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close this bookClinical Guidelines and Treatment Manual (Médecins Sans Frontières, 1993)
close this folderChapter 3 - Gastro-intestinal diseases
View the document(introductory text...)
View the documentStomatitis
View the documentGastritis and Peptic Ulcer
View the documentAcute diarrhoea

Stomatitis

Inflammation of the oral mucosa, with or without infection, frequently found in infants.
If severe can contribute to malnutrition. Always treat carefully, and explain treatment to the mother.

Clinical features

- Sore mouth, dysphagia, anorexia, nausea, vomiting.

- Depending on etiology: red mucosa, aphthous or other ulcers, vesicles, white plaques.

Etiology and treatment

CANDIDA ALBICANS ("THRUSH") (dispensary)

- Common in infants.

- White plaques.

- Clean the mouth with a gauze swab soaked in sodium bicarbonate, then apply gentian violet with a cotton bud. Show the mother how to do this and have her repeat it 6 times a day.

- Often associated with gastro-intestinal candidosis. Treat all cases of oral thrush with: nyststin(PO): 100,000 to 200,000 IU/d divided in 3 doses x 5 to 10 days.
(Use the vaginal tablets if only these are available.)

- Educate the mother about oral hygiene.

- In severe forms, think of HIV infection.

HERPES SIMPLEX (dispensary)

Commoner in older children and adults. Infection causes pain and difficulty eating. Transmission is via microdroplets of saliva. Attacks are often precipitated by a febrile illness or stress.

- Oral toilet and apply gentian violet.

- Continued feeding and ensure good hydration.

- Treat any underlying illness (e.g. malaria, pneumonia).

With a secondary infection (rare if good oral toilet):
cotrimoxazole (PO)
Adult: 1,600 mg/d of SMX divided in 2 doses x 5 days
Child: 40 mg/kg/d of SMX divided in 2 doses x 5 days
or
chloramphenicol(PO): 50 mg/kg/d divided in 3 doses x 5 days

SCURVY (dispensary)

Hemorrhagic stomatitis with bone and joint pains in the lower limbs (due to subperiosteal hemorrages). Caused by dietary vitamin C deficiency.

Local treatment: oral toilet and gentian violet

Curative treatment
ascorbic acid ( vitamine C)
Adult: 500-1000 mg/d divided in 3 doses during 2 to 3 weeks
Child: 100-300 mg/d divided in 3 doses during 2 to 3 weeks

Preventive treatment
ascorbic acid ( vitamine C)
Adult: lOOmg/d
Child: 30-50mg/d

Nutritional education and supplementation with fresh fruit.

Otber causes

Vincent's angina

Measles (Koplik's spot)

Diphtheria

Scarlet fever (strawberry tongue): a streptococcal infection.
Treatment:
PPF(or procain penicillin): 100,000 IU/mg/d in a single injection x 5 days
then
penicillin V(PO): same dose divided in 3 doses/d x 10 days

Angular stomatitis of the lips: deficiencies in iron and various vitamins:
multivitamins
and/or
ferrous sulphate +folic acid .