Vieâm daï daøy

Hoà Ñaêng Quyù Duõng

Ñaët vaán ñeà

1. Chaån ñoaùn vieâm daï daøy qua noäi soi? • Chaån ñoaùn ñaïi theå?• Chaån ñoaùn vi theå?

2. Moái töông quan giöõa chaån ñoaùn noäi soi vaøchaån ñoaùn moâ beänh hoïc.

3. Söï thoáng nhaát veà thuaät ngöõ vaø caùc heä thoángphaân loaïi khaùc nhau.

4. YÙ nghóa laâm saøng.

Ñònh khu giaûi phaãu

Antrum

Corpus

Fundus

Ant

Less

Post

Gre

Cardia

Pylorus

Ñònh khu veà moâ hoïc

Tuyeán hang vòAntral Gland zone

Tuyeán ñaùy vòOxyntic Gland zone

Tuyeán taâm vòCardiac Gland zone

ÑÒNH KHU LOAÏI TEÁ BAØO CHAÁT BAØI TIEÁT

Taâm vò MucousEndocrine

Mucus,Pepsinogen-

Ñaùy vò ParietalChiefEnterochromaffinG

Hydrochloride acid, IFPepsinogenHistamine, SerotoninGastrin

Hang vò GDEnterochromaffin

GastrinSomatostatinHistamine, Serotonin

NIEÂM MAÏC VUØNG ÑAÙY VÒ

Caùc bieåu hieän vieâm qua noäi soi

Descriptive sheet of endoscopic findingsItems Findings

• 1. Surface IrregularRugal hypertrophy

• 2. Atrophy Border of atrophyVisibility of vascular pattern

• 3. Intestinal metaplasia Elevated TypeFlat type

• 4. Redness measuring less than 2mm Spotted• Redness Patchy• Including linear redness on the folds Linear• 5. Edema• 6. Erosive changes Flat/Depressed

Elevated• 7. Whitish exudate Presence/ Absence• 8. Hemorrhage Active• Blood pigment spot Old• Concomitant lesions Absence [ ] Presence [ ]

Michiko Kaminishi et al., Endoscopic classification of chronic gastritis based on apilot study by the research society for gastritis. Digestive Endoscopy (2002),14: 138–151

Endoscopic Characteristics of Inflammation 1. Oedema2. Erythema Punctate

Confluent3. Friability 4. Exudate5. Flat erosion 6. Raised erosion7. Rugal hyperplasia (hyperrugosity)8. Rugal atrophy (hyporugosity)9. Visibility of the vascular pattern 10. Intramural bleeding spots Punctate or petechial

Confluent or ecchymotic11. Nodularity Fine

Coarse

SYDNEY SYSTEM:ENDOSCOPIC DIVISION

1. Phuø neà (Oedema)

1. Laø nhöõng vuøng nieâm maïc hôi nhôït nhaït vaø traéng hôn, coù caáu truùc hình ña giaùc (daáu hieäu da raén)

2. Coù theå coù keøm xuaát tieát.

2. Sung huyeát (Erythema)

1. Laø nhöõng vuøng nieâm maïc coù maøu ñoû hôn moät caùch roõ reät so vôùi nieâm maïc gaàn keà.

2. Sung huyeát: daïng noát, töøng maûng, hoaëc daïng ñöôøng.

3. Söôùt phaúng (Flat erosion)

1. Laø nhöõng vuøng toån thöông nieâm maïc ñaùy coù giaû maïc, phaúng hoaëc hôi loõm, bôø toån thöông coù theå coù nieâm maïc sung huyeát xung quanh (Red halo).

2. Kích thöôùc coù thay ñoåi, coù theå coù ÑK 1cm.3. Phaân bieät vôùi loeùt.

4. Söôùt nhoâ cao (Raised erosion)

1. Laø nhöõng vuøng toån thöông nieâm maïc nhoâ cao coù mieäng loõm ôû giöõa laø veát söôùt.

2. Coù theå ñöùng ñôn ñoäc hoaëc xeáp thaønh chuoãi .

5. Noát xuaát huyeát (Bleeding spot)1. Laø nhöõng vuøng toån thöông nieâm maïc ñaùy coù laø veät maùu ñoû hoaëc maùu

ñen.2. Kích thöôùc coù thay ñoåi, coù theå coù ÑK 1cm.

6. Teo nieâm maïc (Atrophy)1. Laø nhöõng vuøng nieâm maïc moûng, loä roõ nhöõng maïch maùu beân döôùi trong

khi khoâng bôm hôi quaù caêng.2. Caùc neáp nieâm maïc (thaân vò) bieán maát hoaëc teo nhoû.

7. Dò saûn ruoät (Intestinal Metaplasia)

1. Laø nhöõng toån thöông nhoâ cao daïng noát hoaëc töøng maûng nhoû coù maøu traéng ngaø.

2. Thöôøng hay gaëp ôû hang vò.

8. Phì ñaïi (Rugal hyperrugosity)

1. Laø nhöõng toån thöông maø caùc neáp nieâm maïc coù ñöôøng kính ≥5mm, khoâng thay ñoåi khi bôm hôi caêng.

2. Beà maët coù theå coù sung huyeát, söôùt hoaëc xuaát tieát.

8. Phì ñaïi (Rugal hyperrugosity)

• Representative upper gastrointestinal endoscopy of enlarged foldgastritis. (A) Before H. pylori eradication,

• (B) After 1 year of H. pylori eradication, • (C) After 2 years of H. pylori eradication. (Arrows show enlarged fold.)

Yoko Murayama., is helicobacter pylori-induced enlarged fold gastritis ahigh-risk factor for gastric carcinoma?. Digestive Endoscopy (2006),18: 98–104

CHAÅN ÑOAÙN NOÄI SOI

Overview of Gastritis and Gastropathy

• Erosive and hemorrhagic• Nonerosive• Distinctive

Wilfred M. Weinstein, Gastritis and Gastropathy, Gastroenterologic Endoscopy; Vol 1 (2002)

Endoscopic findings and diagnostic criteria

Fundamental types Definition according to endoscopic findings1. Superficial gastritis Findings including edema and redness

(spotted, patchy, linear) are observed2. Hemorrhagic gastritis Hemorrhage is evidenced3. Erosive gastritis Erosive changes including flat or

depressed types4. Verrucous gastritis Erosive changes including elevated type5. Atrophic gastritis Findings such as color change of mucosa,

visible vascular pattern and thinning are observedMetaplastic gastritis Intestinal metaplasia is notedHyperplastic gastritis Remarkable irregularity of mucosa or rugal

hypertrophy of greater curvature in corpus6. Special gastritis (Refer to the appendix)

Michiko Kaminishi et al., Endoscopic classification of chronic gastritis based on apilot study by the research society for gastritis. Digestive Endoscopy(2002),14: 138–151

Sydney System

Updated Sydney Classification

Endoscopic gastritis: Sydney system

1. Endoscopic erythematous/exudativc gastritis 2. Endoscopic flat erosive gastritis 3. Endoscopic raised erosive gastritis 4. Endoscopic atrophic gastritis 5. Endoscopic haemorrhagic gastritis 6. Endoscopic rugal hyperplastic gastritis 7. Endoscopic enterogastric reflux gastritis

* Endoscopic congestive gastroenteropathy

Distinctive Types of Gastritis

INFECTIONS AND INFESTATIONS - Bacterial infections: - Tuberculosis - Syphilis

- Phlegmonous and Emphysematous Gastritis- Viral infections: - Cytomegalovirus infection - Herpesvirus infections - Fungal infections: - Candidiasis (Candida albicans) - Histoplasmosis

- Other: zygomycosis (mucormycosis), aspergillosis- Nematosis and other parasitoses: - Cryptosporidosis - Anisakidosis

- OtherGASTROINTESTINAL TRACT DISEASES

- Crohn's disease - Eosinophilic gastritis

SYSTEMIC DISEASE- Sarcoidosis

CONFINED TO THE STOMACH- Menetrier's disease- Isolated unexplained granulomas

Wilfred M. Weinstein, Gastritis and Gastropathy, Gastroenterologic Endoscopy; Vol 1 (2002)

Special forms of gastritis

1. Chemical or Reactive Gastritis 2. Lymphocytic Gastritis 3. Granulomatous Gastritis 4. Eosinophilic Gastritis 5. Collagenous Gastritis 6. Radiation Gastritis 7. Infectious Gastritis 8. Bacterial 9. Viral 10. Fungal 11. Parasitic

Updated Sydney Classfication

Eosinophilic gastritis

1. Laâm saøng: Ñau thöôïng vò, noân sau aên, suït caân, thieáu maùuthieáu saét, giaûm protid maùu.

2. Tieàn söû dò öùng moät soá loaïi thöùc aên 6 naêm.

Eosinophilic gastritis

(a) Low-power microscopic view of a biopsy specimen from the gastric lesion showing foveolar dilatation and denseinfiltration of inflammatory cells (x 20).

(b) High-power view of the specimen showing that most of the infiltrating cells areeosinophils (x100).

Eosinophilic gastritis

Endoscopic findings ofthe gastric antrumafter steroid therapy

Nodular gastritis

1. Laâm saøng: Thöôøng gaëp ôû nöõ, treû, hình aûnh noäi soi hang vò laø toån thöông daïng noát (haït): daáu hieäu da ngoãng (Goose skin).

2. Coù Hp (+).

Nodular gastritis

Note also the intense inflammatory cell infiltration with large and superficial lymphoid follicle formation in the lamina propria of the mucosal specimens

Endoscopic Gastric syphilis

Gastric syphilis: histology

Gastric syphilis: posttherapy

Menetrier’s disease

Menetrier’s disease

Menetrier’s disease: histologic characteristics

MALT Lymphoma

Cytokeratin stain: Normal gastric mucosa

MALT Lymphoma

Helicobacter pylori to gastric cancer