GASTRITIS IN GASTRITIS IN CHILDRENCHILDRENGASTRITIS IN GASTRITIS IN CHILDRENCHILDREN

Chongqing Children’s HospitalChongqing Children’s HospitalDivision of Infectious Disease Division of Infectious Disease

and Gastroenterologyand Gastroenterology

Chongqing Children’s HospitalChongqing Children’s HospitalDivision of Infectious Disease Division of Infectious Disease

and Gastroenterologyand Gastroenterology

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Gastritis Acute Gastritis Chronic Gastritis

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Acute GastritisAcute Gastritis

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Diffination Etiology & Pathogenesis Pathology

Acute gastritisAcute gastritis

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Food and Drugs: Severe stress state:

Acute infection: Corrosive substances:

Vagal stimulationAcid secretion

Release of vasoactive amine and cytokinesMicrocirculation disdurbance

Gastric mucosal ischemiaImpairment of mucosal and mucous barriers

Back-diffusion of hydrogen ions

Shock, hydrocephalus, sudden trauma, serious infection, major operation, etc

AcuteAcute gastritisgastritis Etiology & PathogenesisEtiology & Pathogenesis

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④ ManifestationsManifestations A sudden onset Typical manifestations: epigastric pain, naus

ea, vomiting, watery diarrhea Fever: caused by bacterial infection or its tox

ins Complications: dehydration, electrolyte distu

rbances, acid-base imbalance, UGI bleeding

AcuteAcute gastritisgastritis ManifestationsManifestations

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⑤⑤ DiagnosisDiagnosis Acute simple gastritis

History

symptoms and signs

GI endoscopy & Biopsy (if necessary)

AcuteAcute gastritisgastritis

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

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A. Remove of offending agents Quit all irritants or stimulus: drugs, alcohol Management of the original diseasesB. Symptomatic treatment 1)Replacement of fluid and electrolyte loss 2)Spasmolysant: Atropine, Belladonna 4)Antiemetic drugs: Domperidone 3)Special management for upper GI bleedingC. Protection of gastric mucosa and inhibitio

n of gastric acid Mucosal protector Antacids: H2-RA, PPI

⑥⑥ Treatment Treatment AcuteAcute gastritisgastritis

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Chronic gastritisChronic gastritis

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The top two reasons for recurrent The top two reasons for recurrent abdominal pain in children are abdominal pain in children are

chronic gastritischronic gastritis && PUDPUD

The top two reasons for recurrent The top two reasons for recurrent abdominal pain in children are abdominal pain in children are

chronic gastritischronic gastritis && PUDPUD

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

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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

ChronicChronic gastritisgastritis

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ClassificationClassification

Update Sydney System in 1996

Superficial

Chronic Gastritis Atrophic

Specific types

ChronicChronic gastritisgastritis

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EtiologyEtiology Helicobacter pylori (HP) Bile reflux Dietary Habit Sequela of acute gastritis Drugs Psychological and genetic factors: E

motional stress Chronic Disease Other factors

ChronicChronic gastritisgastritis

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Helicobacter ploriHelicobacter ploriChronicChronic gastritisgastritis

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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.

ChronicChronic gastritisgastritis

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Clinical manifestationClinical manifestation Recurrent abdominal painRecurrent abdominal pain Dyspeptic symptomsDyspeptic symptoms Excessive belching, acid regurgitation, hicExcessive belching, acid regurgitation, hic

cups, nausea, vomiting, diarrheacups, nausea, vomiting, diarrhea

Growth retardationGrowth retardation Upper GI bleeding Upper GI bleeding

Recurrent abdominal painRecurrent abdominal pain Dyspeptic symptomsDyspeptic symptoms Excessive belching, acid regurgitation, hicExcessive belching, acid regurgitation, hic

cups, nausea, vomiting, diarrheacups, nausea, vomiting, diarrhea

Growth retardationGrowth retardation Upper GI bleeding Upper GI bleeding

ChronicChronic gastritisgastritis

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Clinical manifestationClinical manifestation

A relatively minor manifestatA relatively minor manifestation of diseases ion of diseases

The smaller the children the The smaller the children the more atypical manifestation more atypical manifestation

ChronicChronic gastritisgastritis

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Auxiliary examinationsAuxiliary examinations Gastroscopic examination is the

most reliable method for diagnosis of gastritis

Biopsy X-ray: Barium meal examination HP detection

ChronicChronic gastritisgastritis

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Diagnostic methods of HP infectionDiagnostic 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

ChronicChronic gastritisgastritis

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DiagnosisDiagnosisRecurrent abdominal pain and/or dyspeptic

symptom in children

Gastroendoscopic examination

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

ChronicChronic gastritisgastritis

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Differential DiagnosisDifferential Diagnosis

ChronicChronic gastritisgastritis

EnterositeEnterospasmAbdominal epilepsy

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TreatmentTreatment 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

ChronicChronic gastritisgastritis

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HP eradicationHP eradication

Choose one drug below

PPI Omeprazole

Lansoprazole

Bismuth preparation

Bismuth Subsalicylate Basic

Choose two antibiotics below

Amoxicillin

Clarithromycin

Metronidazole

Furaxone

Triple regimens

ChronicChronic gastritisgastritis

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Prevention of duodenogastric Reflux. Doperidome

Cisapride Reducing gastric acid secretion. H2RT (for 4 weeks):

Ranitiding

Cimetidine

PPI (for 2 weeks)

Omeprazole

Lansoprazole

ChronicChronic gastritisgastritis

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Enhancing mucosal defense

Bismuth compounds

Sucrafate Symptomatic treatment

Atropine

Belladonna

ChronicChronic gastritisgastritis

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Normal Gastric Mucosa Normal Gastric Mucosa

NGMNGM

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gastric mucosal edema gastric mucosal edema

NGMNGM

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Hemorrhagic gastritis Hemorrhagic gastritis

Hemorrhagic gastritis with multiple intramural bleeding spots

NGMNGM

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Gastric Lymphoid HyperplasiaGastric Lymphoid Hyperplasia

Normally there is no Normally there is no organized lymphoid tissue organized lymphoid tissue

in the stomach. in the stomach.

Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection.

NGMNGM

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Alkaline Reflux GastritisAlkaline Reflux Gastritis

Normal gastric Normal gastric mucosa mucosa

Stomach mucosa diffusely covered with bile-stained mucus.

NGMNGM

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Gastric CandidiasisGastric Candidiasis

Normal gastric Normal gastric mucosa mucosa

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

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Chronic Antral GastritisChronic 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.

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Thank you.Thank you.