1. GASTRITIS Primary HP 10%western Countries up to 100% in under developed countries. Primary duodenal ulcer almost always HP Very rare in children below 1 year.

2. GASTRITIS SECONDARY CAUSES: 1.Severe Stress Systemic illness,BurnsHead injury 2.NSAID Ibuprofenmefanamic acid * inhibitHCo 3 Secretion *5 foldsHigh risk of massive bleeding 3.Cauresive gastritismainly Oesphagus 4.Croh ’ s disease 30% ulcer,Can occur at any age,Associated with high mortality 5.Others IronKcl AntibioticsPenicillinTetracyclinCephalosporin

3. PATHOGENESIS Peptic ulcer disease described as a discontinuity in gastric and duodenal mucosa exposed to acid or pepsin. Cause: Loss of balance between mucosal protective mechanism and aggressive factors of acid and pepsin production. Peptic ulcer: deep mucosal lesion Penetrate muscle layer Peptic erosionSuperficial mucosal lesion Don ’ t penetrate muscle coat Site GastricLesser curvature 90% duodenal palb

4. Definition of Gastritis Microscopic evidence of inflammation affecting the gastric mucosa TYPES:ActivePMNL ChronicNopMNLPlasma cells Chronic Active  both acute and chronic inflammatory cells AtrophicAutoimmune Anti parietal cell Ab 

5. HP colonization of gastric mucosa Adultsacute gastritis metaplasia Childrenchronic gastritis in nature no metaplasia Etiology Acid aggressivehost defense* HCo 3 + water Pepsin factor* mucous layer * Blood flow * rapid cell turnover

6. PEPTIC ULCER IN CHILDREN a.d. Incomplete pentrance of hyper pepsingemia in children and parents Blood group O 3 times more common in twins. 60% of children have 1 st degree relatives with peptic ulcer disease.

7. SYMPTOMS Epigastric pain Fullnessnauseavomiting Anorexia Abdominal pain in children present as irritability change of normal feeding pattern  IDA resistant treatment fatigue

8. Zellinger – Ellison disease: More in male TriadSevere ulcer disease gastric acid hyper secretion gastrinoma Pancreas Gastric duodenal

9. How to diagnose Barium contrast study … not sensitive about 40% missed Upper GI Endoscopy The investigation of choice 3 biopsies Gross nodularty indicate HP infection in children not adult The value is doubtful in acute bleeding

10. PROTECTION adequate nutritional states erp frequent consumption of fruits and vegetable Vit. C? HP gm – ve spiral shaped, unibolar flagellated bacteria Colonize gastric mucosa anywhere. There is an association between chronic HP Colonization and development of gastric cancer. Mode of transmission Dental plaques fears person to persons “ vomiting ”