Gastritis

Gastritis: Excerpt from The 5-Minute Pediatric Consult

Janice A. Kelly, MD

Gastritis - BASICS

Gastritis - description

Microscopic inflammation of mucosa of stomach. Most common cause of upper gastrointestinal tract hemorrhage in older children

Gastritis - epidemiology

One of most frequent GI diagnoses

Gastritis - prevalence

• 8 out of every 1,000 people
• >2% of ICU patients have heavy bleeding secondary to gastritis.

Gastritis - etiology

• Helicobacter pylori (children more likely to have more severe gastritis, specifically located in antrum of stomach). Classified by WHO as a class I carcinogen in 1994.
• Physiologic stress (e.g., in CNS disease, overwhelming sepsis, ICU patients)
• Major surgery; severe burns; renal, liver, respiratory failure; severe trauma
• Idiopathic
• Caustic ingestions (e.g., lye, strong acids, pine oil)
• Celiac disease: Lymphocytic gastritis
• Drug induced (e.g., NSAIDs, steroids, valproate; more rarely, iron, calcium salts, potassium chloride, antibiotics)
• Ethanol
• Protein sensitivity (e.g., cow’s milk–protein allergy), allergic enteropathy
• Eosinophilic gastroenteritis
• Crohn disease:
  • Up to 40% of Crohn patients have gastroduodenal involvement.
  • Gastric Crohn may manifest itself as highly focal, non–Helicobacter pylori, non–granulomatous gastritis
• Infection (e.g., tuberculosis, Helicobacter pylori, cytomegalovirus, parasites)
• Less common causes:
  • Radiation
  • Hypertrophic gastritis (Ménétrier disease)
  • Autoimmune gastritis
  • Collagenous gastritis
  • Zollinger-Ellison syndrome
  • Vascular injury
  • Direct trauma (nasogastric tubes)

Gastritis - DIAGNOSIS

Gastritis - signs & symptoms

Gastritis - history

• Epigastric pain
• Abdominal indigestion
• Nausea
• Vomiting postprandially
• Vomiting blood or coffee ground–like material
• Diarrhea
• Dark or black stools (or bright red blood from rectum, if bleeding is brisk and intestinal transit time is short)
• Irritability
• Poor feeding and weight loss
• Less often: Chest pain, hematemesis, melena

Gastritis - physical exam

• Epigastric tenderness is physical finding that most closely correlates with gastritis on endoscopy.
• Normal bowel sounds

Gastritis - tests

Gastritis - lab

• Heme-test all stools.
• CBC for anemia with other signs of chronic blood loss (e.g., microcytosis, low reticulocyte count)
• Helicobacter pylori identification:
  • Noninvasive H. pylori tests, including antibody (from serum, whole blood, saliva, or urine), antigen (from stool), or urea breath testing (UBT). UBT (using ¹³C) and stool antigen tests are more reliable and sensitive than antibody testing; serologic testing is not recommended. However, UBT is not widely available, and is used primarily in adults.
  • Rapid urease test from gastric biopsy specimen for H. pylori
  • Silver Warthin-Starry stain, Genta stain, modified Giemsa stain, or cresyl violet stain of gastric biopsy for H. pylori
  • Culture of homogenized gastric biopsy for H. pylori (difficult to perform outside of research setting)

Gastritis - imaging

• Upper GI radiography when endoscopy not available
• Chest radiograph may detect free abdominal air secondary to perforation.

Gastritis - diag proced-surgery

Upper endoscopy with biopsies:

• Sensitivity greatest
• Possible findings:
  • Edema around small ulcers
  • Thickened hyperemic mucosa
  • Atrophic mucosa
  • Antral micronodules (represent lymphoid follicles) commonly seen in children with Helicobacter pylori infection
  • Antral and prepyloric edema with retained gastric secretions

Gastritis - differencial diagnosis

Of epigastric abdominal pain:

• Gastroesophageal reflux with esophagitis
• Peptic ulcer disease
• Biliary tract disorders
• Pancreatitis
• Inflammatory bowel disease
• Genitourinary pathology (renal stones, infection)
• Nonulcer dyspepsia
• Functional pain
• Allergic enteropathy

Gastritis - TREATMENT

Gastritis - general measures

Gastritis - diet

• Benefit of changes in diet is inconclusive.
• Eliminate alcohol, tobacco, and caffeine.

Gastritis - medication

• Antacids or H
• Ranitidine: 2 –3 mg/kg/dose b.i.d. to t.i.d. in children
• Cimetidine: 10 mg/kg/dose q.i.d. (can be used prophylactically for hospitalized patients at risk for physiologic stress)
• Famotidine: 0.5–2 mg/kg/d divided twice
• Omeprazole, lansoprazole, rabeprazole, or esomeprazole 1 mg/kg/d

Gastritis - FOLLOW UP

Gastritis - prognosis

Significant gastritis relapse rates for children who remain infected with Helicobacter pylori

Gastritis - complications

• Bleeding (from mild to hemorrhagic)
• When gastritis caused by acid/alkali ingestions, outlet obstruction may result from prepyloric strictures (4–8 weeks after ingestion)

Gastritis - patient monitoring

• For stress gastritis with hemorrhage, provide vigilant supportive care with close monitoring of hemodynamics, fluids, and electrolytes.
• Monitor for hemoccult-positive stools.
• Follow CBCs.
• May elect to repeat endoscopy in severe cases

Gastritis - bibliography

1. Aannpreung, P. Hematemesis in infants induced by cow’s milk allergy. Asian Pac J Allergy Immunol. 2003;21(4):211–216.
2. Anand BS, Graham DY. Ulcer and gastritis. Endoscopy. 1999:31(2):215–225.
3. Blecker U, Gold BD. Gastritis and peptic ulcer disease in childhood. Eur J Pediatr. 1999:158(7):541–546.
4. Delvin E, Brazier J, Deslandres C, et al. Accuracy of C13–urea breath test in diagnosing Helicobacter pylori gastritis in pediatric patients. J Pediatr Gastroenterol Nutr. 1999;28:59–62.
5. Drumm B, Koletzko S, Oderda G. Helicobacter pylori infection in children: A consensus statement. European Paediatric Task Force on Helicobacter pylori. J Pediatr Gastroenterol Nutr. 2000;30:207–213.
6. Hino B, Eliakim R, Levine A, et al. Comparison of invasive and non-invasive tests for diagnosis and monitoring of Helicobacter Pylori infection in children. J Pediatr Gastroenterol Nutr. 2004;39:519–523.
7. Malaty HM. Helicobacter pylori infection and eradication in pediatric patients. Paediatr Drugs. 2000;2:357–365.
8. Pashankar DS, Bishop W, Mitros FA. Chemical gastropathy: A distinct histopathologic entity in children. J Pediatr Gastroenterol Nutr. 2002;35:653–657.
9. Stancu M, De Petris G, Palumbo TP, et al. Collagenous colitis associated with lymphocytic gastritis and celiac disease. Arch Pathol Lab Med. 2001;124:1579–1584.
10. Vesoulis Z, Lozanski G, Ravichandran P, et al. Collagenous gastritis: A case report, morphologic evaluation, and review. Mod Pathol. 2000;13:591–596.
11. Weinstein WM. Emerging gastritides. Curr Gastroenterol Rep. 2001;3:523–527.
12. Zheng P-Y, Jones NL. Recent advances in Helicobacter pylori infection in children: From the petri dish to the playground. Can J Gastro. 2003;17:448–454.
13. Zimmermann AE, Walters JK, Katona BG, et al. A review of omeprazole use in the treatment of acid-related disorders in children. Clin Ther. 2001;23:660–679.

Gastritis - CODES

Gastritis - icd9

• 041.86 Helicobacter pylori (h. pylori) infection
• 535 Gastritis and duodenitis
• 535.0 Acute gastritis
• 535.01 Acute gastritis with hemorrhage

Gastritis - FAQ

• Q: Will a bland diet help to resolve gastritis?
• A: Dietary changes have not been shown to affect the natural course of gastritis.
• Q: What is helicobacter pylori?
• A: H. pylori, is a bacterium frequently found in the gastric mucosa of patients with gastritis and peptic ulcer disease. It can be diagnosed by a variety of means, often including a combination of upper endoscopy and urea breath tests. Relapse rates for gastritis secondary to H. pylori are high when the infection is left untreated.
• Q: Is it appropriate to treat cases of gastritis, not proven by culture?
• A: No. It is important to treat only confirmed H. pylori infections, not to treat on suspicion of infection.

Book Source Details

• Book Title: The 5-Minute Pediatric Consult
• Author(s): M. William Schwartz MD; et al.
• Year of Publication: 2008
• Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.

More About Gastritis

• Back to disease: Gastritis: Introduction
• Next Book Extract About Gastritis: Surveys relating to Gastritis
• More Book Extracts: All Online Books for Gastritis

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: The 5-Minute Pediatric Consult Authors: M. William Schwartz MD; et al. Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7577-9

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