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

2. Gastritis
Acute Gastritis
Chronic Gastritis

3. Acute Gastritis

4. Etiology & Pathogenesis Pathology
Acute gastritis
Diffination
Etiology & Pathogenesis
Pathology

5. 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

6. 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

7. 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

8. 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

9. Chronic gastritis

10. 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

11. 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

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

13. 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

14. Chronic gastritis
Helicobacter plori

15. 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.

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

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

18. 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

19. 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

20. 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

21. Differential Diagnosis
Chronic gastritis
Differential Diagnosis
Enterosite
Enterospasm
Abdominal epilepsy

22. 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

23. 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

24. 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

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

26. Normal Gastric Mucosa
NGM

27. gastric mucosal edema
NGM

28. Hemorrhagic gastritis
Hemorrhagic gastritis with multiple intramural bleeding spots
NGM

29. 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.

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

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

32. 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.

33. Thank you.