Slide 1 GASTRITIS IN CHILDREN Chongqing Childrens Hospital Division of Infectious Disease and Gastroenterology Chongqing Childrens Hospital Division of Infectious Disease and Gastroenterology Slide 2 2 Gastritis Acute Gastritis Chronic Gastritis Slide 3 3 Acute Gastritis Slide 4 4 Diffination Etiology & Pathogenesis Pathology Acute gastritis Slide 5 5 Food and Drugs: Severe stress state: Acute infection: Corrosive substances: 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 Shock, hydrocephalus, sudden trauma, serious infection, major operation, etc Acute gastritis Etiology & Pathogenesis Slide 6 6 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 Acute gastritis Manifestations Slide 7 7 Diagnosis Acute simple gastritis History symptoms and signs GI endoscopy & Biopsy (if necessary) Acute gastritis 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 Slide 8 8 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 Treatment Acute gastritis Slide 9 9 Chronic gastritis Slide 10 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. Slide 11 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 Chronic gastritis Slide 12 12 Classification Update Sydney System in 1996 Superficial Chronic Gastritis Atrophic Specific types Chronic gastritis Slide 13 13 Etiology Helicobacter pylori (HP) Bile reflux Dietary Habit Sequela of acute gastritis Drugs Psychological and genetic factors: Emotional stress Chronic Disease Other factors Chronic gastritis Slide 14 14 Helicobacter plori Chronic gastritis Slide 15 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. Chronic gastritis Slide 16 16 Clinical manifestation Recurrent abdominal pain Dyspeptic symptoms Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea Growth retardation Upper GI bleeding Recurrent abdominal pain Dyspeptic symptoms Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea Growth retardation Upper GI bleeding Chronic gastritis Slide 17 17 Clinical manifestation A relatively minor manifestation of diseases The smaller the children the more atypical manifestation Chronic gastritis Slide 18 18 Auxiliary examinations Gastroscopic examination is the most reliable method for diagnosis of gastritis Biopsy X-ray: Barium meal examination HP detection Chronic gastritis Slide 19 19 Diagnostic methods of HP infection Rapid urease test Urea breath test(C 13 ) Histology Serum Antibodies to HP Bacterial Culture Testing for HP stool antigen Polymerase chain reaction Chronic gastritis Slide 20 20 Diagnosis Recurrent abdominal pain and/or dyspeptic symptom in children Gastroendoscopic examination History: Inappropriate dietary habits, family history, medication taking, psychological stress Chronic gastritis Slide 21 21 Differential Diagnosis Chronic gastritis Enterosite Enterospasm Abdominal epilepsy Slide 22 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 Chronic gastritis Slide 23 23 HP eradication Choose one drug below PPIOmeprazole Lansoprazole Bismuth preparation Bismuth Subsalicylate Basic Choose two antibiotics below Amoxicillin Clarithromycin Metronidazole Furaxone Triple regimens Chronic gastritis Slide 24 24 Prevention of duodenogastric Reflux. Doperidome Cisapride Reducing gastric acid secretion. H2RT (for 4 weeks): Ranitiding Cimetidine PPI (for 2 weeks) Omeprazole Lansoprazole Chronic gastritis Slide 25 25 Enhancing mucosal defense Bismuth compounds Sucrafate Symptomatic treatment Atropine Belladonna Chronic gastritis Slide 26 26 Normal Gastric Mucosa NGM Slide 27 27 gastric mucosal edema NGM Slide 28 28 Hemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGM Slide 29 29 Gastric Lymphoid Hyperplasia Normally there is no organized lymphoid tissue in the stomach. Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection. NGM Slide 30 30 Alkaline Reflux Gastritis Normal gastric mucosa Stomach mucosa diffusely covered with bile-stained mucus. NGM Slide 31 31 Gastric Candidiasis Normal gastric mucosa Gastric candidiasis with extensive green-white exudates covering the antrum. Slide 32 32 Chronic Antral Gastritis Increased visibility of the antral vascular pattern with findings compatible with chronic athrophic gastritis associated with H. pylori infection. The rugal folds of the body running longitudinally towards the antrum. Slide 33 33 Thank you.