Clinical diagnosis of upper abdominal pain in children_1776

By Eleanor Gonzales,2014-10-30 14:19
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Clinical diagnosis of upper abdominal pain in children_1776

Clinical diagnosis of upper abdominal pain in children

     Abstract Objective To investigate the above main clinical manifestations of abdominal pain in children with digestive tract disease incidence and its association with Helicobacter pylori (Hp) infection. Methods using gastroscopy detected 450 cases of children by means of an initial clinical diagnosis, pathology testing and at the same time through the Hp-related testing, research digestive tract disease and Hp infection. The results of the disease detection rate of 96%; Hp infection rate of 31.8%; Hp infection in the top three diseases were peptic ulcer (51.7%), superficial gastritis (33.0%), duodenitis (26.7%); Hp infection in by pathological tissue damage showed clear positive correlation between the extent of lesions. Conclusion higher rate of children with gastrointestinal diseases, the lack of obvious clinical symptoms and signs, should pay close attention; Hp infection rate of older higher incidence; Hp infection is a cause of peptic ulcer, superficial gastritis of the main factors 1.

     Key words abdominal pain / diagnosis; Helicobacter pylori; gastroscopy; pathology; children

     Upper abdominal pain in children is a pediatric clinical digestive diseases, one of the most common symptoms. This paper summarizes the Beijing Children's Hospital of

    -patient and ward

    abdominal pain as clinical manifestations of 450 cases with complete data on their clinical symptoms, endoscopic diagnosis, pathological findings and Helicobacter pylori (Hp) infection in and so on preliminary analysis, are reported below.

     1 Data and methods

     1.1 The clinical data of patients in this group for the Beijing Children's Hospital of Tradi

    Weiwanxiashu pain department or outpatient and inpatient treatment of children with a total of 450 cases, of which 262 cases of male and female 188 cases, Male: Female 1.4:1; Age: 3 ~ 4 years 36 cases, 6 ~ 8 years 87 cases, 9 ~ 11 years old 137 cases, 12 ~ 14 years old 190 cases, with an average 8.5 years of age; place of residence: City 237 cases, rural 213 cases; duration: 4 ~ 5 weeks 182 patients, 6 months to 1 year 91 cases, "1 ~ 2 years in 79 cases, 3 to 5 years 66 cases, 6 ~ 10 years, 32 cases, an average of 36.5 months; past history : There is a history of stomach and duodenum were 63 cases of inflammation, ulcer history of 12 cases; family history: immediate family members, there were 106 cases of chronic gastritis, there were 30 cases of peptic ulcer disease.

     450 cases of abdominal pain in children are the main complaint, more than most of

the main abdominal pain, often accompanied by a small number of children out can not

    tell Cullen pain; accompanied by anorexia were 290 cases (64.4%), abdominal distension 126 cases (28.0%), , nausea or vomiting in 34 patients (7.6%), belching back to acid 58 cases (12.9%), fatigue and malaise in 40 patients (8.9%), stool dry and 87 cases (19.3%), stool is not transferred 215 cases (47.8%), even a small number of children accompanied by vomiting blood blood in the stool. Retrospective medical history, onset of upper abdominal pain often an incentive to eat too much, feeling cold cold, tiredness, tension, emotions and so poor, or after acute infection.

     Clinical research methods for more than 1.2 abdominal pain as the main performance, a history of 1 month or more children can be used as selected cases, observation of clinical data of all the children fill in the table and do gastroscopy.

    Doctor based on the clinical outcome of endoscopic diagnosis and pathological gastric mucosa detected by rapid urease test at the same time maximize the involvement of children to do 13C breath test, s

    pathological changes of gastric mucosa in children and Hp infection. All inspections were completed at Beijing Children's Hospital.

     1.2.1 gastroscopy gastroscopy diagnostic criteria refer to section 4 of session of the

    National Digestive Diseases pediatric digestive endoscopy and academic standards developed by the Conference [1]. All children, while doing endoscopy, in the lesion and the gastric antrum mucosa pliers to take three to carry out routine pathological

    examination and rapid urease test Hp detection.

     1.2.2 Hp detection of Hp infection in diagnostic criteria, refer to the 4th National pediatric digestive endoscopy and gastrointestinal diseases academic standards developed by the Conference [1]. Use the following methods. (1) rapid urease test

    selected by the Bio-Chemical Co., Ltd. Fujian three strong production of rapid urease kit. Results found: strong positive (): After a few seconds to 2 min, the specimens and around the immediate and rapid spread of discoloration was red roses; positive (): After 5 ~ 10 min, the specimens and gradually change color and spread around the rose was red; weak positive (?): After 10 ~ 20 min, the specimens and appears around the coloring, the proliferation of obvious, but after 1 h was eggplant color, or dull red; negative (-): 20 min after the specimen and the surrounding non-color, 1 h, still no color

    reaction; (2) Histology Giemsa staining results: organization and bacteria Juncheng purple, but the bacterial form of obvious, in order to determine whether Hp infection; to provide a gas sample collection boxes, according to conventional inspection methods to determine Hp infection; (4) serological test (indirect ELISA) selected Beijing Bell Bio-Engineering Company Limited kits for testing. Results found: A value of "the critical value of Hp antibody positive, A value ? critical value of Hp antibody negative.

     1.2.3 Pathological testing in accordance with conventional detection methods to determine degree of pathological changes. Its diagnostic criteria, refer to the 4th National pediatric digestive endoscopy and gastrointestinal diseases academic standards developed by the Conference [1]. Histopathological changes: epithelial cell degeneration, small concave epithelial cell proliferation, inflammatory cell infiltration in the lamina propria, gland atrophy. Inflammatory cells are mainly lymphocytes, plasma cells. Mild: mild inflammatory cell infiltration, mostly limited to the superficial mucosa 1 / 3, other changes are not obvious; Moderate: pathological changes between light and heavy between the inflammatory cells involving the full thickness of the superficial mucosa 1 / 3 ~ 2 / 3; severe: marked epithelial degeneration, and there is necrosis, gastric pit expansion, variable-length variable depth, may be accompanied by

    intestinal gland metaplasia, inflammatory cell infiltration heavier than mucosa 2 / 3 of

the above, we can see the inherent membrane the formation of lymphoid follicles.

     2 Results

     2.1 The distribution of endoscopic detection of disease, analysis of information, in the course of the disease ? 4 weeks in children with upper abdominal pain, endoscopy

    of the disease detection rate of 96%; of which the highest detection rate of superficial gastritis, 51.1%; 12 refers to 10% enteritis, gastritis, duodenitis combined 20.6%; of peptic ulcer detection rate of 13.4%, which accounted for 10.7% of duodenal ulcer;

    esophagitis incidence is relatively low, accounting for only 0.9%.

     2.2 the specific pathological changes in the extent of the disease in Table 1. Table 1 Detection of clinical diagnosis and pathological analysis of

     2.3 upper abdominal pain in children with Hp infection cases were selected gastric mucosa by rapid urease test and biopsy staining, of which 222 cases at the same time doing serological testing, 205 patients d

    The listed four detection methods, the four were positive, 25 cases, 3 positive of 32 cases, 86 cases of positive 2. Hp infection based on the diagnostic criteria [1], Hp infection rate was 31.8%. Reposted elsewhere in the paper for free download http://

     2.4 The specific diseases associated with Hp infection in peptic ulcer (duodenal ulcer, gastric ulcer) Hp infection rate highest in 31 cases (51.7%), followed by superficial gastritis and duodenitis were 33.0%, 26.7%. The small number of cases due to

    esophagitis, which Hp infection remains to be further studied. In addition, Hp infection were 143 cases, urban children 237/68 cases (28.7%), rural children 213/75 cases (35.21%), also indicate that the incidence of Hp infection in the rural areas is relatively high.

     3 Discussion

     Upper abdominal pain are common symptoms of clinical pediatrics, one to always consider gastrointestinal spasm, gastrointestinal disorders, dyspepsia due to other reasons, only to symptomatic treatment. As the diagnosis is not clear, the lack of specific treatment, so many times for medical treatment in children with abdominal pain caused is still a recurring problem, lingering refractory. The authors duration ? 4 weeks, 450 cases of children with recurrent upper abdominal pain underwent gastroscopy examination found that the overall detection rate of 96% of the disease. Of which 230 cases of superficial gastritis, accounting for 51.1%, while the combined analysis of clinical symptoms in most children with no obvious gastrointestinal symptoms, did not attract attention to the parents; peptic ulcer in children at the same time, often accompanied by abdominal pain, vomiting, the majority of patients child symptoms is not very serious. These results indicate that clinical attention should be paid the diagnosis of digestive diseases in children, with a corresponding detection, in particular, the importance of using diagnostic endoscopy. Children of the endoscopy detected 450 cases of pathological analysis to the highest incidence of superficial gastritis, for example, 230 cases of children with pathological test positive 224 cases (97.4%), of which moderate and severe pathological changes of up to 19.6 %. Peptic ulcer in 60 cases, the pathological changes in different degrees, moderate and severe degree of change up to 70%. Shows all the more pairs of children with digestive

diseases the need for early diagnosis and treatment and importance.

     Hp infection and chronic active gastritis and peptic ulcer disease closely related to [2]. Hp infection predilection for children, especially in the first few years after birth, generally increases with age [3], in different countries and regions Hp infection rates of children vary greatly, generally ranging from 6% to 31% [ 4]. In a pediatric

    gastrointestinal symptoms in, Hp detection rate of 40% ~ 70%, Hp infection and digestive tract diseases in children is closely related to sex has been an increasing number of research data confirm that. Only in this group for more than 450 cases of

    children with chief complaint of abdominal pain, Hp infection rate reached 31.8%, and the relatively high incidence in rural areas is also consistent with medical research. Hp infection in the analysis: 33% of superficial gastritis, peptic ulcer disease accounted for 51.7%. In the above-mentioned two groups of children with Hp infection and further analysis of the relationship between pathological findings also found that all the pathological changes of gastric mucosa in children with Hp infection rate was 100

    percent positive, and there is more pathological changes of Hp-infected heavier, to

    medium and heavy change based [5]. Both changes were directly proportional to histopathology also showed that, Hp infection of serious gastrointestinal mucosal

    damage to lymphocyte infiltration mainly intestinal metaplasia is relatively rare. By this group of children in clinical anti-Hp treatment given to review, the majority of

    children with Hp was negative, while significant improvement in pathological changes.

    Therefore, there are recurrent gastrointestinal clinical symptoms in children, such as endoscopy can not do, should also be done as soon as possible the corresponding Hp testing for early detection of problems, early treatment.

     Hp children susceptible group, 50% of adult Hp infection, the incidence begins with children [6]. The epidemiological data show that, Hp infection exists within the family aggregation, while irrational diet, health habits of the poor, crowded living conditions,

    etc, Hp infection have a certain relevance. This information is summary also shows that there is a family history of gastrointestinal diseases in children, Hp infection rate high, a relatively higher incidence of rural children. Therefore, the source of infection and

    dissemination of Hp attention through the prevention of Hp infection or reinfection of children has an important role.

     In conclusion, due to gastrointestinal tract disease in children with Hp infection in a

    lack of characteristic clinical symptoms and signs, and therefore recurrent upper gastrointestinal symptoms in children with Hp screening should be done as soon as possible, conditional to do a further gastroscopy inspection, given early treatment, which for reducing the incidence of gastrointestinal disease is of great significance.


     [1] Chen Jie. In children with chronic gastritis, peptic ulcer endoscopy diagnostic criteria [J]. Zhonghua Pediatrics, 2003,41 (3): 189.

     [2] Han-fen, Shen Xiaoming, Wah Ying, et al. As to the performance of abdominal pain as the main digestive tract of the relationship between disease and Helicobacter

     [3] Kieltyka A, Szafraniec K, Jedrychowski W, et al.2093 Environmental factors and

    [J]. J Epidemiol Comm Health, 2004,58:30.

     [4] Hu Fu-lian, and Zhou Dian-yuan. Helicobacter pylori infection in basic and clinical

     [5] Ou Wen-chi, Gong 4, Pan Ruifang, et al. Children of upper digestive tract diseases, Helicobacter pylori infection status and pathological analysis [J]. Chinese Journal of

     [6] Eurogast Study Group.Epidemiology of and risk factors for Helicobacter pylori infection among 3194 asymptomatic subjects in populations [J]. Gut, 11676. Reposted elsewhere in the paper for free download http://www.hi138 . com

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