1. Vieâm daï daøy
Hoà Ñaêng Quyù Duõng

2. 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 vaø
chaån ñoaùn moâ beänh hoïc.
3. Söï thoáng nhaát veà thuaät ngöõ vaø caùc heä thoáng
phaân loaïi khaùc nhau.
4. YÙ nghóa laâm saøng.

3. Ñònh khu giaûi phaãu
Antrum
Corpus
Fundus
Ant
Less
Post
Gre
Cardia
Pylorus

4. Ñònh khu veà moâ hoïc
Tuyeán hang vò
Antral Gland zone
Tuyeán ñaùy vò
Oxyntic Gland zone
Tuyeán taâm vò
Cardiac Gland zone

5. ÑÒNH KHU LOAÏI TEÁ BAØO CHAÁT BAØI TIEÁT
Taâm vò Mucous
Endocrine
Mucus,Pepsinogen
-
Ñaùy vò Parietal
Chief
Enterochromaffin
G
Hydrochloride acid, IF
Pepsinogen
Histamine, Serotonin
Gastrin
Hang vò G
D
Enterochromaffin
Gastrin
Somatostatin
Histamine, Serotonin

6. NIEÂM MAÏC VUØNG ÑAÙY VÒ

7. Caùc bieåu hieän vieâm qua noäi soi

8. Descriptive sheet of endoscopic findings
Items Findings
• 1. Surface Irregular
Rugal hypertrophy
• 2. Atrophy Border of atrophy
Visibility of vascular pattern
• 3. Intestinal metaplasia Elevated Type
Flat 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

9. Endoscopic Characteristics of Inflammation
1. Oedema
2. Erythema Punctate
Confluent
3. Friability
4. Exudate
5. Flat erosion
6. Raised erosion
7. Rugal hyperplasia (hyperrugosity)
8. Rugal atrophy (hyporugosity)
9. Visibility of the vascular pattern
10. Intramural bleeding spots Punctate or petechial
Confluent or ecchymotic
11. Nodularity Fine
Coarse
SYDNEY SYSTEM:
ENDOSCOPIC DIVISION

10. 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.

11. 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.

12. 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.

13. 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 .

14. 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.

15. 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.

16. 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.

17. 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.

18. 8. Phì ñaïi (Rugal hyperrugosity)
• Representative upper gastrointestinal endoscopy of enlarged fold
gastritis. (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 a
high-risk factor for gastric carcinoma?. Digestive Endoscopy (2006),18: 98–104

19. CHAÅN ÑOAÙN NOÄI SOI

20. Overview of Gastritis and Gastropathy
• Erosive and hemorrhagic
• Nonerosive
• Distinctive
Wilfred M. Weinstein, Gastritis and Gastropathy, Gastroenterologic Endoscopy; Vol 1 (2002)

21. Endoscopic findings and diagnostic criteria
Fundamental types Definition according to endoscopic findings
1. Superficial gastritis Findings including edema and redness
(spotted, patchy, linear) are observed
2. Hemorrhagic gastritis Hemorrhage is evidenced
3. Erosive gastritis Erosive changes including flat or
depressed types
4. Verrucous gastritis Erosive changes including elevated type
5. Atrophic gastritis Findings such as color change of mucosa,
visible vascular pattern and thinning are observed
Metaplastic gastritis Intestinal metaplasia is noted
Hyperplastic gastritis Remarkable irregularity of mucosa or rugal
hypertrophy of greater curvature in corpus
6. 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

22. Sydney System

23. Updated Sydney Classification

24. 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

25. 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
- Other
GASTROINTESTINAL 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)

26. 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

27. Eosinophilic gastritis
1. Laâm saøng: Ñau thöôïng vò, noân sau aên, suït caân, thieáu maùu
thieáu saét, giaûm protid maùu.
2. Tieàn söû dò öùng moät soá loaïi thöùc aên 6 naêm.

28. 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 are
eosinophils (x100).

29. Eosinophilic gastritis
Endoscopic findings of
the gastric antrum
after steroid therapy

30. 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 (+).

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

32. Endoscopic Gastric syphilis

33. Gastric syphilis: histology

34. Gastric syphilis: posttherapy

35. Menetrier’s disease

36. Menetrier’s disease

37. Menetrier’s disease: histologic characteristics

38. MALT Lymphoma
Cytokeratin stain: Normal gastric mucosa

39. MALT Lymphoma

40. Helicobacter pylori to gastric cancer