GASTRITIS IN
CHILDREN
Chongqing Children’s 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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?Diffination
?Etiology & Pathogenesis
?Pathology
Acute gastritis
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?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
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④ 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
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⑤ 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
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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
⑥ Treatment
Acute gastritis
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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
Chronic gastritis
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Classification
Update Sydney System in 1996
Superficial
Chronic Gastritis Atrophic
Specific types
Chronic gastritis
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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
Chronic gastritis
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Helicobacter plori
Chronic gastritis
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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.
Chronic gastritis
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Clinical manifestation
? Recurrent abdominal pain
? Dyspeptic symptoms
Excessive belching,acid regurgitation,
hiccups,nausea,vomiting,diarrhea
? Growth retardation
? Upper GI bleeding
Chronic gastritis
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Clinical manifestation
? A relatively minor
manifestation of diseases
? The smaller the children the
more atypical manifestation
Chronic gastritis
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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
Chronic gastritis
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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
Chronic gastritis
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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
Chronic gastritis
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Differential Diagnosis
Chronic gastritis
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
Chronic gastritis
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HP eradication
Choose one drug below
PPI Omeprazole
Lansoprazole
Bismuth
preparation
Bismuth
Subsalicylate
Basic
Choose two
antibiotics below
Amoxicillin
Clarithromycin
Metronidazole
Furaxone
Triple regimens
Chronic gastritis
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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
Chronic gastritis
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? Enhancing mucosal defense
Bismuth compounds
Sucrafate
? Symptomatic treatment
Atropine
Belladonna
Chronic gastritis
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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
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
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Alkaline Reflux Gastritis
Normal gastric
mucosa
Stomach mucosa diffusely
covered with bile-stained mucus.
NGM
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Gastric Candidiasis
Normal gastric
mucosa
Gastric candidiasis with
extensive green-white exudates
covering the antrum.
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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.
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Thank you.