Diagnostic Dilemma

Recurrent gastritis

An 8-year-old boy born of non-consanguineous marriage presented with recurrent episodes of hematemesis. He had the first episode 3 years ago which was coffee-colored associated with vomiting. He was treated with antacids at that time. He had another episode of hematemesis 6 months ago and a recent one 15 days ago. All the time, he was treated with antacids. There were no dark-colored stools or jaundice. On examination, there was no organomegaly or any other abnormal physical examination findings. Investigations showed normal platelets, normal prothrombin time (PT) & partial thromboplastin time (PTT), normal liver function tests. Colour doppler of the abdomen showed normal portal vein size and USG abdomen showed no organomegaly. Oesophageogastroscopy (OGDscopy) showed erosive gastritis.

How should this child be managed?
Expert Opinion :
This child has had recurrent gastritis. Treatment with antacids does not seem to help the child. Hence, one needs to find out the cause of his gastritis. Duodenal ulcer is the commonest cause of peptic ulcer disease and is associated with pain, belching, and retrosternal pain. Just hematemesis may be due to drug-induced gastritis or alcohol or stress which seems to be unlikely in this child. Another entity one needs to rule out is H.pylori infection. This can be done by rapid Urease test at the time of OGD scopy or by doing H.pylori IgA and IgG ELISA test. In this child, H.pylori rapid urease test was positive. He was treated with amoxicillin, metronidazole, and proton pump inhibitor to eradicate H.pylori infection.
Answer Discussion :
Amaal Redaa
Take a biopsy and exclude chronic diarrhea (IBD), h. Pylori? Treate e ppi until definitive diagnosis
8 months ago
fathi nils
H pylori eradication treatment along with h2 blockers or PPI
8 months ago

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