GASTRITIS IN CHILDREN Chongqing Children’s Hospital Division of Infectious Disease and Gastroenterology

Gastritis Acute Gastritis Chronic Gastritis

Acute Gastritis

Etiology & Pathogenesis Pathology Acute gastritis Diffination Etiology & Pathogenesis Pathology

Corrosive substances: 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

Manifestations Acute gastritis 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

Diagnosis Acute simple gastritis Acute 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

Treatment Acute gastritis 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

Chronic gastritis

An estimated 10% school age children is affected by recurrent abdominal pain. The top two reasons for recurrent abdominal pain in children are chronic gastritis & PUD

High frequency in children Chronic gastritis 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

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

Etiology Helicobacter pylori (HP) Bile reflux Dietary Habit Chronic gastritis 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 Helicobacter plori

Chronic gastritis 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.

Clinical manifestation Chronic gastritis Clinical manifestation Recurrent abdominal pain Dyspeptic symptoms Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea Growth retardation Upper GI bleeding

Clinical manifestation Chronic gastritis Clinical manifestation A relatively minor manifestation of diseases The smaller the children the more atypical manifestation

Auxiliary examinations Chronic gastritis Auxiliary examinations Gastroscopic examination is the most reliable method for diagnosis of gastritis Biopsy X-ray: Barium meal examination HP detection

Diagnostic methods of HP infection Chronic gastritis 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

Diagnosis Gastroendoscopic examination History: Chronic gastritis Diagnosis Recurrent abdominal pain and/or dyspeptic symptom in children Gastroendoscopic examination History: Inappropriate dietary habits, family history, medication taking, psychological stress

Differential Diagnosis Chronic gastritis Differential Diagnosis Enterosite Enterospasm Abdominal epilepsy

Treatment Etiologic treatment: Chronic gastritis 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

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

Prevention of duodenogastric Reflux. Chronic gastritis Prevention of duodenogastric Reflux. Doperidome Cisapride Reducing gastric acid secretion. H2RT (for 4 weeks): Ranitiding Cimetidine PPI (for 2 weeks) Omeprazole Lansoprazole

Enhancing mucosal defense Bismuth compounds Symptomatic treatment Chronic gastritis Enhancing mucosal defense Bismuth compounds Sucrafate Symptomatic treatment Atropine Belladonna

Normal Gastric Mucosa NGM

gastric mucosal edema NGM

Hemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGM

Gastric Lymphoid Hyperplasia NGM Normally there is no organized lymphoid tissue in the stomach. Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection.

Alkaline Reflux Gastritis NGM Normal gastric mucosa Stomach mucosa diffusely covered with bile-stained mucus.

Gastric Candidiasis Normal gastric mucosa Gastric candidiasis with extensive green-white exudates covering the antrum. Normal gastric mucosa

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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