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GASTRITIS IN CHILDREN

GASTRITIS IN CHILDREN

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GASTRITIS IN CHILDREN

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  1. GASTRITIS IN CHILDREN Chongqing Children’s Hospital Division of Infectious Disease and Gastroenterology

  2. Gastritis • Acute Gastritis • Chronic Gastritis

  3. Acute Gastritis

  4. Acute gastritis • Diffination • Etiology & Pathogenesis • Pathology

  5. Acutegastritis Etiology & Pathogenesis • Food and Drugs: • Severe stress state: • Acute infection: • Corrosive substances: Shock, hydrocephalus, sudden trauma, serious infection, major operation, etc Vagal stimulation Acid secretion Release of vasoactive amine and cytokines Microcirculation disdurbance Gastric mucosal ischemia Impairment of mucosal and mucous barriers Back-diffusion of hydrogen ions

  6. Acutegastritis Manifestations • Manifestations • A sudden onset • Typical manifestations: epigastric pain, nausea, vomiting, watery diarrhea • Fever: caused by bacterial infection or its toxins • Complications: dehydration, electrolyte disturbances, acid-base imbalance, UGI bleeding

  7. Acutegastritis Diagnosis • Acute simple gastritis History symptomsandsigns GI endoscopy & Biopsy (if necessary) • Diffusive hyperemia and edema of the gastric mucosa • Acute inflammation: neutrophilic infiltration in the lamina propria • May accompanied with punctate hemorrhage and mild corrupt lesion

  8. Acutegastritis • Treatment A. Remove of offending agents Quit all irritants or stimulus: drugs, alcohol Management of the original diseases B. Symptomatic treatment 1)Replacement of fluid and electrolyte loss 2)Spasmolysant: Atropine, Belladonna 4)Antiemetic drugs: Domperidone 3)Special management for upper GI bleeding C. Protection of gastric mucosa and inhibition of gastric acid Mucosal protector Antacids: H2-RA, PPI

  9. Chronic gastritis

  10. The top two reasons for recurrent abdominal pain in children are chronic gastritis&PUD An estimated 10% school age children is affected by recurrent abdominal pain.

  11. Chronicgastritis • By definition, is a histopathological entity characterized by chronic inflammation of the stomach mucosa. • It may present with an array of symptoms, the most common being nonspecific recurrent abdominal pain in children. • High frequency in children

  12. Chronicgastritis Classification Update Sydney System in 1996 Superficial Chronic GastritisAtrophic Specific types

  13. Chronicgastritis Etiology • Helicobacter pylori (HP) • Bile reflux • Dietary Habit • Sequela of acute gastritis • Drugs • Psychological and genetic factors: Emotional stress • Chronic Disease • Other factors

  14. Chronicgastritis Helicobacter plori

  15. Chronicgastritis H Pylori is considered to infect virtually all patients with chronic active gastritis and thought to be spread from person to person via oral-oral and/or fecal-oral routes.

  16. Chronicgastritis Clinical manifestation • Recurrent abdominal pain • Dyspeptic symptoms Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea • Growth retardation • Upper GI bleeding

  17. Chronicgastritis Clinical manifestation • A relatively minor manifestation of diseases • The smaller the children the more atypical manifestation

  18. Chronicgastritis Auxiliary examinations • Gastroscopic examination is the most reliable method for diagnosis of gastritis • Biopsy • X-ray: Barium meal examination • HP detection

  19. Chronicgastritis Diagnostic methods of HP infection • Rapid urease test • Urea breath test(C13) • Histology • Serum Antibodies to HP • Bacterial Culture • Testing for HP stool antigen • Polymerase chain reaction

  20. Chronicgastritis Diagnosis Recurrent abdominal pain and/or dyspeptic symptom in children Gastroendoscopic examination History: Inappropriate dietary habits, family history, medication taking, psychological stress

  21. Chronicgastritis Differential Diagnosis Enterosite Enterospasm Abdominal epilepsy

  22. Chronicgastritis Treatment • Etiologic treatment: Dietary adjustment, quit irritant drugs or other stimulus, HP eradication, try to control the bile reflux, etc • Symptomatic treatment • Protection of gastric mucosa • Inhibition of gastric acid

  23. Chronicgastritis HP eradication Triple regimens

  24. Chronicgastritis • Prevention of duodenogastric Reflux. Doperidome Cisapride • Reducing gastric acid secretion. H2RT (for 4 weeks): Ranitiding Cimetidine PPI (for 2 weeks) Omeprazole Lansoprazole

  25. Chronicgastritis • Enhancing mucosal defense Bismuth compounds Sucrafate • Symptomatic treatment Atropine Belladonna

  26. Normal Gastric Mucosa NGM

  27. gastric mucosal edema NGM

  28. Hemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGM

  29. Gastric Lymphoid Hyperplasia NGM Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection. Normally there is no organized lymphoid tissue in the stomach.

  30. Alkaline Reflux Gastritis NGM Normal gastric mucosa Stomach mucosa diffusely covered with bile-stained mucus.

  31. Gastric Candidiasis Gastric candidiasis with extensive green-white exudates covering the antrum. Normal gastric mucosa

  32. Chronic Antral Gastritis The rugal folds of the body running longitudinally towards the antrum. Increased visibility of the antral vascular pattern with findings compatible with chronic athrophic gastritis associated with H. pylori infection.

  33. Thank you.