mucosal atrophy
Introduction
Introduction Mucosal atrophy can be seen in multiple organs, and the mucosal atrophy of the stomach, nose, and pharynx is more common. Chronic inflammation of the pharyngeal mucosa of chronic pharyngitis is often part of chronic inflammation of the respiratory tract. Mostly, the recurrence or delay of treatment of acute pharyngitis is chronic or after a variety of nasal diseases, long-term mouth breathing and nasal secretions due to nasal obstruction, resulting in long-term stimulation of the pharynx, or chronic tonsillitis, rickets, etc. It can be stimulated by various physical and chemical factors: such as dust, neck radiotherapy, long-term exposure to chemical gases, excessive alcohol and tobacco, etc., and systemic factors such as various chronic diseases can be secondary to this disease. Mainly divided into chronic simple pharyngitis, chronic hypertrophic pharyngitis, atrophic or dry pharyngitis. The main manifestation is that the pharynx can have various discomforts, such as foreign body sensation, itching, burning, dryness, slight pain, dry cough, phlegm and more difficult to cough, speech fatigue, or brushing your teeth, and it is easy to nausea when speaking. Atrophic rhinitis is a slow-growing nasal disease characterized by atrophy of the nasal mucosa, loss or disappearance of the sense of smell, formation of scarring of the nasal cavity, and severe atrophy of the periosteum and bone of the nose. Atrophic changes in the mucosa can progress down to the nasopharynx, oropharynx, throat, etc., so some people think that this disease is the nasal manifestation of systemic diseases. Gastric mucosal atrophy is a relatively mild stomach disease.
Cause
Cause
Chronic pharyngitis is a common disease, a diffuse pharyngeal lesion caused by chronic infection, mainly inflammation of the pharynx mucosa. Mostly in adults, the main causes are acute pharyngitis, long-term dust or harmful gas stimulation, excessive alcohol or alcohol or other bad habits, sinusitis secretion stimulation, allergies or reduced body resistance. Chronic pharyngitis can also be a local manifestation of certain systemic diseases such as anemia, diabetes, cirrhosis and chronic nephritis. Pharyngeal discomfort, foreign body sensation, always feel that the pharynx can not swallow and can not spit out things, stimulate cough, dry, bloated, blocked, itching, etc., but rarely sore throat. In the morning, often vomiting sticky lumps can cause nausea. Because the early symptoms of cancer in the esophagus or hypopharynx will have similar symptoms, it is necessary to go to the hospital for detailed examination after the above symptoms are found.
Atrophic rhinitis is a slow-growing nasal disease characterized by atrophy of the nasal mucosa, loss or disappearance of the sense of smell, formation of scarring of the nasal cavity, and severe atrophy of the periosteum and bone of the nose. Atrophic changes in the mucosa can progress down to the nasopharynx, oropharynx, throat, etc., so some people think that this disease is the nasal manifestation of systemic diseases. The patients with this disease are mostly young women. Due to the close occurrence of this disease and the nutritional factors, the disease is increasingly rare in developed countries and has a high incidence in developing countries.
The etiology of chronic atrophic gastritis has not been known so far and may be related to the following factors:
(1) Continuation of chronic superficial gastritis: Chronic atrophic gastritis can be developed from chronic superficial gastritis. Six hospitals including the General Hospital of the People's Liberation Army reported 164 cases of superficial gastritis after 5 to 8 years of follow-up, of which 34 cases were converted into chronic atrophic gastritis (20.7%). The cause of chronic superficial gastritis can become a causative and aggravating factor of chronic atrophic gastritis.
(2) Genetic factors: According to the Varis survey, the incidence of chronic atrophic gastritis was significantly increased among the first generation of relatives of patients with chronic atrophic gastritis, and the genetic factors of pernicious anemia were also obvious. The incidence of relative relationships was 20 times greater than that of the control group, indicating that chronic atrophic gastritis may be related to genetic factors.
(3) Metal contact: The incidence of gastric ulcer in lead workers is high, and the incidence of atrophic gastritis is also increased in gastric mucosa biopsy. Polmer calls it excretory gastritis. In addition to lead, many heavy metals such as mercury, strontium, copper and zinc have certain damage to the gastric mucosa. (4) Radiation: Radiation treatment of ulcer disease or other tumors can cause damage or even atrophy of the gastric mucosa.
(5) Iron deficiency anemia: Many facts indicate that iron deficiency anemia is closely related to atrophic gastritis. Badanoch reported 50 cases of iron deficiency anemia, normal gastric mucosa, superficial gastritis and atrophic gastritis accounted for 14% and 46% respectively. And 40%. However, the mechanism of anemia caused by gastritis is still unclear. Some scholars believe that gastritis is the primary disease, because gastritis is low in stomach acid, iron can not be absorbed, or due to gastric bleeding, resulting in anemia; another opinion is that there is anemia first, because the iron deficiency in the body makes the gastric mucosal renewal rate affected and easily occurs. Inflammation.
(6) Biological factors: The effects of chronic infectious diseases such as hepatitis and tuberculosis on the stomach have also attracted people's attention. Chronic liver disease patients often have symptoms and signs of chronic gastritis. Gastric mucosal staining also confirmed the presence of hepatitis B virus antigen-antibody complex in the gastric mucosa of patients with hepatitis B. Ruijin Hospital reported 91 patients with atrophic gastritis, and 24 patients (26.4%) had chronic hepatitis. Therefore, the impact of chronic infectious diseases, especially chronic liver diseases, on the stomach is worth noting.
(7) Constitutional factors: Clinical statistics show that the incidence of this disease is significantly positively correlated with age. The older the age, the worse the "resistance" of the gastric mucosal function is, and it is easily damaged by external adverse factors.
(8) bile or duodenal reflux: due to pyloric sphincter dysfunction or gastrojejunostomy, bile or duodenal juice can reflux to the stomach, and destroy the gastric mucosal barrier, promote H? + and pepsin Dissemination into the mucosa causes a series of pathological changes leading to chronic superficial gastritis and can develop into chronic atrophic gastritis.
(9) Immune factors: In atrophic gastritis, especially in the blood, gastric juice or plasma cells of atrophic mucosa in patients with atrophic gastritis, wall cell antibodies or internal factor antibodies are often found, so the autoimmune response is considered to be chronic atrophy. The cause of gastritis. In recent years, a small number of patients with gastric antrum gastritis have been found to have gastrin-secreting cell antibodies, which are special autoimmune antibodies of cells, belonging to the Ig G line. Some patients with atrophic gastritis have abnormal lymphocyte transformation test and leukocyte migration inhibition test, suggesting that cellular immune response is also important in the occurrence of atrophic gastritis.
(10) Helicobacter pylori (HP) infection: In 1983, Australian scholars Marshall and Warren first isolated HP from the gastric mucosal layer and epithelial cells of patients with chronic gastritis. Since then, many scholars have carried out a large number of experimental studies on patients with chronic gastritis, and HP is cultured in the gastric mucosa of 60% to 90% of patients with chronic gastritis, and then it is found that the degree of HP infection is positively correlated with the degree of gastric mucosal inflammation. At the eighth session of the World Gastroenterology Society in 1986, HP infection was one of the important causes of chronic gastritis.
In addition, such as improper diet, long-term tobacco and alcohol, drug abuse, chronic inflammation of the upper respiratory tract, central nervous system dysfunction, damage to the gastric mucosa, and gastric resection, the gastric antrum excretion of gastrin, resulting in the stomach Mucosal dystrophies, etc., are likely to cause damage to the gastric mucosa and atrophy and inflammatory changes.
Examine
an examination
Related inspection
Laboratory examination of anti-internal factor antibodies for gastric mucosal biopsy
Diagnosis of chronic pharyngitis:
Pharyngeal discomfort, foreign body sensation, always feel that the pharynx can not swallow and can not spit out things, stimulate cough, dry, bloated, blocked, itching, etc., but rarely sore throat. In the morning, often vomiting sticky lumps can cause nausea. Because the early symptoms of cancer in the esophagus or hypopharynx will have similar symptoms, it is necessary to go to the hospital for detailed examination after the above symptoms are found.
(l) Medical history: There is often a history of recurrent episodes of acute pharyngitis, or long-term mouth breathing due to nasal diseases, excessive alcohol and tobacco, dry air in the environment, dust and irritating gas pollution.
(2) Symptoms: pharyngeal discomfort, or pain, or itching, or dryness, burning sensation, smoky sensation, foreign body sensation, etc.; irritating cough, cough up secretions in the morning, or even nausea. The course of the disease is more than 2 months, often caused by cold, cold, fatigue, and more words.
(3) Examination: chronic congestion of the pharynx, aggravation. Dark red, or dendritic congestion; lymphoid follicular hyperplasia in the posterior pharyngeal wall, or swollen pharyngeal side; pharyngeal mucosa hypertrophy, or dry, atrophic, thin, with secretions attached. With each of the above symptoms and 1 or More than one inspection can be diagnosed.
Diagnosis of atrophic rhinitis:
Atrophic rhinitis is a slow-growing nasal disease characterized by atrophy of the nasal mucosa, loss or disappearance of the sense of smell, formation of scarring of the nasal cavity, and severe atrophy of the periosteum and bone of the nose. Atrophic changes in the mucosa can progress down to the nasopharynx, oropharynx, hypopharynx, and the like.
Diagnosis of chronic atrophic gastritis:
Chronic atrophic gastritis has no specific clinical manifestations, so the diagnosis of chronic atrophic gastritis requires clinical manifestations combined with related auxiliary examinations, especially gastroscopy and gastric mucosal biopsy. The following systematically introduces the diagnosis basis of chronic atrophic gastritis:
(1) Clinical manifestations: mainly loss of appetite, nausea, belching, upper abdominal fullness or dull pain, a small number of patients may have upper gastrointestinal bleeding, weight loss, anemia, crisp nails, glossitis or tongue nipple atrophy. (
2) Laboratory inspection
1 gastric juice analysis: patients with type A CAG are mostly acid-free or low-acid, and patients with type B CAG can be normal or low in acid.
2 Pepsinogen assay: Pepsinogen is secreted by the main cell, and the content of pepsinogen in blood and urine is reduced in chronic atrophic gastritis.
3 serum gastrin assay: G cells of the gastric antrum mucosa secrete gastrin. In patients with type A CAG, serum gastrin is often significantly increased; gastric mucosa atrophy in patients with type B CAG directly affects the secretion of gastrin by G cells, and serum gastrin is lower than normal.
4 immunological examination: wall cell antibody (PCA), internal factor antibody (IFA), gastrin secretion cell antibody (GCA) determination, can be used as a secondary diagnosis of chronic atrophic gastritis and its classification.
(3) X-ray examination: X-ray stomach barium meal examination Most patients with atrophic gastritis have no abnormal findings. Air sputum double contrast can show that the gastric mucosa folds flat and thin, the serrated mucosal folds of the corpus callosum become thin or disappear, the bottom of the stomach is smooth, and some gastric antrums can be serrated or mucous membranes. .
(4) Gastroscope and biopsy: gastroscopy and biopsy are the most reliable diagnostic methods. Gastroscopic diagnosis should include the extent of the lesion, degree of atrophy, intestinal metaplasia and degree of dysplasia. The mucosa of the atrophic gastritis was mostly pale or grayish, and the folds became thin or flat. The mucous membranes can be red and white, and in severe cases there are scattered white patches. Submucosal blood vessels are characterized by atrophic gastritis. Red reticular arterioles or capillaries can be seen, and severe atrophic gastritis can be seen. Epithelial cells proliferate to form fine particles or larger nodules. There are also mucosal erosions and bleeding. Gastric mucosal biopsy pathology mainly causes glandular atrophy and disappearance, and is replaced by pyloric gland metaplasia or intestinal gland metaplasia, and interstitial inflammation infiltration is significant.
Diagnosis
Differential diagnosis
Differential diagnosis of chronic pharyngitis:
1, chronic pharyngitis and chronic tonsillitis often accompanied. When chronic tonsillitis is the main manifestation, it is often accompanied by submandibular lymphadenopathy; while chronic pharyngitis is predominant, it is characterized by lymphoid follicular hyperplasia of the posterior pharyngeal wall.
2, chronic pharyngitis and esophageal cancer can occur in the early stages of pharyngeal discomfort, if not seriously differentiated, delaying the condition will have very serious consequences. In general, esophageal cancer has not experienced dysphagia early in the early stage, often with pharyngeal discomfort or post-sternal pressure. At this time, if you make an esophagus or esophagus meal, you can distinguish it.
3, pharyngeal diphtheria can also appear throat discomfort, dysphagia and other symptoms, it is necessary to pay attention to the difference. General pharyngeal diphtheria systemic symptoms are obvious, wilting, grayish white pseudomembrane can be seen in the pharynx, and diphtheria bacilli can be found by taking the secretions for laboratory examination.
Second, the differential diagnosis of atrophic rhinitis: atrophic rhinitis should be differentiated from nasal necrotizing granuloma, nasal tuberculosis, nasal diphtheria, nasal induration, nasal syphilis, leprosy.
Third, the differential diagnosis of atrophic gastritis: mainly differentiated from some diseases that cause chronic upper abdominal pain, but also should be differentiated from other types of gastritis. It is not difficult to identify by gastroscopy and biopsy.
Diagnosis of chronic pharyngitis:
Pharyngeal discomfort, foreign body sensation, always feel that the pharynx can not swallow and can not spit out things, stimulate cough, dry, bloated, blocked, itching, etc., but rarely sore throat. In the morning, often vomiting sticky lumps can cause nausea. Because the early symptoms of cancer in the esophagus or hypopharynx will have similar symptoms, it is necessary to go to the hospital for detailed examination after the above symptoms are found.
(l) Medical history: There is often a history of recurrent episodes of acute pharyngitis, or long-term mouth breathing due to nasal diseases, excessive alcohol and tobacco, dry air in the environment, dust and irritating gas pollution.
(2) Symptoms: pharyngeal discomfort, or pain, or itching, or dryness, burning sensation, smoky sensation, foreign body sensation, etc.; irritating cough, cough up secretions in the morning, or even nausea. The course of the disease is more than 2 months, often caused by cold, cold, fatigue, and more words.
(3) Examination: chronic congestion of the pharynx, aggravation. Dark red, or dendritic congestion; lymphoid follicular hyperplasia in the posterior pharyngeal wall, or swollen pharyngeal side; pharyngeal mucosa hypertrophy, or dry, atrophic, thin, with secretions attached. With each of the above symptoms and 1 or More than one inspection can be diagnosed.
Diagnosis of atrophic rhinitis:
Atrophic rhinitis is a slow-growing nasal disease characterized by atrophy of the nasal mucosa, loss or disappearance of the sense of smell, formation of scarring of the nasal cavity, and severe atrophy of the periosteum and bone of the nose. Atrophic changes in the mucosa can progress down to the nasopharynx, oropharynx, hypopharynx, and the like.
Diagnosis of chronic atrophic gastritis:
Chronic atrophic gastritis has no specific clinical manifestations, so the diagnosis of chronic atrophic gastritis requires clinical manifestations combined with related auxiliary examinations, especially gastroscopy and gastric mucosal biopsy. The following systematically introduces the diagnosis basis of chronic atrophic gastritis:
(1) Clinical manifestations: mainly loss of appetite, nausea, belching, upper abdominal fullness or dull pain, a small number of patients may have upper gastrointestinal bleeding, weight loss, anemia, crisp nails, glossitis or tongue nipple atrophy.
(2) Laboratory inspection
1 gastric juice analysis: patients with type A CAG are mostly acid-free or low-acid, and patients with type B CAG can be normal or low in acid.
2 Pepsinogen assay: Pepsinogen is secreted by the main cell, and the content of pepsinogen in blood and urine is reduced in chronic atrophic gastritis.
3 serum gastrin assay: G cells of the gastric antrum mucosa secrete gastrin. In patients with type A CAG, serum gastrin is often significantly increased; gastric mucosa atrophy in patients with type B CAG directly affects the secretion of gastrin by G cells, and serum gastrin is lower than normal.
4 immunological examination: wall cell antibody (PCA), internal factor antibody (IFA), gastrin secretion cell antibody (GCA) determination, can be used as a secondary diagnosis of chronic atrophic gastritis and its classification.
(3) X-ray examination: X-ray stomach barium meal examination Most patients with atrophic gastritis have no abnormal findings. Air sputum double contrast can show that the gastric mucosa folds flat and thin, the serrated mucosal folds of the corpus callosum become thin or disappear, the bottom of the stomach is smooth, and some gastric antrums can be serrated or mucous membranes. .
(4) Gastroscope and biopsy: gastroscopy and biopsy are the most reliable diagnostic methods. Gastroscopic diagnosis should include the extent of the lesion, degree of atrophy, intestinal metaplasia and degree of dysplasia. The mucosa of the atrophic gastritis was mostly pale or grayish, and the folds became thin or flat. The mucous membranes can be red and white, and in severe cases there are scattered white patches. Submucosal blood vessels are characterized by atrophic gastritis. Red reticular arterioles or capillaries can be seen, and severe atrophic gastritis can be seen. Epithelial cells proliferate to form fine particles or larger nodules. There are also mucosal erosions and bleeding. Gastric mucosal biopsy pathology mainly causes glandular atrophy and disappearance, and is replaced by pyloric gland metaplasia or intestinal gland metaplasia, and interstitial inflammation infiltration is significant.
