《儿科学教学课件》17、儿童慢性胃炎(下)

1、Chronic Gastritis in Children,Introduction,Chronic gastritis is a chronic inflammation of the gastric mucosa caused by long-term or repeated harmful factors Chronic gastritis is a common disease of the upper digestive tract in childhood The main diagnosic method are gastroscopy and pathological exam

2、ination,Classification,1. Chronic superficial gastritis (CSG): 90-95% 2. Chronic atrophic gastritis,Etiology,1. Infection of Helicobacter Pylori (HP) 2. Bile reflux 3. The further development of acute gastritis Bad eating habits or improper diet Adverse reaction of medicine Non-steroidal anti-inflam

3、matory drugs NSAIDs Cortisone, etc food allergy 4. Others neuropsychiatric factors Stress, fatigue or overwork chronic diseases genetic factos,Helicobacter Pylori(HP),Etiology,1. Infection of Helicobacter Pylori (HP) 2. Bile reflux 3. The further development of acute gastritis Bad eating habits or i

4、mproper diet Adverse reaction of medicine Non-steroidal anti-inflammatory drugs NSAIDs Cortisone, etc food allergy 4. Others neuropsychiatric factors Stress, fatigue or overwork chronic diseases genetic factos,The severity is varying. The course is varying 1. Recurrent abdominal pain： recurrent lack

5、 of regularity intensity location the relationship with diet 2. Other dyspepsia symptoms 3. Growth stunted： 4. Upper gastrointestinal bleeding：,Clinical manifestations,The younger the children, the less typical of abdominal pain,1. Gastroscope： the first choice for examination the basis of diagnosis

6、 2. Pathological examination of gastric mucosa Chronic superficial gastritis(CSG) Chronic atrophic gastritis 3. Barium meal X-ray examination 4. Bacteriological examination for HP infection bacterial culture tissue section staining Hp urease rapid urease test 13C-urea breath test urea NH4+ + CO2 exa

7、mination of serum Antibody against HP,Auxiliary examination,Normal gastric mucosa,Edema of gastric mucosa,Hemorrhagic gastritis,Hemorrhagic gastritis with multiple intramural bleeding spots,Normal gastric mucosa,Lymphatic hyperplastic nodule in antrum of stomach caused by HP,Gastritis caused by bile

8、 reflux,Chronic antral gastritis,1. Gastroscope： the first choice for examination the basis of diagnosis 2. Pathological examination of gastric mucosa Chronic superficial gastritis(CSG) Chronic atrophic gastritis 3. Barium meal X-ray examination 4. Bacteriological examination for HP infection bacter

9、ial culture tissue section staining Hp urease rapid urease test 13C-urea breath test urea NH4+ + CO2 examination of serum Antibody against HP,Auxiliary examination,Helicobacter Pylori(HP) Silver stain,1. Gastroscope： the first choice for examination the basis of diagnosis 2. Pathological examination

10、 of gastric mucosa Chronic superficial gastritis(CSG) Chronic atrophic gastritis 3. Barium meal X-ray examination 4. Bacteriological examination for HP infection bacterial culture tissue section staining Hp urease rapid urease test 13C(14C)-urea breath test urea NH4+ + CO2 examination of serum antib

11、ody against HP,Auxiliary examination,1. Clinical manifestations 2. Medical history 3. Gastroscope and pathological examination of gastric mucosa 4. Bacteriological examination for HP infection,Diagnosis,Intestinal ascariasis Enterospasm Functional abdominal pain caused by psychological factors,Diffe

12、rential diagnosis,1. Remove the causes 1) anti-HP infection 2) discontinuation drugs causing gastric mucosal injury 3) reduce stress 2. Dietotherapy 3. Pharmacotherapy 1) symptomatic treatment 2) gastric mucosal protective agent: Sucralfate Bismuth potassium citrate , etc 3) antacids: H2 receptor in

13、hibitor (H2RI) PPI Aluminum hydroxide 4) gastroprokinetic agent: Domperidone (Motilium),Treatment,Anti-HP drugs Antibiotics: Amoxycillin Clarithromycin Metronidazole, etc. Bismuth agent: Bismuth potassium citrate, etc PPI,Treatment,Anti-HP regimen 1. PPI triple therapy PPI + 2 antibiotics 1w or 2w 2

14、. bismuth agent triple therapy Bismuth potassium citrate + 2 antibiotics 4w6w 2w 3. bismuth agent Quadruple therapy Bismuth potassium citrate + H2RI + 2 antibiotics 4w6w 4w8w 2w,Treatment,1. Remove the causes 1) anti-HP infection 2) discontinuation drugs causing gastric mucosal injury 3) reduce stress 2. Dietotherapy 3. Pharmacotherapy 1) sym