GASTRITIS IN CHILDREN

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GASTRITIS IN CHILDREN Powered By Docstoc
					GASTRITIS IN
CHILDREN

   Chongqing Children’s Hospital
       Division of Infectious Disease
              and Gastroenterology
 Gastritis
    Acute Gastritis
    Chronic Gastritis




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Acute Gastritis



                  3
Acute gastritis




 Diffination
 Etiology & Pathogenesis
 Pathology


                            4
Acute gastritis     Etiology & Pathogenesis

   Food and Drugs:
   Severe stress state:
   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
   Acute infection:
   Corrosive substances:                         5
Acute gastritis     Manifestations




④ 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

                                                     6
Acute gastritis

             ⑤ 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
                                                          7
Acute gastritis
              ⑥ 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
                                                    8
   Antacids: H2-RA, PPI
Chronic gastritis



                    9
             An estimated 10%
             school age children is
             affected by recurrent
             abdominal pain.

The top two reasons for recurrent
 abdominal pain in children are
   chronic gastritis & PUD

                                      10
Chronic gastritis


 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



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Chronic gastritis


            Classification
   Update Sydney System in 1996


                       Superficial
   Chronic Gastritis   Atrophic
                       Specific types


                                        12
Chronic gastritis
                    Etiology
  Helicobacter pylori (HP)
  Bile reflux

  Dietary Habit

  Sequela of acute gastritis

  Drugs

  Psychological and genetic factors:
   Emotional stress
  Chronic Disease

  Other factors
                                        13
Chronic gastritis
          Helicobacter plori




                               14
Chronic gastritis




  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.       15
Chronic gastritis

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

                                              16
Chronic gastritis

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


                                   17
Chronic gastritis

   Auxiliary examinations
 Gastroscopic   examination is the
  most reliable method for diagnosis
  of gastritis
 Biopsy

 X-ray: Barium meal examination

 HP detection


                                       18
Chronic gastritis

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


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

      Gastroendoscopic examination
 History:
 Inappropriate dietary habits, family history,
 medication taking, psychological stress

                                                 20
Chronic gastritis


    Differential Diagnosis
         Enterosite
         Enterospasm
         Abdominal epilepsy




                              21
Chronic gastritis

               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

                                                 22
Chronic gastritis
           HP eradication
      Triple regimens
Choose one drug below       Choose two
PPI         Omeprazole      antibiotics below
                                Amoxicillin
            Lansoprazole
                             Clarithromycin
Bismuth     Bismuth          Metronidazole
preparation Subsalicylate       Furaxone
            Basic
                                           23
Chronic gastritis
    Prevention of duodenogastric Reflux.
      Doperidome
      Cisapride
    Reducing gastric acid secretion.
       H2RT (for 4 weeks):
         Ranitiding
         Cimetidine
       PPI (for 2 weeks)
        Omeprazole
        Lansoprazole
                                            24
Chronic gastritis


    Enhancing mucosal defense
        Bismuth compounds
        Sucrafate
    Symptomatic treatment
        Atropine
        Belladonna


                                 25
Normal Gastric Mucosa




            NGM

                        26
gastric mucosal edema



      NGM




                        27
Hemorrhagic gastritis




          Hemorrhagic gastritis with
  NGM     multiple intramural bleeding
          spots
                                         28
Gastric Lymphoid Hyperplasia




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




          NGM
  Normal gastric   Stomach mucosa diffusely
     mucosa        covered with bile-stained mucus.


                                                      30
Gastric Candidiasis




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

                                                  31
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.

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Thank you.




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