1GASTRITISINCHILDREN

Dr.LiuChonghaiGastritis

AcuteGastritisChronicGastritis3AcuteGastritis4FoodandDrugs:(NonsteroidalAntiinflammatoryDrugs,NSAIDs)Severestressstate:Acuteinfection:

Corrosivesubstances:VagalstimulationAcidsecretionReleaseofvasoactiveamineandcytokinesMicrocirculationdisdurbanceGastricmucosalischemiaImpairmentofmucosalandmucousbarriersBack-diffusionofhydrogenions

Shock,hydrocephalus,suddentrauma,seriousinfection,majoroperation,etcAcute

gastritisEtiology&Pathogenesis5

ManifestationsAsuddenonsetTypicalmanifestations:epigastricpain,nausea,vomiting,waterydiarrheaFever:causedbybacterialinfectionoritstoxinsComplications:dehydration,electrolytedisturbances,acid-baseimbalance,UGIbleedingAcute

gastritisManifestations6DiagnosisAcutesimplegastritisHistorysymptoms

and

signsGIendoscopy&Biopsy(ifnecessary)Acute

gastritis

DiffusivehyperemiaandedemaofthegastricmucosaAcuteinflammation:neutrophilicinfiltrationinthelaminapropriaMayaccompaniedwithpunctatehemorrhageandmildcorruptlesion7NormalGastricMucosaNGM8gastricmucosaledemaNGM9HemorrhagicgastritisHemorrhagicgastritiswithmultipleintramuralbleedingspots

NGM10A.RemoveofoffendingagentsQuitallirritantsorstimulus:drugs,alcoholManagementoftheoriginaldiseasesB.Symptomatictreatment1)Replacementoffluidandelectrolyteloss2)Spasmolysant:Atropine,Belladonna4)Antiemeticdrugs:Domperidone3)SpecialmanagementforupperGIbleedingC.ProtectionofgastricmucosaandinhibitionofgastricacidMucosalprotectorAntacids:H2-RA,PPITreatmentAcute

gastritis11Chronicgastritis12Thetoptworeasonsforrecurrentabdominalpaininchildrenare

chronicgastritis

&

PUDAnestimated10%schoolagechildrenisaffectedbyrecurrentabdominalpain.13Bydefinition,isahistopathologicalentitycharacterizedbychronicinflammationofthestomachmucosa.Itmaypresentwithanarrayofsymptoms,themostcommonbeingnonspecificrecurrentabdominalpaininchildren.HighfrequencyinchildrenChronic

gastritis14Classification

Non-atrophic(Superficial):90-95%

ChronicGastritis

Atrophic

SpecifictypesChronic

gastritis15EtiologyHelicobacterpylori(HP)BilerefluxDietaryHabitSequelaofacutegastritisDrugsPsychologicalandgeneticfactors:EmotionalstressChronicDiseaseOtherfactorsChronic

gastritis16HelicobacterploriChronic

gastritis17HPyloriisconsideredtoinfectvirtuallyallpatientswithchronicactivegastritisandthoughttobespreadfrompersontopersonviaoral-oraland/orfecal-oralroutes.Chronic

gastritis18Clinicalmanifestation

RecurrentabdominalpainDyspepticsymptoms

Excessivebelching,acidregurgitation,hiccups,nausea,vomiting,diarrheaGrowthretardationUpperGIbleedingChronic

gastritis19Clinicalmanifestation

ArelativelyminormanifestationofdiseasesThesmallerthechildrenthemoreatypicalmanifestationChronic

gastritis20AuxiliaryexaminationsGastroscopicexaminationisthemostreliablemethodfordiagnosisofgastritisBiopsyX-ray:BariummealexaminationHPdetectionChronic

gastritis21DiagnosticmethodsofHPinfectionRapidureasetestUreabreathtest(C13)HistologySerumAntibodiestoHPBacterialCultureTestingforHPstoolantigenPolymerasechainreactionChronic

gastritis22NormalGastricMucosaNGM23GastricLymphoidHyperplasiaNormallythereisnoorganizedlymphoidtissueinthestomach.MultiplepapulesintheantrumcorrespondingtolymphoidhyperplasiainducedbyHelicobacterpyloriinfection.

NGM24AlkalineRefluxGastritis

NormalgastricmucosaStomachmucosadiffuselycoveredwithbile-stainedmucus.

NGM25GastricCandidiasis

NormalgastricmucosaGastriccandidiasiswithextensivegreen-whiteexudatescoveringtheantrum.

26ChronicAntralGastritis

IncreasedvisibilityoftheantralvascularpatternwithfindingscompatiblewithchronicathrophicgastritisassociatedwithH.pyloriinfection.

Therugalfoldsofthebodyrunninglongitudinallytowardstheantrum.

27DiagnosisRecurrentabdominalpainand/ordyspepticsymptominchildrenGastroendoscopicexaminationHistory:Inappropriatedietaryhabits,familyhistory,medicationtaking,psychologicalstressChronic

gastritis28DifferentialDiagnosisChronic

gastritisEnterosite(ascarisinfection)Enterospasm29TreatmentEtiologictreatment:Dietaryadjustment,quitirritantdrugsorotherstimulus,HPeradication,trytocontrolthebilereflux,etcSymptomatictreatmentProtectionofgastricmucosaInhibitionofgastricacidChronic

gastritis30HPeradicationChooseonedrugbelowPPIOmeprazoleLansoprazoleBismuthpreparationBismuthSubsalicylateBasicChoosetwoantibioticsbelowAmoxicillinClarithromycinMetronidazoleFuraxoneTripleregimensChronic

gastritis31

PreventionofduodenogastricReflux.

DoperidomeCisapride

Reducinggastricacidsecretion.

H2RT(for4weeks):

RanitidingCimetidinePPI(for2weeks)

OmeprazoleLansoprazoleChronic

gastritis32

Enhancingmucosal