癌风险，因此必须识别有患胃癌风险的患者，以便有针对性地寻找肿瘤发展较快的病变，从而在早期阶段进行破坏性较小的治疗。 OLGA 分期系统是最可靠、最强大的系统，可以识别患胃癌风险较高的患者。
Chronic gastritis is a long-lasting disease that can lead to a loss of appropriate gastric glands. Gastritis, as term, apply to an inflammation of the stomach, histologically proven, sometimes with structural mucosal changes. Worldwide Helicobacter pylori's infection play a pivotal role as the main etiological effector of chronic active gastritis. H. p. is a bacterium with a selective tropism for the gastric mucosa, able to survive in a hostile environment for colonization of organisms other than itself, able to develop strategies for survival and for avoidance of the defence mechanisms, causing inflammatory changes, that vary from asymptomatic mild gastritis to more severe injury such as peptic ulcer as well as premalignant lesions and malignant tumours. The pattern and distribution of gastritis strongly correlate with these sequelae and chronic atrophic gastritis with intestinal metaplasia is now assessed as a precancerous lesion with definite risk of evolution towards intraepithelial lesions of both low and high grade, as expected in the model of the Correa's cascade. In fact, the leading complication of chronic gastritis remains its close correlation with gastric cancer being biologically linked to H. pylori infection, nowadays known as a class I carcinogen. Gastric carcinogenesis is due to environmental factors, as well as to bacterial strain, host responses and gastric mucosal microbiome dysbiosis. Since, individual patients show different gastric cancer risk, it is mandatory to identify patients at risk of developing gastric cancer to offer a targeted search for lesions with a more rapid development of neoplasm liable, in an early phase, to a less destructive treatment. OLGA staging system is the most reliable and powerful system that allow the recognition of patient with a higher risk of developing gastric cancer.