Gastritis The 5 Minute Pediatric Consult


	Gastritis

Andrew E. Mulberg

Database
Differential Diagnosis
Data Gathering
Physical Examination
Laboratory Aids
Therapy
Follow-Up
Common Questions and Answers
Bibliography

DATABASE

DEFINITION

Gastritis is inflammation of the mucosa of the stomach. It is the most common cause of upper gastrointestinal tract hemorrhage in older children.

CAUSES

Helicobacter pylori (children more likely to have more severe gastritis)
Stress (e.g., in CNS disease, ICU patients)
Idiopathic
Caustic ingestions (e.g., lye, strong acids, pine oil)
Drug-induced (e.g., NSAIDs, steroids, valproate)
Ethanol
Protein sensitivity (e.g., cow’s milk protein allergy)
Eosinophilic gastroenteritis
Crohn disease
Infection (e.g., tuberculosis, H. pylori, cytomegalovirus, parasites)

EPIDEMIOLOGY

One of the most frequent GI diagnoses

COMPLICATIONS

Bleeding (from mild to hemorrhagic)
When gastritis caused by acid/alkali ingestions, outlet obstruction may result from pre-pyloric strictures.

DIFFERENTIAL DIAGNOSIS

Peptic ulcer disease
Gastroesophageal reflux with esophagitis
Pancreatitis
Inflammatory bowel disease
Lactose intolerance

DATA GATHERING

HISTORY

Epigastric pain
Vomiting postprandially
Irritability
Poor feeding and weight loss
Less often: chest pain, hematemesis, or melena

PHYSICAL EXAMINATION

Epigastric tenderness

LABORATORY AIDS

TESTS

Heme-test all stools.
Anemia with other signs of chronic blood loss on CBC (e.g., microcytosis, low reticulocyte count)
H. pylori antibody
Culture of homogenized gastric biopsy for H. pylori
Silver or hematoxylin and eosin stain of gastric biopsy for H. pylori

PROCEDURES

Upper endoscopy with biopsies: sensitivity greatest
When endoscopy not available, upper GI radiography

THERAPY

DRUGS

Antacids or H₂ blockers to maintain gastric pH greater than 4
- Ranitidine, 2 to 3 mg/kg tid in children
- Cimetidine, 10 mg/kg qid
- Famotidine, 0.5 to 2.0 mg/kg/d divided twice
- Omeprazole, lansoprazole for resistant cases
Discontinue NSAIDs.
Eliminate alcohol and tobacco.

DIET

Dietary changes not helpful
Stress gastritis with hemorrhage
Vigilant supportive care with close monitoring of hemodynamics, fluids, and electrolytes
H. pylori
- H₂ blocker therapy for 8 weeks
- If symptoms persist, amoxicillin, bismuth, and metronidazole for 10 days
- Drug regimens change frequently.

FOLLOW-UP

Monitor for hemoccult-positive stools.
Follow complete blood counts.
May elect to repeat endoscopy in severe cases

PITFALLS

Antacids are not palatable to children and can lead to diarrhea or constipation.
Ranitidine is less effective and can increase toxicity when given to patients receiving other medicines metabolized by the cytochrome P-450 system (e.g., theophylline)
Significant relapse rates for H. pylori

COMMON QUESTIONS AND ANSWERS

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. Relapse rates for gastritis secondary to this cause are high and can be diagnosed by a combination of upper endoscopy and urea breath tests.

ICD-9-CM 558.9

BIBLIOGRAPHY

Berquist WE. New, improved Helicobacter pylori eradication therapy in children. J Pediatr Gastroenterol Nutr 1998;26(3):360–361.

Cox K, Ament ME. Upper gastrointestinal bleeding in children and adolescents. Pediatrics 1979;63:408–413.

Czinn SJ. Helicobacter pylori gastroduodenal disease in infants and children. In: Wyllie R, Hyams JS, eds. Pediatric gastrointestinal disease. Philadelphia: WB Saunders, 1993:429, 434.

Eule AR. Gastritis. In: Wyllie R, Hyams JS, eds. Pediatric gastrointestinal disease. Philadelphia: WB Saunders, 1993:435–446.

Hassall E, Dimmidk JE. Unique features of Helicobacter pylori disease in children. Dig Dis Sci 1991;36:417–423.

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