儿童胃炎(英文)

nullGASTRITIS IN CHILDREN GASTRITIS IN CHILDREN Chongqing Children’s Hospital Division of Infectious Disease and Gastroenterologynull Gastritis Acute Gastritis Chronic GastritisAcute GastritisAcute GastritisAcute gastritisAcute gastritis Diffination Etiology & Pathogenesis PathologynullFood 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 gastritisEtiology & Pathogenesisnull 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 gastritisManifestationsDiagnosisDiagnosis 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 lesionTreatment 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, PPITreatment Chronic gastritisChronic gastritisThe top two reasons for recurrent abdominal pain in children are chronic gastritis & PUDThe top two reasons for recurrent abdominal pain in children are chronic gastritis & PUDAn estimated 10% school age children is affected by recurrent abdominal pain.nullBy 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 childrenClassificationClassification Update Sydney System in 1996 Superficial Chronic Gastritis Atrophic Specific typesEtiologyEtiology Helicobacter pylori (HP) Bile reflux Dietary Habit Sequela of acute gastritis Drugs Psychological and genetic factors: Emotional stress Chronic Disease Other factorsHelicobacter ploriHelicobacter plorinullH 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 manifestationClinical manifestation Recurrent abdominal pain Dyspeptic symptoms Excessive belching, acid regurgitation, hiccups, nausea, vomiting, diarrhea Growth retardation Upper GI bleeding Clinical manifestationClinical manifestation A relatively minor manifestation of diseases The smaller the children the more atypical manifestation Auxiliary examinationsAuxiliary examinationsGastroscopic examination is the most reliable method for diagnosis of gastritis Biopsy X-ray: Barium meal examination HP detectionnullDiagnostic 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 DiagnosisDiagnosisRecurrent abdominal pain and/or dyspeptic symptom in children Gastroendoscopic examinationHistory: Inappropriate dietary habits, family history, medication taking, psychological stressDifferential DiagnosisDifferential DiagnosisEnterosite Enterospasm Abdominal epilepsy TreatmentTreatmentEtiologic 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 acidHP eradicationHP eradicationTriple regimensnull Prevention of duodenogastric Reflux. Doperidome Cisapride Reducing gastric acid secretion. H2RT (for 4 weeks): Ranitiding Cimetidine PPI (for 2 weeks) Omeprazole Lansoprazolenull Enhancing mucosal defense Bismuth compounds Sucrafate Symptomatic treatment Atropine BelladonnaNormal Gastric Mucosa Normal Gastric Mucosa NGMgastric mucosal edema gastric mucosal edema NGMHemorrhagic gastritis Hemorrhagic gastritis Hemorrhagic gastritis with multiple intramural bleeding spots NGMGastric Lymphoid HyperplasiaGastric Lymphoid HyperplasiaNormally there is no organized lymphoid tissue in the stomach. Multiple papules in the antrum corresponding to lymphoid hyperplasia induced by Helicobacter pylori infection. NGMAlkaline Reflux Gastritis Alkaline Reflux Gastritis Normal gastric mucosa Stomach mucosa diffusely covered with bile-stained mucus. NGMGastric Candidiasis Gastric Candidiasis Normal gastric mucosa Gastric candidiasis with extensive green-white exudates covering the antrum. Chronic Antral Gastritis 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. Thank you.Thank you.