GASTRITIS IN CHILDREN

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GASTRITIS IN CHILDREN

• Chongqing Childrens Hospital
• Division of Infectious Disease
• and Gastroenterology

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• Gastritis
• Acute Gastritis
• Chronic Gastritis

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Acute Gastritis
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Acute gastritis

• Diffination
• Etiology Pathogenesis
• Pathology

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Acute gastritis
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
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Acute gastritis
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

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Diagnosis

• Acute simple gastritis
• History
• symptoms and signs
• 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

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1. 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

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Chronic gastritis
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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.
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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

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Classification
Update Sydney System in 1996
Superficial Chronic Gastritis Atrophic
Specific types
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Etiology

• Helicobacter pylori (HP)
• Bile reflux
• Dietary Habit
• Sequela of acute gastritis
• Drugs
• Psychological and genetic factors Emotional
  stress
• Chronic Disease
• Other factors

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Helicobacter plori
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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.
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Clinical manifestation

• Recurrent abdominal pain
• Dyspeptic symptoms
• Excessive belching, acid regurgitation,
  hiccups, nausea, vomiting, diarrhea
• Growth retardation
• Upper GI bleeding

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Clinical manifestation

• A relatively minor manifestation of diseases
• The smaller the children the more atypical
  manifestation

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Auxiliary examinations

• Gastroscopic examination is the most reliable
  method for diagnosis of gastritis
• Biopsy
• X-ray Barium meal examination
• HP detection

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• 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
  

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Diagnosis

• Recurrent abdominal pain and/or dyspeptic symptom
  in children

Gastroendoscopic examination
History Inappropriate dietary habits, family
history, medication taking, psychological stress
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Differential Diagnosis
Enterosite Enterospasm Abdominal epilepsy
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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

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HP eradication
Triple regimens
Choose one drug below Choose one drug below
PPI Omeprazole
PPI Lansoprazole
Bismuth preparation Bismuth Subsalicylate Basic
Choose two antibiotics below
Amoxicillin
Clarithromycin
Metronidazole
Furaxone
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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

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• Enhancing mucosal defense
• Bismuth compounds
• Sucrafate
• Symptomatic treatment
• Atropine
• Belladonna

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Normal Gastric Mucosa
NGM
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gastric mucosal edema
NGM
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Hemorrhagic gastritis
Hemorrhagic gastritis with multiple intramural
bleeding spots
NGM
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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.
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Alkaline Reflux Gastritis
NGM
Normal gastric mucosa
Stomach mucosa diffusely covered with
bile-stained mucus.
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Gastric Candidiasis
Gastric candidiasis with extensive green-white
exudates covering the antrum.
Normal gastric mucosa
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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.
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Thank you.