Chronic gastritis in children

　　The etiology of chronic gastritis in children has not been fully clarified yet, and it may be related to the following factors:

　　1. Helicobacter pylori In recent years, it has been confirmed that Helicobacter pylori infection in the stomach is the main etiology.

　　2. Reflux of duodenal fluid When the pyloric sphincter function is disordered, it increases the reflux of duodenal fluid into the stomach. The duodenal fluid contains bile, intestinal juice, and pancreatic juice, which can destroy the normal barrier function of the gastric mucosa, causing chronic gastritis to persist.

　　3. Bacterial and viral infections After acute gastritis, some patients have gastric mucosal lesions that do not heal for a long time, developing into chronic gastritis; some children have infection foci in the nasal sinuses, oral cavity, and other places, and swallowing bacteria and toxins from these foci can cause inflammation of the gastric mucosa.

　　4. Chemical drugs During the pediatric period, frequent colds and fevers, and repeated use of non-steroidal anti-inflammatory drugs, can reduce the endogenous substances prostaglandins in the gastric mucosa, lower the barrier function of the gastric mucosa, and lead to gastric mucosal injury.

　　5. Unreasonable dietary habits Rough foods, overly cold, hot, sour, spicy, salty, or frequently overeating, drinking strong tea or coffee, irregular eating habits, etc., can all cause chronic inflammation of the gastric mucosa. A lack of protein and B vitamins in food also increases the susceptibility to chronic gastritis.

　　6. Abdominal cold It is the most common cause of pediatric gastritis, especially during seasonal changes. If not properly cared for, it often leads to gastrointestinal influenza, with common symptoms being abdominal pain and diarrhea. If treatment is not timely or the treatment method is incorrect, the condition may become chronic gastritis.

　　7. Psychological and neurological factors Persistent mental stress, excessive pressure, and psychological factors caused by gastritis are most common in kindergarten and primary school children, almost occurring every morning, with mild symptoms during rest and symptoms worsening when exams are approaching.

　　8. Multiple chronic diseases affect Such as chronic nephritis, uremia, severe diabetes, diseases of the liver and gallbladder system, rheumatoid arthritis, systemic lupus erythematosus, and others.

　　9. Other factors Factors such as X-ray radiation, retention of gastric contents, heredity, immunity, and nutrition are all related to the onset of the disease. The diffuse entry into the gastric mucosa causes inflammatory changes, vascular dilation, increased inflammatory exudation, and maintains the chronic gastritis.

　　In addition to its clinical manifestations, pediatric chronic gastritis can also lead to other diseases. If this condition is not given due attention, it can often lead to weight loss, malnutrition, and anemia in children, which should be highly emphasized by clinical doctors and patients.

　　The clinical manifestations of pediatric chronic gastritis are non-specific, and the younger the child, the less typical the symptoms. The majority of children present with recurrent episodes of upper abdominal or umbilical pain, with some children experiencing pain in varying locations, often occurring during or after meals. Mild cases may present with intermittent dull pain, while severe cases may exhibit severe colicky pain, often accompanied by vomiting. Other symptoms include postprandial upper abdominal fullness, nausea, anorexia with acid regurgitation, belching, and rarely, hematemesis and melena. Symptoms are often triggered or exacerbated by cold foods, hard foods, spicy foods, or other irritants. Hemorrhage is also a symptom, especially when accompanied by erosion, which can cause recurrent small amounts of bleeding or even massive hemorrhage. Young infants may also present with chronic diarrhea and malnutrition. During examination, there may be tenderness in the upper abdomen, or there may be no obvious signs. A few patients may have weight loss and anemia.

　　The prevention of pediatric chronic gastritis mainly involves preventing the early removal of various causes that induce or exacerbate gastritis, avoiding excessive mental stress and fatigue, reducing pressure, paying attention to rest, ensuring sleep, and strengthening exercise. Improve poor eating habits, eat regularly and in moderation, eat less spicy and irritating foods, and pay attention to nutritional matching. Pay attention to climatic changes and prevent catching a cold. Actively treat chronic infections in the oral cavity, nasopharynx, and other parts, and reduce the use of drugs that irritate the gastric mucosa.

　　As for Helicobacter pylori, from the survey results, it can be seen that person-to-person contact is the main transmission route, and person-to-person contact is the main mode of transmission. If the parents are infected with Helicobacter pylori, the chance of infection for their children is much higher than that of other families. In order to prevent the transmission of Helicobacter pylori, it is best to implement a separate food system at home, adults should not feed children mouth-to-mouth, and it is necessary to maintain oral hygiene, brush teeth frequently, and remove Helicobacter pylori hidden in dental plaque. Strengthen disease awareness, early diagnosis and treatment, and improve the health level of children.

　　Gastroscopy can directly observe the gastric mucosa and can simultaneously take living tissue samples for histological and bacteriological examination. This method is safe and reliable with a high diagnostic rate and is the preferred method for diagnosing pediatric chronic gastritis.

　　First, laboratory examination:

　　1. Gastric acid measurement: The gastric acid in superficial gastritis is normal or low, while in atrophic gastritis, it is significantly reduced, even lacking acid.

　　2. Pepsinogen: Its secretion amount is consistent with that of gastric acid.

　　3. Intrinsic factor: Checking the content of intrinsic factor is beneficial to the diagnosis of atrophic gastritis and pernicious anemia.

　　4. Gastrin: The serum gastrin levels measured by different laboratories are not consistent, and the reasons need to be further explored.

　　5. Helicobacter pylori detection: Hp examination should be performed for all children with chronic gastritis. One is to clarify the cause, and the other can guide treatment. At present, there are many methods for diagnosing Hp infection, including gastric mucosal tissue staining and culture, urease test, serological anti-Hp IgG, IgM antibodies, PCR detection of Hp-DNA, 13C breath test, etc.

　　Second, X-ray barium meal examination:It is difficult to find positive results. Barium double contrast examination can improve the diagnostic rate.

　　Third, gastric ultrasound examination, electrogastric examination:It cannot be used as a basis for diagnosis.

　　Parents of children with chronic gastritis should pay attention to not letting the child eat foods that stimulate the stomach, and to eat more easily digestible foods.

　　First, what is the best food for chronic gastritis?

　　1. Pay attention to soft, tender, and digestible: The main food, vegetables, and meat dishes such as fish, especially beans, peanuts, and other hard nuts, should be well-boiled and well-cooked to make them soft and tender, which is convenient for digestion and absorption. Eat less rough and fibrous foods, and require food to be well-prepared and nutritious.

　　2. Maintain freshness and lightness: All kinds of food should be fresh and not stored for too long before consumption. Eat fresh vegetables and fruits with low fiber content, such as winter melon, cucumber, tomato, potato, spinach leaves, pak choi, apple, pear, banana, orange, etc. Eat light and low-fat foods. Light foods are easy to digest and absorb, and are beneficial to the recovery of gastric diseases.

　　Secondly, what should not be eaten for childhood chronic gastritis?

　　It is not advisable to eat sweet, salty, strong, cold, hot, or sour soups and dishes to prevent injury to the gastric mucosa. Excessive consumption of carbonated beverages can also cause varying degrees of damage to the gastric mucosa. Eat less snacks, especially frozen snacks.

　　There is currently no specific treatment for childhood chronic gastritis, and those without symptoms do not need treatment. First, clarify the cause, and focus on treatment for the cause.

　　1. Diet should be chosen with easily digestible and non-irritating foods, and cold drinks and seasonings should be eaten less.

　　2. Eradication of Helicobacter pylori: For gastritis caused by Helicobacter pylori, especially active gastritis, anti-H. pylori treatment should be given. The drugs used include:

　　(1) Potassium Bicarbonate Citrate (Colloidal Bicarbonate Citrate, CBS): 6～9mg/(kg·d).

　　(2) Antibiotics: amoxicillin (ampicillin) 50mg/(kg·d), clarithromycin 15～20mg/(kg·d), metronidazole 20mg/(kg·d), furazolidone 5～10mg/(kg·d).

　　(3) Proton pump inhibitors: omeprazole 0.6～0.8mg/(kg·d).

　　(4) Combination therapy: treatment regimens can be selected from the above drugs. Compose dual or triple therapy:

　　① Bismuth-containing regimen: bismuth agents plus 1 or 2 antibiotics.

　　② Bismuth-free regimen: proton pump inhibitors plus 1 or 2 antibiotic combinations.

　　3. For those with bloating, nausea, and vomiting, gastrointestinal motility drugs such as domperidone (Motilium) and cisapride can be given.

　　4. For those with high acid or active gastritis, H2 receptor antagonists such as cimetidine, ranitidine, and famotidine can be given.

　　5. For those with bile reflux, aluminum hydroxide magnesium (Gastadex), ursodeoxycholic acid combined with bile acids, and drugs to promote bile excretion should be given.

　　Prognosis

　　Early and clear diagnosis of the cause of the disease, adhering to etiological treatment can often be cured, but if the cause is not excluded, it often leads to prolonged illness.