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GASTRITIS IN CHILDREN

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... PPI Chronic gastritis The top two reasons for recurrent abdominal pain in children are chronic gastritis & PUD ... (tuberculosis) Author: Jacky Lui Last modified ... – PowerPoint PPT presentation

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Title: GASTRITIS IN CHILDREN


1
GASTRITIS IN CHILDREN
  • Chongqing Childrens Hospital
  • Division of Infectious Disease
  • and Gastroenterology

2
  • Gastritis
  • Acute Gastritis
  • Chronic Gastritis

3
Acute Gastritis
4
Acute gastritis
  • Diffination
  • Etiology Pathogenesis
  • Pathology

5
Acute gastritis
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
Acute gastritis
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
Diagnosis
  • Acute simple gastritis
  • History
  • symptoms and signs
  • 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
  1. 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
  • 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
Classification
Update Sydney System in 1996
Superficial Chronic Gastritis Atrophic
Specific types
13
Etiology
  • Helicobacter pylori (HP)
  • Bile reflux
  • Dietary Habit
  • Sequela of acute gastritis
  • Drugs
  • Psychological and genetic factors Emotional
    stress
  • Chronic Disease
  • Other factors

14
Helicobacter plori
15
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
Clinical manifestation
  • Recurrent abdominal pain
  • Dyspeptic symptoms
  • Excessive belching, acid regurgitation,
    hiccups, nausea, vomiting, diarrhea
  • Growth retardation
  • Upper GI bleeding

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

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

19
  • 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
Diagnosis
  • Recurrent abdominal pain and/or dyspeptic symptom
    in children

Gastroendoscopic examination
History Inappropriate dietary habits, family
history, medication taking, psychological stress
21
Differential Diagnosis
Enterosite Enterospasm Abdominal epilepsy
22
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
HP eradication
Triple regimens
Choose one drug below Choose one drug below
PPI Omeprazole
PPI Lansoprazole
Bismuth preparation Bismuth Subsalicylate Basic
Choose two antibiotics below
Amoxicillin
Clarithromycin
Metronidazole
Furaxone
24
  • Prevention of duodenogastric Reflux.
  • Doperidome
  • Cisapride
  • Reducing gastric acid secretion.
  • H2RT (for 4 weeks)
  • Ranitiding
  • Cimetidine
  • PPI (for 2 weeks)
  • Omeprazole
  • Lansoprazole

25
  • 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.
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