Pediatric gastric concretions

　　One, Etiology

　　There are two types of gastric stones: plant balls and hair balls. Plant balls are composed of various plant seeds and cellulose ingested. Eating raw persimmons or hawthorn is prone to the formation of plant balls, as raw persimmons and hawthorn contain a large amount of tannic acid, which can react with gastric acid to become a sticky gelatinous substance, combining with excessive plant fibers ingested. Hair balls are composed of hair of varying lengths and plant fibers, with a color ranging from dark green to black, hard texture, and a foul odor. This disease is more likely to occur in girls who have the habit of biting and swallowing their hair.

　　Two, Pathogenesis

　　Children, in a fasting state, ingest a large amount of hawthorn or persimmon. Due to the presence of tannic acid, gum, pectin, and other components, the content in unripe persimmons can reach 25%. Under the action of gastric acid, they can coagulate and precipitate to form lumps. Tannic acid protein, gum, and pectin bind the persimmon skin, seeds, and plant fibers together, forming gastric stones in the stomach. In addition, swallowing hair, eating hawthorn, strawberries, raw eggs, and red bean skins have also been reported to cause gastric stones. Long-term use of calcium supplements and traditional Chinese medicine pills can also lead to the formation of gastric stones. Newborns fed with formula milk containing a high amount of casein have been reported to have gastric meconium stones. However, this is very rare after switching to formula milk. After gastric stones are formed in the stomach, they can accumulate with food residue, becoming larger and larger, forming large masses. Long-term stimulation of the stomach by these masses can cause indigestion, ulcers, or obstruction.

　　Long-term impact on appetite, vomiting can lead to anemia and nutritional disorders; may be complicated by gastric and duodenal ulcers; complications of pyloric obstruction, stones passing into the intestines causing intestinal obstruction; intestinal obstruction can lead to water and electrolyte imbalance, causing alkalosis or acidosis; even gastric perforation can cause peritonitis. In the later stage, symptoms of gastrointestinal dysfunction may appear, such as dull pain or discomfort in the upper abdomen, or a feeling of fullness. Nausea and vomiting may also occur. Long-term stimulation of the gastric mucosa by gastric stones can lead to ulcers, causing symptoms of ulcer disease. In severe cases, vomiting of blood or hematochezia may occur, even leading to perforation and peritonitis.

　　Gastric stone disease is more common in pre-school children, and its clinical manifestations depend on the type of gastric stone, its location, and whether there are complications.

　　Children with vegetable gastric stone disease often have a history of swallowing a large amount of black dates, persimmons, hawthorn, etc. on an empty stomach in recent days or a few hours before the onset. The main symptoms are indigestion, which may include nausea, vomiting, intermittent pain in the upper abdomen, decreased appetite, constipation, etc. A few children may present with an abdominal mass and can feel an irregularly shaped, hard mass in the upper abdomen during physical examination, which is movable and slightly tender.

　　Children with trichoblastic gastric stone disease have a history of biting and chewing their hair. In the early stages, there may be no symptoms, or it may be an accidental discovery of a foreign body in the stomach. In the later stages, symptoms of gastrointestinal dysfunction may appear, such as dull pain or discomfort in the upper abdomen, or a feeling of fullness. Nausea and vomiting may also occur. Long-term stimulation of the gastric mucosa by gastric stones can lead to ulcers, causing symptoms of ulcer disease. In severe cases, vomiting of blood or hematochezia may occur, even leading to perforation and peritonitis. Long-standing disease may lead to weight loss, decreased body weight, and malnutrition. A movable mass that is round or elliptical, smooth in surface, clear in boundary, and hard in texture can be felt in the upper abdomen. There is no tenderness or only slight tenderness. Large gastric stones can cause incomplete or complete pyloric obstruction. In addition, these children often have sparse hair on the forehead.

　　Symptoms may appear a few hours after eating a large amount of persimmons, with discomfort or pain in the upper abdomen, which worsens after eating. Nausea, vomiting, and the vomit may be watery or contain mucus and food residue, in small amounts. There may be coffee-like substances, but there will not be a large amount of blood vomiting. The cause of bleeding is the irritation of the gastric mucosa by persimmon stones, leading to gastritis or gastric ulcer. Other symptoms may include loss of appetite, weight loss, fatigue, acid regurgitation, and heartburn.

　　About 1/3 of patients can feel a mass in the upper abdomen during physical examination, with diffuse tenderness in the upper abdomen. Gastric stones (such as large clumps) can block the pylorus, causing symptoms of pyloric obstruction. The pressure from gastric stones on the gastric wall can lead to necrosis and perforation; if they pass into the intestines, they can cause intestinal obstruction.

　　The main cause is that children swallow a large amount of hawthorn or persimmon in an empty stomach, due to the coagulation and precipitation of pectin and tannic acid contained in them with stomach acid, forming a mass, known as gastric persimmon stone. There are also cases where masses are formed in the stomach due to swallowing hair or eating raw eggs, red bean skin, etc. Therefore, it is necessary to strengthen preventive education and publicity, and avoid swallowing a large amount of hawthorn or persimmon in an empty stomach, and avoid the habit of swallowing hair, raw eggs, etc.

　　1. X-ray examination

　　Jujube stones cannot penetrate X-rays, and abdominal radiography or plain film can show increased density shadows. Barium meal examination can show filling defects, and when the position is changed, they can move in the stomach.

　　2. Ultrasound

　　Retention in the stomach can be detected, and in the case of large gastric stones, an arc-shaped light band can be felt in the abdomen, with irregular edges and roughness, and moving dark areas can be seen on both sides, the movement of the stone is not obvious, and in the case of small gastric stones, the light mass moves with the position after drinking water.

　　3. Gastroscopy

　　Dark brown movable gastric stones can be seen, which can be diagnosed clearly by biopsy forceps.

　　Diet should be light. Pay attention to the proportion of sugar, fat, and protein in food, and pay attention to the content of vitamins and other essential nutrients. Avoid cold, hot, and hard foods: such as, cold and hot food and drinks. Semi-liquid diet can be eaten, such as noodles, wontons, millet red bean porridge, steamed buns, bread, soda crackers, braised tofu, steamed fish, braised fresh vegetables, etc. Avoid刺激性 foods, such as chili, mustard, pepper, strong tea, coffee, cocoa, and other food or drink.

　　1. Treatment

　　1. Internal medicine treatment

　　(1) Repeatedly wash the stomach with 2% to 5% sodium bicarbonate or take 10% sodium bicarbonate orally, 10ml, 3 times a day.

　　(2) Traditional Chinese medicine treatment.

　　(3) Use gastroscopy biopsy forceps or snare, basket碎石 and remove the gastric stone.

　　(4) Laser碎石 treatment under gastroscopy.

　　2. If the gastric stone is very large and the above methods are ineffective, or there is pyloric obstruction or perforation, especially when the mass in the stomach is due to the entanglement of hair and gastric stone blocks, it is difficult to disperse with medication, surgical treatment should be considered.

　　2. Prognosis

　　Gastric stones can be spontaneously excreted or surgically removed with a good prognosis; in the case of gastric stones accompanied by gastric or duodenal ulcers, it is generally recommended to remove the gastric stones and the ulcers can heal spontaneously.