GASTRITIS IN CHILDREN Chongqing Children’s Hospital Division of Infectious Disease and Gastroenterology
Gastritis • Acute Gastritis • Chronic Gastritis
Acute gastritis • Diffination • Etiology & Pathogenesis • Pathology
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
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
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
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
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.
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
Chronicgastritis Classification Update Sydney System in 1996 Superficial Chronic GastritisAtrophic Specific types
Chronicgastritis Etiology • Helicobacter pylori (HP) • Bile reflux • Dietary Habit • Sequela of acute gastritis • Drugs • Psychological and genetic factors: Emotional stress • Chronic Disease • Other factors
Chronicgastritis Helicobacter plori
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.
Chronicgastritis Clinical manifestation • Recurrent abdominal pain • Dyspeptic symptoms Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea • Growth retardation • Upper GI bleeding
Chronicgastritis Clinical manifestation • A relatively minor manifestation of diseases • The smaller the children the more atypical manifestation
Chronicgastritis Auxiliary examinations • Gastroscopic examination is the most reliable method for diagnosis of gastritis • Biopsy • X-ray: Barium meal examination • HP detection
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
Chronicgastritis Diagnosis Recurrent abdominal pain and/or dyspeptic symptom in children Gastroendoscopic examination History: Inappropriate dietary habits, family history, medication taking, psychological stress
Chronicgastritis Differential Diagnosis Enterosite Enterospasm Abdominal epilepsy
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
Chronicgastritis HP eradication Triple regimens
Chronicgastritis • Prevention of duodenogastric Reflux. Doperidome Cisapride • Reducing gastric acid secretion. H2RT (for 4 weeks): Ranitiding Cimetidine PPI (for 2 weeks) Omeprazole Lansoprazole
Chronicgastritis • Enhancing mucosal defense Bismuth compounds Sucrafate • Symptomatic treatment Atropine Belladonna
Hemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGM
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.
Alkaline Reflux Gastritis NGM Normal gastric mucosa Stomach mucosa diffusely covered with bile-stained mucus.
Gastric Candidiasis Gastric candidiasis with extensive green-white exudates covering the antrum. Normal gastric mucosa
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.