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
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
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
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
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 Chronic gastritis
12 Classification Update Sydney System in 1996 Superficial Chronic Gastritis Atrophic Specific types Chronic gastritis
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
14 Helicobacter plori Chronic gastritis
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
17 Clinical manifestation A relatively minor manifestation of diseases The smaller the children the more atypical manifestation Chronic gastritis
18 Auxiliary examinations Gastroscopic examination is the most reliable method for diagnosis of gastritis Biopsy X-ray: Barium meal examination HP detection Chronic gastritis
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
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
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
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
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
30 Alkaline Reflux Gastritis Normal gastric mucosa Stomach mucosa diffusely covered with bile-stained mucus. NGM
31 Gastric Candidiasis Normal gastric mucosa Gastric candidiasis with extensive green-white exudates covering the antrum.
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.