以反复腹痛为主要表现的慢性胃炎的临床特点和治疗

Clinical Features and Therapeutic Methods on Chronic Gastritis in Children with Abdominal Pain as Present Symptoms

目的探讨以反复腹痛为主要表现的小儿慢性胃炎的临床特点和治疗方法。方法对本院以反复腹痛为主要表现的186例慢性胃炎患儿的临床表现、胃镜结果进行分析及总结,对幽门螺杆菌(Hp)感染组与非Hp感染组患儿的临床资料和胃镜结果进行统计学分析,并随机随访84例病例的治疗措施及转归。结果 186例慢性胃炎患儿中,141例(75.8%)存在不合理的饮食习惯。腹痛病程:1 d～2周36例(19.4%),>2周～3个月51例(27.4%)、>3个月～10 a 99例(53.2%);疼痛部位:腹中上区85例(45.7%)、脐区52例(28.0%)、部位不固定23例(12.4%);伴随症状:恶心呕吐55例(29.6%)、纳差46例(24.7%)、嗳气31例(16.7%)、口臭21例(11.3%)、反酸12例(6.5%)。Hp感染17例,Hp相关性胃炎与非Hp相关性胃炎患儿临床表现比较差异均无统计学意义(Pa>0.05),而胃镜镜下病变特点差异有统计学意义(P<0.05);Hp相关性胃炎进行规范根除治疗后腹痛基本缓解;在非Hp相关性慢性胃炎中使用抗生素组与不使用抗生素组间疗效的差异无统计学意义(P>0.05)。结论小儿慢性胃炎的腹痛病程相对较长,多为无明显规律的上腹部疼痛,可伴嗳气、恶心、呕吐、纳差、口臭等症状;Hp相关性胃炎的临床症状无特异性,镜下改变以结节为主,规范根除治疗效果好;非Hp相关性慢性胃炎治疗效果与使用抗生素无关,仅需给予保护胃黏膜、通便、饮食调理等综合治疗。

Objective To analyze the clinical features and therapeutic methods on chronic gastritis in children with abdominal pain as present symptoms. Methods A total of 186 cases of chronic gastritis with abdominal pain （AP） as present symptoms, were involved in this study, and their clinical features and gastroscopy result were analyzed by gastroscopy. A stochastical follow - up was set to 84 cases, on their therapies and prognosis. Results Among the 186 cases,the course of AP in 36 cases less than 2 weeks,51 cases ranged 2 weeks to 3 months, 99 cases ranged 3 months to 10 years,in detail;AP in middle or upper abdomen in 85 （45.7%） cases,52 cases（28.0% ） in around navel and 23 cases（ 12.4% ） obscure. Fifty -five cases were complicated with nausea or vomiting （29.6%） ,46 cases（24.7% ） with anore-xia,33 ca- ses（ 16.7% ） with eructation,21 cases（11. 3% ） with halitosis and 12 eases（6.5% ） with sour regurgitation. Seventeen cases infected by Hp were found. Between the patients with AP infected with or without Hp, there was no significant difference of the clinical manifestations （ P 〉 0.05 ） , while there was significant difference of gastroscopic findings （ P 〈 0.05 ）. The clinical features of Hp - associated chronic gastritis were remission treated by regular eradication therapy. In non - Hp - associated chronic gastritis patients, there was no significant diffe-rence between prognosis of AP compared children who accept antibiotic therapy and those did not （ P 〉 0.05 ）. Conclusions AP in children with chronic gastritis has long - lasting and irregular, and AP localizes mainly in upper abdomen, which can be complicated with eructation, nausea or vomiting, anorexia, halitosis, etc. Antral nodularity is relatively distinctive in Hp - associated chronic gastritis while hyperemia and oedema of mucosa are common in non - Hp - associated chronic gastritis. The eradication therapy is necessary for the Hp - associated chronic gastritis. Instead of antibiotic therapy, general therapies including mucosal protective agent, dietary therapy and alvi - dejections etc. are necessary in non - Hp - associated chronic gastritis in children.