《兒科學(xué)教學(xué)課件》兒童慢性胃炎（下）

IntroductionlChronic 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 Classification1. Chronic superficial gastritis (CSG): p 90-95%2. Chronic atrophic gastritisEtiology1. 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 drugs NSAIDs Cortisone, etc o food allergy 4. Othersoneuropsychiatric factors nStress, fatigue or overworkochronic diseasesogenetic factos Helicobacter Pylori(HP)Etiology1. 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 drugs NSAIDs Cortisone, etc o food allergy 4. Othersoneuropsychiatric factors nStress, fatigue or overworkochronic diseasesogenetic factos The severity is varying. The course is varying1. Recurrent abdominal pain：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 pain1. 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. Bacteriological examination for HP infectionnbacterial culturentissue section staining Hp ureasenrapid urease testn13C-urea breath test urea NH4+ + CO2nexamination of serum Antibody against HPAuxiliary examinationNormal gastric mucosa Edema of gastric mucosaHemorrhagic gastritisHemorrhagic gastritis with multiple intramural bleeding spots Normal gastric mucosa Lymphatic hyperplastic nodule in antrum of stomach caused by HPGastritis caused by bile refluxChronic antral gastritis1. 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. Bacteriological examination for HP infectionnbacterial culturentissue section staining Hp ureasenrapid urease testn13C-urea breath test urea NH4+ + CO2nexamination of serum Antibody against HPAuxiliary examinationHelicobacter Pylori(HP) Silver stain1. 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. Bacteriological examination for HP infectionnbacterial culturentissue section staining Hp ureasenrapid urease testn13C(14C)-urea breath test urea NH4+ + CO2nexamination of serum antibody against HPAuxiliary examination1. Clinical manifestations2. Medical history3. Gastroscope and pathological examination of gastric mucosa4. Bacteriological examination for HP infection Diagnosiso Intestinal ascariasis o Enterospasmo Functional abdominal pain caused by psychological factorsDifferential diagnosis1. 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 Bismuth potassium citrate , etc 3) antacids: n H2 receptor inhibitor (H2RI)n PPIn Aluminum hydroxide 4) gastroprokinetic agent: Domperidone (Motilium)TreatmentoAnti-HP drugsnAntibiotics:oAmoxycillinoClarithromycinoMetronidazole, etc.nBismuth agent: oBismuth potassium citrate, etcnPPI TreatmentAnti-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 Treatment1. 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 Bismuth potassium citrate, etc 3) antacids: n H2 receptor inhibitor (H2RI)n PPIn Aluminum hydroxide 4) gastroprokinetic agent: Domperidone (Motilium)Treatment。