摘要
幽门螺杆菌(Helicobacter pylori H.pylori)是最常见的感染性细菌之一,据估计大约有近半数世界人口的胃粘膜上寄居有H.pylori。H.pylori感染不仅是成人消化性溃疡、慢性胃炎、十二指肠炎、胃粘膜淋巴瘤、胃癌等胃十二指肠疾病发生发展的重要致病因素,也是导致儿童慢性胃炎的主要常见病因,其与小儿的慢性胃炎、十二指肠炎、消化性溃疡的发生发展亦密切相关。研究表明H.pylori在儿童胃炎的发病机制中起重要作用。它的作用机制虽有几种解释,但目前尚不清楚。
人群中的H.pylori感染非常普遍,研究儿童H.pylori感染是非常重要的,因为H.pylori感染在儿童引起的临床症状没有成人典型,其发病年龄较早,感染率随着年龄增长而上升,并与不同地域的社会经济、卫生状况和教育程度有关;卫生落后地区的儿童获H.pylori感染的年龄较小,而在发展中国家儿童出生后不久即可感染H.pylori。另外H.pylori感染有家庭聚集现象,其病因尚不清楚。儿童H.pylori感染的发病机制及流行病学,以及其在可能导致胃炎、胃癌中的作用尚需要进一步研究。
胃粘膜病理组织学改变。H.pylori主要侵犯患儿的胃窦部,内镜下见胃窦粘
Helicobacter pylori is one of the most common pathogenic bacterial infections, colonising an estimated half of humans. It is associated with the development of serious gastroduodenal disease - including peptic ulcers, gastric lymphoma, chronic gastritis and gastric cancer. Studies in children have demonstrated a specific association between helicobacter pylori and primary gastritis. No specific symptoms have been associated with the presence of helicobacter pylori gastritis in children now. helicobacter pylori gastritis may therefore be an asymptomatic condition in the majority of infected children. Several mechanisms have proposed to explain its role. But it's not clear.Further studies in relation fo helicobacter pylori gastritis and symptoms in children will be important because it should be easier to identify specific symptoms in children than in adults. The incidence of helicobacter pylori infection in childhood is uncommon but clinically important. Studies in children are important in determining the
epidemiology of helicobacter pylori. Infection becomes more common with increasing age. Children in underdeveloped countries and those living in poor social conditions in countries are much more likely to be infected at a young age. The reason for the increased prevalence of infection among these groups is not known. There is also significant intrafamilial clustering of helicobacter pylori infection. Again, it is unclear why the organism is clustered within households and institutions. Future studies on children will be of importance in determining whether helicobacter pylori gastritis is a cause of specific symptoms, the epidemiology of helicobacter pylori infection, and the possible role of the organism in the natural history of gastritis and gastric cancer.The pathohistology of gastritis infected helicobacter pylori. The change of pathohistology of gastric mucosa: helicobacter pylori mainly encroach on children sinus ventriculi, under gastroscope we can see mucous hyperemia, hydrops erosion in it and nodus change of sinus ventriculi. The formation of folliculus lymphaticus of membrana mucosa has favourable dependability with lesser tubercle under gastroscope. All above is histologic characteristics of helicobacter pylori infected children. We seldom see glandular metaplasia of intestinales in gastric mucosa of positive gastritis and the degree is light without beaker cell. There is a manifest contrast comparing with the high attack rate of glandular metaplasia of intestinales of adult gastritis. This probably hint
that the damage of gastric mucosa in childhood is easy to repair. There is a tendency for helicobacter pylori infection to initiate neutrophil infiltrating in gastric mucosa and glandulae pyloricae emarciding. The formation of folliculus lymphaticus and acidophilic cell infiltrating are also one of pathology characteristics of helicobacter pylori positive gastritis.The diagnostic method of helicobacter pylori infection in childhood divides into two types of invsive and non-invsive. invsive includes bacterial culture, histopathologic examination, rapid urease test, PCR. non-invsive includes 13C-UBT/14C-UBT, serum H.pylori immunoglobulin G, Fecal helicobacter pylori antigen, Fast urine antibody test, invsive need gastroscope to gain tissue sample of gastric mucosa. Helicobacter pylori gastritis in children can be diagnosed by obtaining antral biopsy specimens for culture and histologic study during upper gastrointestinal endoscopy. Serologic study is also a sensitive and specific indicator of helicobacter pylori infection providing that children's sera are used to standarding the assay. Noninvasive tests such as 13C-urea breath tests (13C-UBT) /14C-UBT and/or Helicobacter pylori stool antigen (HpSA) are very attractive for use in children but 13C-UBT is expensive.Treatments for gastritis infected with Helicobacter pylori include diet, protective agant and anti-Helicobacter pylori therapy. The therapeutic alliance is better method. Helicobacter pylori can be
eradicated from the gastric mucosa in as many as 70% of children by using a combination of metronidazole or amoxicillin with colloidal bismuth subcitrate or bismuth subsalicylate.The study review the connection between inflammatory activity in Helicobacter pylori infection and children gastritis. In this annotation, we discuss the epidemiology, symptomatology, diagnosis and treatment of helicobacter pylori in children.
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