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1、 Introductionl Chronic gastritis is a chronic inflammation of the gastric mucosa caused by long-term or repeated harmful factorsl Chronic gastritis is a common disease of the upper digestive tract in childhoodl The main diagnosic method are gastroscopy and pathological examination Classification1. C
2、hronic superficial gastritis (CSG): p 90-95%2. Chronic atrophic gastritis 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 Corti
3、sone, etc o food allergy 4. Others o neuropsychiatric factors n Stress, fatigue or overworko chronic diseaseso genetic 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 Adv
4、erse reaction of medicine Non-steroidal anti-inflammatory drugs NSAIDs Cortisone, etc o food allergy 4. Others o neuropsychiatric factors n Stress, fatigue or overworko chronic diseaseso genetic factos The severity is varying. The course is varying1. Recurrent abdominal pain：n recurrentn lack of reg
5、ularityn 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 1. Gastroscope：n the first choice for examinationn the basis of diagnosis2. Pat
6、hological examination of gastric mucosan Chronic superficial gastritis(CSG)n Chronic atrophic gastritis3. Barium meal X-ray examination4. Bacteriological examination for HP infectionn bacterial culturen tissue section staining Hp ureasen rapid urease testn 13C-urea breath test urea NH4+ + CO2n exami
7、nation 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 r
8、eflux Chronic antral gastritis 1. Gastroscope：n the first choice for examinationn the basis of diagnosis2. Pathological examination of gastric mucosan Chronic superficial gastritis(CSG)n Chronic atrophic gastritis3. Barium meal X-ray examination4. Bacteriological examination for HP infectionn bacter
9、ial culturen tissue section staining Hp ureasen rapid urease testn 13C-urea breath test urea NH4+ + CO2n examination of serum Antibody against HP Auxiliary examination Helicobacter Pylori(HP) Silver stain 1. Gastroscope：n the first choice for examinationn the basis of diagnosis2. Pathological examin
10、ation of gastric mucosan Chronic superficial gastritis(CSG)n Chronic atrophic gastritis3. Barium meal X-ray examination4. Bacteriological examination for HP infectionn bacterial culturen tissue section staining Hp ureasen rapid urease testn 13C(14C)-urea breath test urea NH4+ + CO2n examination of s
11、erum antibody against HP Auxiliary examination 1. Clinical manifestations2. Medical history3. Gastroscope and pathological examination of gastric mucosa4. Bacteriological examination for HP infection Diagnosis o Intestinal ascariasis o Enterospasmo Functional abdominal pain caused by psychological f
12、actorsDifferential diagnosis 1. Remove the causes 1) anti-HP infection 2) discontinuation drugs causing gastric mucosal injury 3) reduce stress2. Dietotherapy3. Pharmacotherapy 1) symptomatic treatment 2) gastric mucosal protective agent:n Sucralfaten Bismuth potassium citrate , etc 3) antacids: n H
13、 2 receptor inhibitor (H2RI)n PPIn Aluminum hydroxide 4) gastroprokinetic agent: Domperidone (Motilium) Treatment o Anti-HP drugsn Antibiotics:o Amoxycillino Clarithromycino Metronidazole, etc.n Bismuth agent: o Bismuth potassium citrate, etcn PPI Treatment Anti-HP regimen1. PPI triple therapy PPI +
14、 2 antibiotics 1w or 2w2. bismuth agent triple therapy Bismuth potassium citrate + 2 antibiotics 4w6w 2w3. bismuth agent Quadruple therapy Bismuth potassium citrate + H 2RI + 2 antibiotics 4w6w 4w8w 2w Treatment 1. Remove the causes 1) anti-HP infection 2) discontinuation drugs causing gastric mucosal injury 3) reduce stress2. Dietotherapy3. Pharmacotherapy 1) symptomatic treatment 2) gastric mucosal protective agent:n Sucralfaten Bismuth potassium citrate, etc 3) antacids: n H 2 receptor inhibitor (H2RI)n PPIn Aluminum hydroxide 4) gastroprokinetic agent: Domperidone (Motilium) Treatment
《兒科學教學課件》17、兒童慢性胃炎(下)
