Acid Related Disorder

8/11/2019 Acid Related Disorder

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Acid Related Disorder

in Children


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Acid Related Disorders

Peptic ulcer disease (PUD)

Gastroesophageal Reflux Disease (GERD)

Helicobacter pylori infection

Need acid suppressor agent


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Mechanisme of PUD

Imbalance between cytotoxic andcytoprotectivefactore in uper GI tract

Toxic mechanisms

- acid, pepsin , bile acids- medications (corticosteroids, NSAID)

- helicobacter pylory infection


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Defensive (cytoprotective)mechanisms

- mucous layer

- local bicarbonate secretion

- mucosa blood flow


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Clinical manifestation dyspepsia

A syndrome of non specific symptoms related tothe upper gastrointestinal tract that are intermitent

or continuous for at least 2 months duration


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Criteria diagnosis of dyspepsia Mayor criteria

- epigastric abdominal pain

- Recurrent vomiting for least 3x/mo

Minor criteria

- symptoms associated with eating (anorexia/weight loss)

- pain awakening the child at night

- heartburn

- oral refurgitation

- chronic nausea

- excessive belching / hiccuping


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- early satiety

- periumbilical abdominal pain

- family history of PUD, dyspepsia, or IBS

Need further evaluation

2 major or

1 major + 2 minor

4 minor


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Evaluation dyspepsia

Careful history should focus particulary onsymptoms such as :

- epigastric abdominal pain, nocturnal pain, oral

regurgitation, heartburn, weight loss,

hematemesis and melena

Dietary history

fatty meals, spicy food, lactose, cafein


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Causative medications

- corticosteroids NSAID

- Alcohol, tobacco

- acid suppresivemedications


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Laboratories Studies Laboratory evaluation should be based on the

presenting symptoms and finding on physicalexamination

Initial evaluation

- CBC with differential count

- ESR, LFT, electrolytes- stool ova and parasites

- urinalysis and urine culture

Futher test

- upper gastrointestinal series- USG of liver and gallblader

- endoscopy

- hydrogen breath test


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Treatment of Acid Peptic Disease

H2 receptor antagonist

- cimetidine 20-40 mg/kg bb/ day twice daily (max

400 mg)

- famotidine 1.0-1.2 mg/kg/day twice daily (max

20 mg)

- ranitidine 2-4 mg/kg/day twice daily (max 150

mg)


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Proton Pump Inhibitor

- lansoprazole 0.8 mg/kg/day

- omeprazole 0.8 mg/kg/day Cytoprotective agents

- sucralfate 40-80 mg/kg/day four times a day (max 1

g)


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Helicobacter pylory infection

H.pylory infection is mainly acquired in childhood

Cross sectional studies indicate that most

infections are even acquired before 5 years of

age

Most infected children are smptomatic

H.pylory infection in children causes chronic

gastritis in children

H. Pylory infection is associated with duodenalulcer disease in children


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Epidemiology of HP infection

Most epidemiology studies of Hp infection havebeen perfored in adults, who probably were

infected for decades before diagnosis

Data on the incidence of Hp infection in children

are limited

The incidence of Hp infection in inndustialized

countries, 0,5% of the susceptible population/year


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Why Hp infection in children should

be treated ?

Colonization of the human stomach with Hp

- chronic active gastritis

- gastritis adenocarcinoma

- gastric lymphoma

R d bi ti di ti


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Recommenden cpmbination eradication

therapies for H.pyloryassociated disease in

children

Amx (14 d) Cla (14d) Ome (1 m)

Amx (14 d Met ( 14 d) Ome (1 m)

Cla (14d) Met (14 d) Ome (1 m)

Doses :

Amoxicilin 50 mg/kg/day 2 dosesClarithromicin 15 mg/kg/day doses

Omeprazole 1 mg/kg/day 2 doses

Metronidazole 20 mg/kg/day doses


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Triple therapy combination

Combination

therapy

investigators

No ofpatients

days Eradication rate

(%)

O-A-M Bell et al 127 14 96,4

O-C-M Lebenz etal

80 7 95.0

O-C-A Lind et al 787 7 96,0

O = omeprazole A= ampxicilin M = metronidazoleC= claritromycine

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Acid Related Disorder