Clinical assessment

Symptoms of gastritis and gastropathy are usually not specific. The most common presenting clinical features are upper gastrointestinal bleeding and abdominal pain, which can also characterize other clinical conditions (Table 7.4). In very young children, abdominal pain is usually poorly localized and in some cases may manifest as feeding refusal or irritability, whereas in older children and adolescents, the site of pain is more often defined and a mealtime relationship may be present. Rarely, acute abdominal pain, resulting from ulcer perforation, may dominate the clinical presentation. Gastric blood losses can be revealed by chronic signs such as iron deficiency anemia or, alternatively, by acute hemorrhage, with hema-temesis and/or melena. Severe bleeding and perforation may occur, resulting in a high mortality rate.

defects, 3-10 mm in diameter, with central punctate flecks of barium reflecting central superficial ulceration, usually located on antral and/or gastric body hypertrophied rugae.40 In patients with Menetrier's disease, upper gastrointestinal series identified the characteristic gastric ruga hypertrophy, localized predominantly in the fundus and proximal corpus. However, in the evaluation of children with suspected organic abdominal pain, a radiology study of the upper gastrointestinal tract is performed to exclude anatomic abnormalities such as malrotation, duodenal bands or antral web.

Upper gastrointestinal endoscopy represents the first-line procedure for investigating gastric mucosal pathology. Endoscopic features have been previously discussed in each section. Although upper gastrointestinal endoscopy is the most reliable method for identifying the bleeding source, defining the lesions and localizing the anatomic site of mucosal damage, the ability to make a definitive diagnosis based on endoscopic appearance alone is limited, because of a poor correlation between endoscopic abnormalities and histologi-cal findings. The diagnosis and definition of gastritis and gastropathy are primarily established by histology. A sampling strategy dealing with number and size of specimens taken during endoscopy is recommended. Biopsy specimens should be taken from both endoscopically visible lesions and normal-appearing sites, adjacent to the lesions. Ideally, at least two specimens from each site should be taken. Visualization and knowledge of endoscopic and histological findings of other sites of the gastrointestinal tract (esophagus, duodenum and colon) can be helpful for a correct assessment of the gastric mucosa.

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