《儿科学教学》17、儿童慢性胃炎（下）

1、编辑ppt编辑pptIntroductionlChronic gastritis is a chronic inflammation of the gastric mucosa caused by long-term or repeated harmful factorslChronic gastritis is a common disease of the upper digestive tract in childhoodlThe main diagnosic method are gastroscopy and pathological examination 编辑pptClassif

2、ication1. Chronic superficial gastritis (CSG): p 90-95%2. Chronic atrophic gastritis编辑pptEtiology1. Infection of Helicobacter Pylori (HP) 2. Bile reflux3. The further development of acute gastritiso Bad eating habits or improper diet o Adverse reaction of medicine Non-steroidal anti-inflammatory dru

3、gs NSAIDs Cortisone, etc o food allergy 4. Othersoneuropsychiatric factors nStress, fatigue or overworkochronic diseasesogenetic factos 编辑pptHelicobacter Pylori(HP)编辑ppt编辑pptEtiology1. Infection of Helicobacter Pylori (HP) 2. Bile reflux3. The further development of acute gastritiso Bad eating habit

4、s or improper diet o Adverse reaction of medicine Non-steroidal anti-inflammatory drugs NSAIDs Cortisone, etc o food allergy 4. Othersoneuropsychiatric factors nStress, fatigue or overworkochronic diseasesogenetic factos 编辑pptThe severity is varying. The course is varying1. Recurrent abdominal pain：

5、n recurrentn lack of regularityn intensity n locationn the relationship with diet2. Other dyspepsia symptoms3. Growth stunted：4. Upper gastrointestinal bleeding：Clinical manifestationsThe younger the children, the less typical of abdominal pain编辑ppt1. Gastroscope：nthe first choice for examinationnth

6、e basis of diagnosis2. Pathological examination of gastric mucosanChronic superficial gastritis(CSG)nChronic atrophic gastritis3. Barium meal X-ray examination4. Bacteriological examination for HP infectionnbacterial culturentissue section staining Hp ureasenrapid urease testn13C-urea breath test ur

7、ea NH4+ + CO2nexamination of serum Antibody against HPAuxiliary examination编辑pptNormal gastric mucosa 编辑pptEdema of gastric mucosa编辑pptHemorrhagic gastritisHemorrhagic gastritis with multiple intramural bleeding spots Normal gastric mucosa 编辑pptLymphatic hyperplastic nodule in antrum of stomach caus

8、ed by HP编辑pptGastritis caused by bile reflux编辑pptChronic antral gastritis编辑ppt1. Gastroscope：nthe first choice for examinationnthe basis of diagnosis2. Pathological examination of gastric mucosanChronic superficial gastritis(CSG)nChronic atrophic gastritis3. Barium meal X-ray examination4. Bacteriol

9、ogical examination for HP infectionnbacterial culturentissue section staining Hp ureasenrapid urease testn13C-urea breath test urea NH4+ + CO2nexamination of serum Antibody against HPAuxiliary examination编辑pptHelicobacter Pylori(HP) Silver stain编辑ppt1. Gastroscope：nthe first choice for examinationnt

10、he basis of diagnosis2. Pathological examination of gastric mucosanChronic superficial gastritis(CSG)nChronic atrophic gastritis3. Barium meal X-ray examination4. Bacteriological examination for HP infectionnbacterial culturentissue section staining Hp ureasenrapid urease testn13C(14C)-urea breath t

11、est urea NH4+ + CO2nexamination of serum antibody against HPAuxiliary examination编辑ppt1. Clinical manifestations2. Medical history3. Gastroscope and pathological examination of gastric mucosa4. Bacteriological examination for HP infection Diagnosis编辑ppto Intestinal ascariasis o Enterospasmo Function

12、al abdominal pain caused by psychological factorsDifferential diagnosis编辑ppt1. Remove the causes 1) anti-HP infection 2) discontinuation drugs causing gastric mucosal injury3) reduce stress2. Dietotherapy3. Pharmacotherapy 1) symptomatic treatment 2) gastric mucosal protective agent:n Sucralfaten Bi

13、smuth potassium citrate , etc 3) antacids: n H2 receptor inhibitor (H2RI)n PPIn Aluminum hydroxide 4) gastroprokinetic agent: Domperidone (Motilium)Treatment编辑pptoAnti-HP drugsnAntibiotics:oAmoxycillinoClarithromycinoMetronidazole, etc.nBismuth agent: oBismuth potassium citrate, etcnPPI Treatment编辑p

14、ptAnti-HP regimen1. PPI triple therapy PPI + 2 antibiotics 1w or 2w2. bismuth agent triple therapy Bismuth potassium citrate + 2 antibiotics 4w6w 2w3. bismuth agent Quadruple therapy Bismuth potassium citrate + H2RI + 2 antibiotics 4w6w 4w8w 2w Treatment编辑ppt1. Remove the causes 1) anti-HP infection 2) discontinuation drugs causing gastric mucosal injury3) reduce stress2. Dietotherapy3. Pharmacotherapy 1) symptoma