Diseases of the gastrointestinal tract in children. The most common diseases of the digestive system in young children

The functioning of the digestive organs at an early age has its own specific characteristics and therefore not every specialist who treats adult patients can accurately diagnose and choose the best method of treating gastrointestinal tract diseases in a child. Detects and treats diseases of the digestive system in children pediatric gastroenterologist. A highly qualified gastroenterologist can promptly recognize and prescribe a course of treatment for diseases of the gastrointestinal tract in a child, such as gastritis, sigmoiditis, esophagitis, hepatitis, peptic ulcers (duodenal and gastric ulcers), duodenitis, colitis and others.

The slightest concern about burning and pain in the gastrointestinal tract in a child should alert you - effective treatment without possible complications of diseases of the digestive system depends on timely detection of the disease at an early stage of development.

Pediatric gastroenterologist You should definitely examine your child if the following symptoms appear:
1. Vomiting, nausea, belching, heartburn
2. Disturbance in the process of defecation
3. Chronic pain in the abdominal area
4. Decreased appetite
5. Bleeding from the digestive organs
6. Bad breath
7. Abnormal stool (diarrhea, constipation, unstable stool)
8. Weight loss

Pediatric gastroenterologist will examine the child, listen to complaints and collect an anamnesis about the child’s development, find out the features of possible previous treatment of diseases and features of the diet. Then the gastroenterologist will prescribe additional examinations and diagnostics: stool tests for scatology, dysbacteriosis, carbohydrates,
general blood analysis,
Ultrasound examination (ultrasound) of organs digestive system,
If necessary, refer the child for examination by other specialists for a more accurate diagnosis.

Below is information about the main diseases of the digestive system in children, which are detected pediatric gastroenterologist and then prescribes a course of treatment:

How to recognize the symptoms of gastrointestinal diseases in an infant?
Baby's tummy pain infancy manifested by twisting legs, frequent restlessness, bending of legs towards the stomach, and strong crying. The baby's tummy may be dense, noticeably swollen, and make specific sounds: transfusion and rumbling. At the same time, the baby strains, blushes heavily, and groans.
Abdominal pain in an infant may occur due to the accumulation of gases, severe colic (spontaneous intestinal spasms), which leads to sleep disturbances and loss of appetite.

An experienced pediatric gastroenterologist will determine the causes of symptoms of digestive diseases in an infant. The reasons can be very different:
1. General immaturity of the digestive system in an infant, characteristic of any infant at an early age (frequent colic and accumulation of gases are quite normal phenomenon for completely healthy children up to 4 one month old)
2. Intestinal dysbiosis
3. Lactase deficiency due to imperfect enzymatic systems in the child’s body
Lactose intolerance is a fairly common phenomenon for children under 1 year of age. Lactose (or milk sugar) is found in fermented milk products, breast milk, cow's milk and infant formula. A deficiency of the enzyme that breaks down lactose (lactase) in the baby’s body leads to poor tolerance to dairy foods and poor absorption of lactose (lactose intolerance).
Lactase deficiency in an infant can develop due to hereditary predisposition, and against the background of intestinal dysbiosis or general enzymatic immaturity. Symptoms of lactose intolerance in an infant: tummy pain during or after feeding, frequent loose (and even foamy) stools (more than 10 times a day), bloating and weight loss. After examining the baby, the pediatric gastroenterologist may give a referral for a stool test for carbohydrates to confirm the diagnosis.

When there is an imbalance intestinal microflora with the developing dominance of pathogenic bacteria in the gastrointestinal tract, the functioning of the digestive system is disrupted and dysbiosis begins in children. Analysis of stool for dysbacteriosis (study of intestinal microflora) allows you to accurately establish a diagnosis and prescribe appropriate treatment to correct the intestinal microflora and restore the functionality of the child’s digestive system.

Often see a pediatric gastroenterologist They bring children with periodically occurring acute abdominal pain that is not associated with diseases of the digestive system. The child complains of abdominal pain after suffering shocks and psycho-emotional stress. These are so-called neurotic pains in children. After the examination, the gastroenterologist may advise you to consult with a pediatric neurologist, a child psychologist, and also a cardiologist - abdominal pain may be part of vegetative-vascular dystonia.

Why does my child have a stomach ache? The most common causes of digestive system dysfunction in children encountered pediatric gastroenterologist in your medical practice:

1. Overeating
Often found in very young children. Do you never deny your child a supplement? Do not be surprised if, some time after overeating, the child begins to complain of pain in the tummy, he develops lethargy, apathy, and mild nausea.
If this happens, put the baby to bed and if he vomits, give him some water to drink. Enzyme preparations can significantly alleviate the condition, but they can only be given after consultation with a pediatrician!
And most importantly, try to teach your child to eat in moderation!

2. Colic (spontaneous intestinal spasms)
If the child is very small (several months old), then colic is usually provoked by air collecting in the intestines.
Manifestations of colic in a child - the baby cries a lot for a long time after eating.
What you need to do - if you are breastfeeding your baby, make sure that he grasps not only the nipple with his mouth, but also the areola around it. Try to use only easily digestible foods. And if your baby is artificial nutrition, then consult your pediatrician to choose the appropriate option baby food(mixtures) for the baby.
Prevention: Hold the baby upright for some time after feeding, until excess air is released from the intestines.

3. Constipation
You should be wary of your child having bowel movements that are too infrequent (only a few times a week), as well as the appearance of periodic abdominal pain and frequent flatulence.
What you need to do: Be sure to take your child for examination see a pediatric gastroenterologist. Constipation can be a consequence of functional disorders of the pancreas or thyroid gland, as well as the liver. But similar reasons do not occur often and in most cases it is enough to change the child’s lifestyle and diet. Give your child more foods that perfectly activate the intestines, maintaining the balance of microflora - acidophilus milk, yogurt with bifidobacteria, kefir, as well as dried fruits (dried apricots, prunes, raisins) and raw and cooked vegetables (carrots, beets, apples, tomatoes) .
Constipation in a child can also be a consequence of dehydration - give the baby as much liquid as possible (juices, fruit drinks, compote).
The best way to combat constipation in a child is to eat a nutritious diet, drink as much fluid as possible and walk more in the fresh air.

4. Pathogenic bacteria
Some of the most common bacteria that cause disease digestive system - these are salmonella and shigella.
Symptoms of salmonellosis in a child are high fever, diarrhea, diarrhea, vomiting, abdominal pain.
What to do? Be sure to show the child to a pediatrician to clarify the diagnosis. A course of antibiotic treatment is usually prescribed. Treatment begins with the use of sorbents - activated carbon, sillard, smecta.
With shigellosis (dysentery) in a child, the child’s body temperature rises to 38-39 degrees, watery stools mixed with mucus and blood, and a painful urge to defecate appear.
What to do? Be sure to take your child to the pediatrician for examination. For dysentery, treatment with antibacterial drugs is usually prescribed. It is imperative to give a glucose-saline solution, and when the baby gets better, replace it with a weak solution of unsweetened tea. Diet for dysentery - steamed cutlets, porridge, baked apples. Give more fruits, berries and vegetables (wash them thoroughly).

5. Viral diseases
A fairly diverse group of pathogenic microorganisms - enteroviruses lead to stomach upset in a child.
Enteroviral diarrhea. Absolutely any child can get sick by putting a dirty toy in their mouth or interacting with an infected peer. Typically, enteroviral diarrhea affects children under 4 years of age. Symptoms: fever up to 38 degrees, cough, stuffy nose, sore throat. If you have symptoms of diarrhea, check with your pediatrician about the dosage of cold medications and treatment regimen. Let your child drink as much fluid as possible. Build your child's immunity.
Another disease caused by a certain type of enterovirus is Hepatitis A in a child. The infection is transmitted through personal hygiene items, infected dishes, and tap water (if the child drank raw water). Symptoms: the temperature rises sharply, the child suffers from nausea and acute abdominal pain. The stool becomes discolored and the urine turns dark yellow. Yellowness of the whites of the eyes appears, then the face and then the whole body (signs of infectious jaundice).
With hepatitis A, the child will have to stay in the hospital for some time. Diet for hepatitis A - vegetable soups, dietary meat (rabbit, turkey, chicken), dishes from stewed, boiled and raw vegetables.
The best cure for hepatitis A is vaccination. Teach your child to eat only washed fruits and to wash their hands thoroughly before eating.

6. Acetonomic crisis
The causes are poor nutrition, frequent overwork, long trips - severe stress for the child's body, leading to excessive production of ketone bodies in the blood (acetone acetic acid and acetone).
Symptoms - the child often vomits undigested food mixed with bile. The temperature rises and severe abdominal pain appears. The child's breath smells like acetone.
Be sure to take your child for examination see a pediatric gastroenterologist to clarify the diagnosis. Every five minutes, give your child a teaspoon of a solution of rehydron or alkaline mineral water without gas. Do an enema to cleanse the intestines (2 teaspoons of soda per 200 grams of water). Give your child a sorbent (polysorb, smecta, sillard). Diet - for several days, give your baby porridge, crackers, pureed vegetable soups.
A complete diet and exclusion stressful situations will prevent recurrence of the child’s illness with acetone crisis.

Tests and diagnostics prescribed pediatric gastroenterologist :
1. Stool tests for carbohydrates, dysbacteriosis, scatology
2. Biochemical blood test
3. Diagnosis of the pancreas and liver
4. Gamma-glutamyltransferase, aspartate aminotransferase, proteinogram (protein fractions), alpha-1-acid glycoprotein, total bilirubin, antitrypsin, cholinesterase, etc.
5. Ultrasound examination (ultrasound) abdominal cavity

Diseases of the stomach and duodenum among diseases of the digestive organs in children account for 58-65%, and combined damage to these organs is detected in 85-90%, which indicates the commonality of their etiology and pathogenesis.

Acute gastritis (AG) - “acute inflammation of the mucous membrane

stomach lining.

Etiology. Depending on the causes of occurrence, there are:

Primary (exogenous) and,

Secondary (endogenous) acute gastritis.

Exogenous OH can develop as a result of eating poor quality food, quantitative food overload, especially fatty, hot, spicy, rough and insufficiently chewed. There may be an infectious factor. The most common pathogens are staphylococci, salmonella, as well as Shigella, Yersinia, Clsbiella, and E. coli. Exogenous factors also include chemicals and medications. These are alkalis, acids, household chemical products, alcohols, compounds of arsenic, iodine, phosphorus, acetone; medications (11GSH11, sulfonamides, glucocorticoids, antibiotics, antibetabolites, reserpine, nootropics, iodine, bromine, iron, potassium preparations. Food allergens also play a certain role in the etiology of OH.

13 Unlike primary, secondary OH can develop against the background of common infectious diseases, both due to exposure to toxins and directly to viruses and bacteria. The background of endogenous OH can be diphtheria, influenza, measles, viral hepatitis, typhus, scarlet fever, pneumonia. At purulent inflammation All layers of the stomach can develop endogenous phlegmonous gas, most often caused by hematogenous penetration of staphylococcus into the stomach wall. Phlegmonous gas can develop in a septic condition or gastric trauma. The development of secondary OH has also been described in acute renal failure.

Pathogenesis. In case of primary OH of alimentary origin, food irritates the gastric mucosa, its secretory function is disrupted, the digestion process slows down, and evacuation is disrupted. As a result, the products of incomplete digestion and bacterial decomposition of food cause inflammation of the gastric mucosa. In case of food poisoning, pathogens and their toxins act on the gastric mucosa. Chemical substances and medicines

also directly irritate the gastric mucosa and cause inflammation. NSAIDs interfere with the regeneration of the mucous membrane due to their inherent cytotoxic effect. In secondary OH, an acute inflammatory process develops as a result of hematogenous damage. The development of corrosive exhaust gas is possible when chemical burn mucous membrane.

Clinic. Exogenous OG is distinguished by its bright clinical symptoms. In the nutritional form, the disease begins suddenly, 6-12 hours after the food error. First, the child complains of malaise, chills, a feeling of fullness in the stomach, a feeling of pressure and heaviness in the epigastric region, combined with nausea, drooling, bad taste in the mouth, belching air and the smell of rotten eggs. At the same time there may be general weakness, headache and dizziness. Appetite disappears, even to the point of aversion to food. Soon diffuse, aching, bursting, cramping pain appears in the epigastrium and navel area. The temperature may rise to 37.5-37.8°C. Some relief comes from repeated vomiting of gastric contents, sometimes with mucus, bile and blood. When enterocolitis occurs, diarrhea appears.

When examining the patient, attention is drawn to the pallor of the skin, which is sometimes covered with cold, sticky sweat, and the child’s lethargy. The tongue is coated with a whitish coating; with repeated vomiting, the breath smells of acetone. The abdomen is swollen, moderately painful on palpation in the area of ​​the enigastrium and navel.

The toxic-infectious form of exogenous OG occurs as gastroenteritis or gastroenterocolitis.

The symptoms of acute allergic gastritis are usually combined with other manifestations of allergies and a burdened allergic history. Corrosive gas is manifested by symptoms of inflammation not only of the stomach, but also of the oral cavity and esophagus.

Symptoms of endogenous OH are observed against the background of general intoxication caused by the underlying disease, manifested by moderate pain in the epigastrium, nausea, anorexia, and vomiting.

Symptoms of phlegmonous OH are high fever, repeated vomiting, severe epigastric pain. On examination, pallor, dry tongue, soreness and muscle tension in the epigastrium are noted.

Diagnosis. OH is diagnosed, as a rule, without additional examinations. Great importance has a medical history and the presence of clinical symptoms: belching with air, a feeling of fullness in the epigastrium, nausea, vomiting, pain in the enigastric and navel areas, no signs of peritoneal irritation.

Differential diagnosis. Differential diagnosis must be made with acute appendicitis, especially when the process is located in an arrogant position. OH is not characterized by rapid resolution of the pain syndrome, despite the therapy; irradiation of pain, a history of similar attacks. Vomiting with OH brings relief.

OH must be differentiated from high intestinal obstruction, which is accompanied by cramping pain at the navel level, radiating to the epigastric region, profuse vomiting with bile, severe intoxication; an x-ray examination reveals horizontal levels in the intestines.

In acute pancreatitis in children, pain radiates to the left in the hypochondrium and back, the abdomen is sharply swollen, peristalsis is suppressed, the level of diastase in the urine increases, and amylase in the blood.

Treatment. First of all, it is necessary to empty the stomach of food debris. Washing is carried out with a 0.5-1% solution baking soda, isotonic solution sodium chloride, mineral or regular warm water until “clean wash water” appears. The intestines are cleansed by prescribing a laxative or cleansing enema. Bed rest for 1-3 days. Introductory tea disga for 6-12 hours: chilled tea, boiled water with lemon, 5% glucose solution with isotopic sodium chloride solution or Ringer's solution (1:1). At severe course diseases for the correction of input-electrolyte disturbances, parenteral administration of a 5% glucose solution, saline solution, and potassium preparations is indicated. After the introductory tea break, mucous soups, liquid pureed porridges, and jelly are introduced; on days 5-7 they are transferred to normal food. To eliminate pain, antispasmodics (no-spa, papaverine), anticholinergics (buscopan, ilatifillin, belladonna preparations), and antacids are used. For vomiting, prokinstics (cerucal, motilium) are used. In addition, adsorbents (smskta, polyphenam, enterodes, enterokat M, cholstyramine), enzymes (mezim-forts, panzinorm-forts, krson, festal) are prescribed.

For OH of toxic-infectious etiology, oral antibiotics are prescribed. In case of phlegmonous OH, laparotomy, gastrotomy with drainage of the purulent focus and detoxification and antibacterial therapy are performed.

Forecast and prevention. The course of gastrointestinal tract is favorable and ends with recovery, except for corrosive gastritis, the outcome of which can be cicatricial strictures and deformities. Hslicobacterial OT" forms into chronic gastritis.

Prevention of OH consists of following the principles of age-related diet and food hygiene (avoid overeating.

systematic consumption of raw loads, long-term use NP13P).

Chronic gastritis (CG), chronic duodenitis(HD).

Chronic gastritis and chronic duodenitis is a chronic recurrent disease, expressed by diffuse or focal inflammatory-dystrophic lesions of the gastric mucosa (duodenum) with possible development its atrophy. Considering that only 10-15% of children have isolated inflammation of the stomach or duodenum, and in other cases their combined lesions are detected, the term chronic gastroduodeitis (CGD) is more often used.

Etiology. There are two groups of causes of CGD - exogenous and endogenous.

Among the exogenous causes currently identified:

1. Helicobacter pilori: Hp - spiral-shaped gram-negative rod with affinity for the surface epithelium antrum stomach;

2. Food allergies;

3. Use of medications, especially NSAIDs, corticosteroids;

Endogenous CGD develops against the background of diseases of other organs: insulin-dependent diabetes mellitus, pernicious anemia, chronic active hepatitis, chronic adrenal insufficiency and is a consequence of an autoimmune process, since in this case autoantibodies to the parietal cells of the stomach are always detected. Although CGD (autoimmune) in children is very rare - 1-3% in the structure of CGD. More often, the cause of endogenous CGD is duodenal gastric reflux (DGR), which, in turn, is a consequence of increased pressure in the duodenum as a result of its dysmotility.

Pathogenesis. Exogenous Hp-associated CGD occurs through infection in the family, through the fecal-oral route due to the use of endoscopes and probes. Further, the process occurs according to the properties of Нр; Having a affinity for carbohydrates of the surface epithelium of the antrum of the stomach, HP causes an inflammatory process first in the antrum, and then can spread to the body and further to the duodenum. In the layer of integumentary mucus, HP actively multiplies, adheres to the epithelium and secretes enzymes - mucinase, catalase, phospholipase A, ursase.

proteases, as well as toxins: vacuolating and ulcerogenic. The main virulence enzyme of HP is considered to be urease, which breaks down urea, which is always present in the interstitial fluid and gastric secretions. Due to the hydrolysis of urea, carbon dioxide and ammonia are formed, which damage the epithelium and the alkalizing environment around the microbe creates optimal conditions for it, stimulates G-cells, gastrin production and increased gastric secretion. When the gastric epithelium is damaged, an inflammatory process develops, phagocytosis is activated, and specific IgA and IgG are produced in the mucous membrane. One of the properties of Ir is that it is not involved in the internal environment of the body, therefore, immune mechanisms The defenses of the macroorganism cannot completely eliminate it. The result of this property is a chronic wave-like course of the disease. The development of HP-duodenitis can disrupt the production of hormones that regulate the motor and secretory functions of the gastrointestinal tract, which leads to the destruction of neuroendocrine connections and disruption of autonomic regulation.

Endogenous CGD includes autoimmune, in which the body of the stomach is primarily affected. Antibodies (AT), binding to parietal cells, damage the fundic glands and lead to the death of highly differentiated cells. Further, the affected parietal cells acquire the properties of an antigen, to which antibodies are formed. The antibodies then bind to normal parietal cells and cause them to die. In autoimmune CGD there is a persistent decrease secretory function stomach, a distinctive feature of which is resistance to its stimulation. The production of gastrin increases compensatoryly, its level in the blood increases, but the atrophied glands cannot enhance the secretory response. With the production of antibodies to the intrinsic factor of Castle, gastritis will be combined with pernicious anemia.

CGD, associated with gastric damage due to medications or severe duodenogasgral reflux (DTG), belongs to the exogenous-endogenous type. NPVG1 have local (the ability to add H in an acidic environment) and general (inhibition of cycloxygenase, which results in a decrease in the production of prostaglandins and , as a consequence, bicarbonates and mucus) exposure. With GHD, bile acids, having detergent properties, disrupt the mucous barrier; phospholipase A, contained in duodenal juice, combines with HCL in the stomach to form cytotoxic lysolecithin, which damages the epithelium.

Classification of gastroduodenitis in children, compiled on the basis of the Sydney system (Shabanov N.P. 2001)

More than 70% of patients have aggravated family history: chronic pathology of the stomach and colon, chronic cholecystitis, colitis, etc. from parents and relatives.

Seasonality of exacerbations (September-October and March-April) is usually observed in patients with a disease duration of more than three years.

Patients complain of pain that occurs on an empty stomach or 1–2 hours after eating, sometimes at night or late in the evening. However, children more often experience early pain that appears after 20-30 minutes after eating; their equivalent is a feeling of “quick satiety.” It should be noted that the relationship between the occurrence of pain and food intake will depend on the severity of the localization of inflammation in the stomach or duodenum. So, in XI" children, pain occurs soon after eating and lasts for 1-2 hours, gradually subsiding; their appearance is explained by distension of the stomach after eating; and for HD, pain that occurs on an empty stomach or 2 hours after eating or “hunger” pain is more typical.

With increased secretion of gastric juice, older children may experience the classic Moynihan rhythm of pain: “hunger-pain-sniffing food-relief-hunger-pain.

Among the factors that relieve pain, children most often point to eating a small amount of food, and those that increase it include eating fatty foods, overeating, and physical activity (running, jumping).

Dyspeptic complaints are represented by heartburn, belching of air or sour, nausea, and occasionally vomiting of sour contents, which brings relief. Abnormal bowel movements are often detected, with a tendency to constipation most often occurring, but unstable stools and polyphecapia may also occur.

Common symptoms may include fatigue, headaches, emotional lability, and sweating.

An objective examination reveals a coated tongue. On palpation of the abdomen, pain is detected in the epigastric region with a punctum maximum in the pyloroduodenal zone and the area of ​​​​the projection of Grain's angle (the place of transition of the lower horizontal knee of the duodenum into the jejunum (projected along the outer edge of the left rectus abdominis muscle 4-5 cm above the navel). Due to the peculiarities of the anatomical location, common innervation and blood supply of the duodenum and bile ducts

paths and due to the frequency of combination of CGD with biliary dyskinesias (3/4 of children with CGD suffer from biliary dyskinesia), pain often occurs in the pyloroduodenal zone and in the right hypochondrium, and the so-called symptoms (Ortnsra, Kera, Murphy, etc.) are often positive .

Diagnosis. The diagnosis is made on the basis of anamnesis, objective examination, endoscopic examination, ultrasound of the abdominal cavity, and functional methods.

With endoscopy, changes in the mucous membrane of the stomach and duodenum are detected and motor function is assessed, where the work of the sphincters and pathological refluxes are clearly visible.

A pH-metric study reveals either preserved or increased acid-forming function of the stomach. In rare cases, hypo- or anacidity may be observed, but as numerous studies have shown, this is not due to true atrophy of the gastric mucosa (which is extremely rare in children), but to the pathological reflux of alkaline duodenal contents into it.

Diagnosis of HP infection is mandatory to clarify the etiopathological type of CGD and its treatment. HP can be detected using the serological method (determination of specific antibodies to HP in the blood), the polymerase chain reaction method (DNA determination of the presence of HP in the stomach), breath tests - (depending on the substance registered in the exhaled air, there are carbon C,., and C |3 and ammonia - “Aerotsst”, “Heliktest”).

Differential diagnosis. Carry out with peptic ulcer disease, acute and chronic pancreatitis, inflammatory diseases of the biliary tract and functional stomach disorders (impaired motor or secretory function of the stomach without morphological changes in the mucosa). The diagnosis is based on endoscopic and histological findings.

Treatment. Therapy for patients with CGD should be carried out comprehensively, taking into account the etiopathogenesis and period of the disease. During an exacerbation, hospital treatment is recommended.

For abdominal pain, bed rest is prescribed for 5-7 days. Diet therapy is the basis of complex therapy,

are used in stages, tables No. 1a, 16, 1 (according to Pevzner) and with positive dynamics in the fifth week they are transferred to table No. 5.

Currently used to correct gastric hypersecretion the following groups antisecretory drugs:

1. Non-absorbable antacids: almagel, phospholugel. Maaloke, Gastal, Gelusil, etc.

3. Selective blockers M1-cholinergic receptors: pyrenzenin (gatropemin, gastril, pyrene).

4. NK'-ATPase blockers (proton pump inhibitors)

Omeprozole (losec, osid, omez).

If CGD Hp is detected in patients, antihelicobacter therapy is prescribed. For this purpose, bismuth preparations (de-nol, gribimol, ventrisol), antibiotics (amoxicillin, oxacilli, klacid, clarigromycin, rulide, sumamed), as well as metronidazole (trichopolum, klion, flagyl, eflorac, metrogil) are used.

For correction motor disorders prescribe:

antispasmodics (no-spa, papaverine, halidor).

anticholinergics (ilatiphylline, buscopan, belloid).

prokinetics (in the presence of pathological reflux -

/DGR, GER) - tsrukal, motilium, cisapride.

To improve metabolic processes in the gastric mucosa, the following is indicated:

Purpose of vitamins B2, B3, B; , B^, B)2, folic acid, A and E.

Membrane stimulating drugs:

Essentiale Forte, lipostabil, karsil.

IN in complex treatment of CGD are also used

enzyme preparations:

pepsin, abomin, mucosa (containing extracts of the gastric mucosa),

pancreatin, mezim-forte, creon (containing pancreatic enzymes),

digistal, festap, enzistal, cholenzyme (containing pancreatin, pancreatic enzymes, components

bile and cellulose).

For CGD caused by taking NG1VP, the following is prescribed:

Cytoprotectors - “film-forming” - Alcide B, Ventroxol, Venter and prostaglamdia (Cytotec, Cytotec, Enirostil, Misoprostol). Sucralfate, Venter, Apsucral, Carbepoxolone, and Bnogastron also have cytoprotective properties.

Medicines that improve regeneration processes and are called “reiaranti” belong to various pharmacological groups; Such drugs as pentoxyl, actovegin, alapton, and sea buckthorn oil are widely used.

Sedative therapy is prescribed for the combination of CGD with vegetative-vascular dystonia. Minor tranquilizers, decoctions of valerian, motherwort, bslloid, and bellataminal are used.

Physiotherapy in acute period may include laser treatment, electrophoresis with platyphylline or novocaine, electrosleep, acupuncture. During the period of subremission and remission, mud therapy, ozokerite, paraffin, hydrotherapy, and physical therapy can be used.

Sanatorium-resort treatment is indicated in period of remission in local balneological sanatoriums and resorts. Recommended mineral waters: Slavyanovskaya, Smirnovskaya, Essentuki No. 4, Arzii.

Dispensary observation of children with CGD is carried out for 5 years, in the 1st year - 4 times a year, from the 2nd year 2 times a year. Dynamic control includes questioning, examination and endoscopy. To prevent relapses and complications, it is recommended to prescribe vitamins, biostimulants and physiotherapy.

Ulcerative stomach disease (GSD) and (or) duodenal ulcer

intestines (DU)

Peptic ulcer is a chronic relapsing disease, the main local manifestation of which is a peptic ulcer of the stomach or duodenum.

In the last decade it has been noted a sharp increase prevalence of ulcer among children of high school age and adolescents. In the structure of gastrointestinal tract pathology in children, UC makes up 5-6%, with approximately the same frequency in boys and girls. PUD in children is significantly prevalent and accounts for 81% of the total number of patients with PU, PUD - 13%, and the combination of PUD and PUD - 6%:

Etiology. PU refers to polyetiological diseases. The most important place is occupied by hereditary burden, genetically determined increased aggressiveness of gastric juice, belonging to blood group 0 (1) (1.5 more often and more severe

get sick I B). G

Helicobacter pylori (Hp) is recognized as a leading factor in the development of ulcerative gastric ulcers and DU (Hp is detected in 99.9% of cases). The following factors play a major role in the formation of ulcers: psycho-emotional (psychotrauma, persistent stress, conflict situations in the family and school), toxic-allergic (frequent and unreasonable use of medications, food and drug allergy), bad habits.

Pathogenesis. The pathogenesis of ulcer can be represented as an imbalance between aggressive and protective factors. Aggressive factors acting in ulcers include HP,

acid-peptic, gastroduodenal dysmotility. Protective factors that protect the epithelium from death include a mucous-bicarbonate barrier, normal regeneration, sufficient blood supply, and the presence of irostaglandins in the mucosa. In the pathogenesis of DU, the weakening of protective factors is more significant.

Classification of peptic ulcer in children (Karanov A. A. and

al. 1996)

Clinic. The complaints of a child suffering from peptic ulcer are, first of all, localized pain. in the epigastric and pyloroduodenal zones. Pain may radiate to the sternum, to the heart, right lumbar region, or lumbar region spine. The Moynihan rhythm of pain is characteristic; “hunger-pain-reception-niche-relief-hunger-pain...”. Of the dyspeptic disorders, the most common is heartburn, which is associated with a combination of ulcers with refluxesophagitis, and may include belching and nausea. Vomiting, usually one-time, with sour contents, bringing relief. Children with ulcers are more likely to experience constipation.

An objective examination reveals pain on palpation of the abdomen in the epigastrium, pyloroduodenal area, and skin hyperesthesia. Deep palpation reveals muscle protection in the upper abdomen and causes the child to resist. Mendel's symptom is pathognomonic for ulcerative disease in children.

Asthenoneurotic syndrome is also characteristic, manifested by sleep disturbances, emotional lability, headaches and dizziness.

A feature of PU in children in modern conditions is its latent course: the absence of abdominal pain and dyspeptic symptoms. Only occasionally do children complain of nausea, a feeling of early satiety and heaviness in the stomach. First clinical manifestation in this case, the symptoms of ulcerative bleeding are vomiting “coffee grounds”, melena, severe weakness.

Diagnosis. The diagnosis of ulcer is made on the basis of endoscopy data when detected ulcer defect in the stomach or duodenum. Endoscopically, a fresh ulcer (J stage) looks like a rather deep defect in the mucous membrane, covered with a whitish coating of fibrin, surrounded by an inflammatory shaft. The mucous membrane of other parts of the stomach and duodenum also shows signs of active inflammation. Against the background of epithelization (stage II), the hyperemia of the mucous membrane decreases and the swelling around the ulcer smoothes out. Its edges become denser and move towards the center, reducing its size and depth. The bottom of the defect begins to clear of fibrin, the ulcer may have a red-white appearance. During healing ( Stage III) at the site of the defect, a red scar with or without deformation is first determined. However, signs of the concomitant inflammatory process persist for 2-3 months, after which the ruby ​​skin at the site of the ulcer turns white. The healing time for stomach ulcers in children is on average 23 days. duodenal ulcers 28 days. If carried out X-ray examination with barium, then a typical x-ray sign of an ulcer is the discovery of a niche - contrast has flowed deep into the wall of the organ.

The study of HP is also included in the mandatory study regimen for patients with ulcerative disease and is found in the vast majority of patients.

When the pH level of the stomach is detected, a significant increase in its acid-forming function is revealed.

Complications. The most common complication of ulcer in children is bleeding. It manifests itself as vomiting “coffee grounds”, black tarry stools (observed after a loss of more than 60 ml of blood). At large blood loss weakness, nausea, pallor, tachycardia, cold sticky sweat, drop in blood pressure, dizziness, and sometimes fainting appear. Characteristic is the disappearance of pain (Bergmann's symptom). Hemoglobin and hematocrit decrease in the blood. Bleeding may be hidden, but occult blood is detected in the stool.

Much less often, perforation of the ulcer occurs, which is manifested by sudden “dagger” pain in the epigastrium, nausea, board-like tension of the muscles of the anterior abdominal wall, and progressive deterioration of the patient’s condition. At

X-rays in a standing position may reveal free gas under the diaphragm.

The rarest complication of UC in children is ulcers - the spread of an ulcer beyond the wall of the stomach or duodenum into surrounding tissues and organs. Duodenal ulcers usually penetrate into the head of the pancreas, bile ducts, liver, and colon. Stomach ulcers - in the lesser omentum and body of the pancreas. The clinic depends on the depth of penetration and damage to the organ. The first sign of psnetration is a change in the nature of the pain: it intensifies, becomes constant, radiates to the back and is not relieved by antacids: there may be an increase in body temperature, leukocytosis and accelerated ESR are noted in the blood. An X-ray examination reveals an additional shadow of barium next to the organ involved in the process; sometimes a so-called styloid ulcer is detected.

Stenosis of the pylorus and duodenum is a chronically developing complication of ulcer. Symptoms of cicatricial stenosis develop gradually and are characterized by a feeling of fullness, fullness of the stomach, nausea, belching, and then vomiting. Patients lose weight, and a splashing sound may be detected in the epigastrium. X-ray signs: high segmenting peristalsis, dilatation of the stomach and slower emptying.

Differential diagnosis. PUD or DU must be differentiated from symptomatic or acute ulcers(stressful, medicinal, endocrine,<]юне панкреатита, цирроза печени), синдромом Zollinger-Ellisoia, conditioned gastrinoma-gastrimsecreting pancreatic tumor or 12-colon. Syndrome Zollinger-Ellison characterized by a continuous course with the formation of ulcers in 12 ring intestine, less often in the stomach, prone to bleeding and perforation. The diagnostic criterion is to determine the level of gastria in the blood; it increases in 2-3 times.

In addition, the differential diagnosis of ulcer should be made with chronic gastritis and all diseases of the gastroduodenal region and biliary system.

Treatment: Children with ulcer are prescribed bed rest for 2-4 weeks. Diet therapy is based on the principle of mechanical, chemical and thermal movement of the stomach. Table No. 1 is prescribed during the period of exacerbation, during the remission phase - table No. 5.

Drug therapy for ulcer is carried out taking into account natogonesis, the basis of treatment is the impact on the main factors of defense and aggression. This therapy is called basic therapy.

Drugs that reduce the aggressive effects of gastric

1. Antisecretory:

H-2 receptor blockers (cimetidium, ranitidine, Zantac,

famotidine);

Selective blockers of M-1-cholinergic receptors (gastrocepin, pirenzepine, gasfil);

NK+ -ATPase blockers - ductal pump inhibitors (omez, omeprazole, Losek, Osid).

2. Antacids: almagel, phospholugel. Maalox, Gastal, gastrogel.

3. Drugs that enhance mucosal protection:

Film-forming(de-nol, venter, sucralfate, alsukral, depepsin,

Considering the role of HP in ulcerogenesis, eradication of Ir is an important task. It is carried out as an addition to the basic therapy of antibiotics and metronidazole. 13 currently use three- or four-component schemes. So, for example, three-component scheme using bismuth preparations:

De-nol 240 mg 2 times a day, metronidazole 500 mg 2 times a day, amoxicillin J000 mg 2 times a day.

Four-component scheme:

Ds-nol 240 mg, metronidazole 500 mg, amoxicillin 1000 mg, omeprazole 20 mg - each drug in this dose is used 2 times a day for 7 days.

The suggested doses are prescribed to children over seven years of age.

According to the Maastricht Agreement (1996), the following treatment regimen for DU associated with HP was adopted.

Stage I eradication- 7 days. Piloride, clarithromycin and metronidazole are prescribed.>

1! stage - healing. Pylorid is prescribed for 3 weeks.

If you have DGR. Dophareceptor blockers are used for GER: cerucal, motilium. Antispasmodic drugs are used mainly for spastic pain: no-spa, papaverine.

To improve regeneration processes, “reparants” are used: stimulants of mucin formation (alanton), pentoxyl, actovegin, sea buckthorn oil. "

For symptoms of vegetative neurosis, sedative herbs and tranquilizers are prescribed.

Physiotherapy is included in the complex treatment of ulcer. They use electrosleep, tranair, EHF, electrophoresis with bromine on the collar zone and with novocaine on the epigastric zone.

Sanatorium-resort treatment of IB is indicated only during the period of remission. Therapeutic factors: sanatorium-resort treatment, therapeutic nutrition, casting (mineral waters are used), balneotherapy, ozokerite therapy, exercise therapy, etc.

Dispensary observation in the first year after an exacerbation - 4 times, FGDS - 2 times after 6 months and at the end of the year of observation, HP - express method 1 time at the end of the year; 2nd year - gastroenterologist 2 times, FGDS 1 time at the end of the year of observation, 3rd year and subsequent - pediatrician 2 times a year, FGDS according to indications.

Acute and chronic cholecystitis

Acute cholecystitis (OC) is an acute inflammation of the gallbladder. It is rare in children and accounts for approximately 12% of all cases of cholecystitis. Boys get sick 2 times more often than girls.

Etiology and pathogenesis. The main cause of the development of AC in children is infection, but we must not forget about poor diet, stress and physical inactivity. Pathogens - Escherichia coli, staphylococcus, streptococcus, Klebsiella, Proteus, viruses, typhoid bacilli, Giardia, can penetrate the bile ducts by enterogenous, hematogenous and lymphogenous routes. Most often in children, AC occurs due to stagnation of bile in gallbladder, usually caused by abnormalities in the development of the biliary tract.

Classification. Acute cholecystitis is classified as:

Catarrhal

Phlegmonous

Gangrenous.

Clinical picture. Will, dyspeptic disorders and intoxication are manifestations of AC. The pain syndrome appears suddenly at night and is expressed in cramping pain in the right half or throughout the abdomen; the attack lasts from several minutes to several hours. The pain intensifies when lying on the right side. Rarely, but possible irradiation of pain in the back, right shoulder, shoulder blade, collarbone and limbs. Approximately 50% of children experience vomiting, nausea, and, much less frequently, constipation. Manifestations of intoxication are usually represented by an increase in body temperature to febrile and chills. The skin is pale, moist, the mucous membranes of the mouth and lips are dry and bright, the tongue is coated, headache, tachycardia. In rare cases, meningeal symptoms, convulsions and fainting have been described.

When examining the abdomen, there is a lag in the upper sections during breathing and flatulence. Jaundice in AC occurs in approximately 50% of patients due to obstruction of the common bile duct. At

Palpation of the abdomen reveals rigidity of the muscles of the anterior abdominal wall on the right, more at the top and in the hypochondrium, positive cystic symptoms - Mendel, Ortner, Murphy, Ksra, frenicus symptom, as well as the Schstkin-Blumberg symptom.

IN leukocytosis is detected in peripheral blood in patients with AC

With neutrophilia and increase in ESR. Approximately 30% of children exhibit symptoms of “infectious kidney” in the form of microhematuria and microproteinuria.

The diagnosis is made based on the clinical picture (pain, dyspepsia, intoxication), examination (positive cystic symptoms), inflammatory changes in the peripheral blood and ultrasound data (thickening and heterogeneity of the walls of the gallbladder, inhomogeneous contents of its cavity).

Differential diagnosis. Acute cholecystitis differentiate from acute appendicitis, epidemic hepatitis, intussusception, peritonitis, exacerbation of chronic cholecystitis, acute pancreatitis, acute gastritis, pyelonephritis, right-sided lobar pneumonia, abdominal disease syndrome Schönlein-Gepoha. The severity of the clinical picture of AC in children

And diagnostic difficulties require dynamic observation by a surgeon, hospitalization in a surgical department is advisable

hospital.

Treatment. The choice of therapy depends on the form of AC (catarrhal, phlegmonous and gangrenous).

Catarrhal AC is treated conservatively. Bed rest, hunger, drinking plenty of fluids (tea with sugar, fruit juice, rosehip decoction, mineral water), then table No. 5, natural choleretic agents (eggs, fruit and vegetable juices, vegetable oil). Antibacterial therapy - ampiox, cefuroxin, cefamezin, erythromycin, etc., is prescribed for 7-10 days. Antispasmodic (atropine, metacin, platyfillin), analgesic (baralgin, etc.) drugs, infusion therapy, anti-enzyme drugs (contrical, gordox, etc.) are prescribed depending on the severity of the disease.

Monitoring of the patient must be carried out by a pediatrician and a pediatric surgeon.

Forecast. In most cases, AC transforms into a chronic form, and in 30% of children it is completely cured.

Chronic cholecystitis

Chronic cholecystitis (XX)- chronic inflammation of the walls of the gallbladder. More often it occurs as chronic cholecyetocholangitis and accounts for approximately 15% in the structure of pediatric gastroenterology. Chronic cholecystitis is practically

is always secondary, developing against the background of dyscholia, dyskinesia and congenital anomalies of the biliary system.

Pathogen. XX. can be calculous and non-calculous.

Calculous XX is extremely rare in pediatrics.

There are three ways of infection entering the gallbladder:

Ascending - from the intestine through the ductus choledochus,

Lymphogenic,

Hematogenous.

The last two develop in the presence of foci of chronic infection.

Predisposing factors for the development of XX are: anomalies in the development of the biliary tract, dyskinesia of the hypomotor type, disturbances in the composition of bile and changes in its physical chemical properties, intestinal dysbiosis.

For catarrh The mucous membrane of the gallbladder is affected, and when the process spreads to the entire wall, resulting in its sclerosis, adhesions and jericholecystitis occur, which can contribute to the development of stones.

If we talk about calculous cholecystitis, then for its formation you need:

hypomotor biliary dyskinesia and parietal bile stagnation,

gallbladder inflammation

changes in the chemical properties of bile as a consequence of metabolic disorders

U children early age yellow pigment stones are found, which contain bilirubin, cholesterol and some calcium; in older children, the stones are usually dark in color, consisting of cholesterol crystals.

Clinic. Patients with XX most often complain of

localized in the right hypochondrium, epigastrium and around the navel,

sometimes radiate to the right scapula. Pain can be provoked by eating cold, fried, fatty, spicy foods, carbonated drinks, physical activity, stress, or intercurrent illnesses. Most often, pain occurs 20-30 minutes after eating and lasts about 2-3 hours. Sometimes the pain is paroxysmal, stabbing and cutting.

In addition to pain, patients experience prolonged low-grade fever, weakness, increased fatigue, irritability, headaches, nausea, bitterness, decreased appetite, belching, vomiting, flatulence, constipation, or, conversely, loose stools. Persistent intestinal dysbiosis develops.

Upon objective examination: the skin is pale, dry, peeling and cracked lips, subcutaneous hemorrhages, and sometimes there is moderate yellowness of the skin and sclera (consequences of cholestasis). Symptoms of intoxication, tachycardia or bradycardia, labile pulse, functional heart murmur, and decreased blood pressure are expressed. The tongue is covered with a whitish-yellow coating, sometimes swollen with teeth marks along the edges.

On palpation of the abdomen, there is a moderate enlargement of the liver, positive symptoms of Kehr, Ortner, Murphy, Mendel, Georgievsky-Musset, pain in the Choffard area.

With calculous cholecystitis, which in children, as a rule, is a complication of cholecystitis against the background of complete well-being, severe, acute pain in the abdomen (biliary colic) appears, mainly in the hypochondrium with irradiation under the right shoulder blade, shoulder and lower back, lasting from several minutes to 2-3 hours. Pain may be accompanied by nausea, vomiting, fever, bradycardia, bradypnea and collapse. If the bile duct is blocked, there may be obstructive jaundice and acholic stools.

The diagnosis is made on the basis of anamnesis: characteristic complaints, family history, clinics and instrumental studies. Ultrasound of the biliary tract is of decisive importance in the diagnosis: the walls of the gallbladder are diffusely thickened by more than 3 mm, compacted, layered, the bladder is deformed, a decrease or increase is possible, its cavity is inhomogeneous.

A blood test during the period of exacerbation of XX is characterized by leukocytosis with neutrophilia, increased ESR, and during the period of remission with a long course of XX - leukopenia. IN biochemical analysis blood in the acute stage XX - dysproteinemia due to an increase in a (and P - globulins, an increase in bilirubin and an increase in alkaline phosphatase activity. Some patients show changes in the urine: microproteinuria, microhematuria and leukocyturia.

Differential diagnosis XX is carried out for other diseases of the biliary system and gastroduodenal region: duodenitis, exacerbations of chronic gastritis, gastroduodenitis, gastric ulcer and 12-point intestines, pancreatitis. In addition, it is necessary to differentiate XX from acute appendicitis, nonspecific mesadenitis, pyelonephritis, helminthic infestation, abdominal syndrome, disease Sheilsin-Henoch, nonspecific ulcerative colitis.

Complications of XX in children are extremely rare. However, in the chronic course of cholecystitis, sooner or later the stomach and duodenum are affected, the exocrine function of the pancreas is disrupted, and functional changes liver. Cholecystocholangitis can lead to the development of focal hepatitis, which, when inflammation in the biliary system subsides, tends to:< обратному развитию. У больных с XX достаточно часто встречаются атопические дерматиты.

Treatment. Bed rest is prescribed during the period of exacerbation of XX, but not for long, so that there is no stagnation of bile.

Diet table No. 5, fractional meals, limiting extractive substances, excluding fried foods, very cold drinks (from the refrigerator) and ice cream, seasonings, fibs, pork, smoked meats, canned food, fresh baked goods, coffee, cocoa.

IN period of exacerbation, especially against the background of fever,

Fasting days are prescribed: apple, watermelon, milk and curd days. It is recommended to consume products with lipotoxic properties - cottage cheese, egg white, cod, yeast and containing lecithin - buckwheat, carrot, green pea, egg yolk. The diet includes foods that have a choleretic effect - vegetables, fruits, berries, vegetable oil. The amount of liquid consumed per day should be at least 1.5-2.0 liters: tea, rosehip decoction, fruit juices, soups, milk, kefir, fruit juice. The diet is prescribed for 3 years after an exacerbation of XX.

Drug therapy. In order to eliminate the pain syndrome, atropine, papaverine, no-shpu, extrajug belladonna, antispasmodic, baralgin, tramal are prescribed. In case of an ongoing attack of biliary colic, it is possible to use promedol or pantopon with atropine.

Broad-spectrum antibiotics - ampiox, gentamicin, cephalosporins; in case of exacerbation of XX, they are prescribed for 7-10 days in combination with bactisubtil and vitamins C, B, A. From chemotherapy drugs! Nicodin (also has a choleretic effect), oxafeiamide, f)urazolidone, and cyclone are used. In case of severe exacerbation of XX, detoxification therapy is indicated: intravenous administration of glucose, saline solutions, hemodesis.

Mandatory in the treatment of XX is the appointment choleretic drugs, which are divided into 2 groups:

1. Choleretics - increase the secretion of bile and stimulate the formation of bile acids.

2. Cholekintics - stimulate bile secretion.

IN The group of choleretics includes:

Preparations containing bile acids:

Allohol, holagotum, holagol, choleizim, nicodin, cyqualon

Drugs plant origin:

Corn silk, rose hips. tansy, chamomile, flamin, holosas.

Drugs that increase bile secretion due to the water component (hydrocholerics):

Sodium salicylate, mineral waters, valerian, etc.

Kholinokinetics include:

Drugs that increase the tone of the gallbladder and reduce the tone of the bile ducts:

Cholecystokinin, egg yolks, magnesium sulfate,

Relaxing drugs increased tone biliary tract:

Atropine, platiphylline, cholelitan, belladonna extract, mstacin, etc.

Typically, patients are prescribed choleretic drugs of both groups. To eliminate cholestasis, tubes according to G. S. Demyanov are used.

Widely used in the treatment of XX vitamin therapy (A, C, PP, B], B2, Bb, E), herbal medicine (collections of gallstone herbs), drinking mineral waters with a predominance of bicarbonates, sulfates, CL, Mg, Na, Ca (Essentuki 4, 17, 20, Smirnovskaya, Slavyanovskaya, Borjomi, Naftusya, etc.), physiotherapy and physical therapy.

In cases of tracing leziogo XX. can be used

Drug therapy with the use of litholytic agents (ursofalk, helofalk, lithopalk) provided that the diameter of the stone is no more than 15 mm, the stones are floating, the gallbladder is able to contract, and the cystic duct is traversed. It is possible to use ultrasound lithotripsy and surgical treatment- cholecystectomy.

Forecast. With XX it is possible to achieve stable long-term remission up to full recovery with the right

dispensary observation and treatment. However, in cases where XX is caused by certain congenital anomalies of the biliary tract or previous viral hepatitis, complete recovery, as a rule, does not occur. Relapses of XX can lead to the development of anatomical and functional disorders (so-called thickening of the gallbladder wall, the appearance of parietal stasis, possible formation of stones).

Dysfunctional disorders of the biliary tract Dysfunctional disorders of the biliary tract (DBD) -

disruption of the flow of bile into the duodenum due to biliary tract motility disorder (ZHB1).

Etiology. The basis of DRBT is a violation of the motor-evacuation function of the gallbladder, ducts and sphincters. The more common concept now is that dyskinesia is secondary form pathology and develops in connection with already formed diseases.

Pathogenesis. Disorders of the motility of ZHVG1 can be caused by disturbances in the functional state of gspatonitis (in connection with which dyscholia can develop - a change in the composition of bile) and a violation of the neurogenic regulation of the muscular wall of the gallbladder. The general tone of the bile ducts, papilla of Vater, and smooth muscles of the duodenum is significantly influenced by the parasympathetic part of the central nervous system(CNS). Excitation of naryca leads to contraction of the gallbladder and relaxation of the sphincters of Lutkens, Oddi, and duodenum. Disturbances on the part of the central nervous system, weakening of the ss regulatory effect on the autonomic centers, hypothalamic syndrome affect the coordination of the activity of the biliary system. Functional disorders occur in three sections - the gallbladder, the vesical sphincter and the nipple of Vater. Normally, contractions of the gallbladder, ducts and sphincters are regulated by hormones. Calcitonin and glucagon inhibit contractions of the gallbladder. Hormones of the pituitary gland, gastria, secretin and cholecystokinin increase contractions of the gallbladder (secretin and cholecystokinin are produced by the mucous membrane of the duodenum). In ensuring the motor-evacuation function of the gallbladder essential have hydrodynamic factors.

Violation of conjugate motility leads to a delay in the emptying of bile, increases pressure with stretching of the tract, and increases peristalsis to overcome obstacles.

Clinic. DRBT can be observed in the form hypertensive,

hypotonic and mixed form.

In hypertensive form children complain of short-term paroxysmal, stabbing pain in the right hypochondrium or right side. Sometimes pain occurs 30-40 minutes after eating cold food, and may appear after running or fast walking. Rarely radiates to the right shoulder blade and shoulder.

For the hypotonic form DRBT is characterized by a decrease in the tone of the gallbladder, which may result in an increase in its volume. This form of dyskinesia is accompanied by spasm of the sphincters, manifested by dull pain in the right hypochondrium or around the navel, a feeling of fullness in the right side, often occurring 1-1.5 hours after eating food, especially fatty and sweet ones. Dyspepsia manifests itself in decreased appetite, nausea, intolerance to fatty foods; vomiting occurs less frequently (with overeating, eating fatty and sweet foods), and bitterness in the mouth. There may be variegation in the color of the stool.

Upon examination, attention is drawn to asthenic neurotic disorders, often with a predominance of the sympathetic department of the autonomic nervous system. On palpation of the abdomen, pain is noted in the right hypochondrium, positive symptoms of Murphy, Kera, Ortier, Gsorgievsky-Mussy.

The diagnosis is made based on the results of the examination: pain in the right hypochondrium, positive “vesical” symptoms, central nervous system conditions, identification possible reasons occurrence of DRBT (see etiology). It is necessary to identify foci of chronic infection and examine stool for worm eggs and Giardia cysts. An ultrasound scan of the liver and gallbladder significantly helps to clarify the nature of dyskinesia, the presence and severity of cholestasis, and abnormalities in the development of the biliary tract.

Restoring the functions of bile formation and bile excretion by normalizing motor disorders and eliminating cholestasis.

Medical nutrition is prescribed to children for a period of at least a year; table No. 5 is usually prescribed. Patients suffering from DRBT but hypertensive type, you should stick to a diet

causing a significant increase in the activity of the biliary system. You should not eat foods that are rich in coarse fiber and promote flatulence (rye bread, peas, beans), very cold dishes and drinks; they contribute to spasm of the sphincter of Oddi, gallbladder and other parts of the biliary system, which can provoke a painful attack and increase cholestasis. For hypotonic DRB"G recommends products that have a choleretic effect: butter and vegetable oil, cream, sour cream, a significant amount of vegetables, fruits, and black bread.

The central place in the pharmacotherapy of diseases of the gallbladder and bile ducts belongs to drugs called choleretic drugs. According to their pharmacodynamic properties, they are divided into three groups:

1. Choleretics:

Containing bile or bile acids (chologon, decholine);

Synthetic (nicodin, adveston);

Extracted from medicinal plants(chophytol, corn silk);

Combined drugs (allochol, cholenzyme).

2. Cholinokinetics:

Synthetic (magnesium sulfate, xylitol, sorbitol);

Extracted from medicinal plants (lingonberry leaves, cornflower flowers, dandelion root, rose hips);

Combined drugs (olimethin, cholagol,

hepatobene)

They have a predominant effect on the release of bile into the intestine and reduce the motor activity of the gallbladder and reduce the tonic tension of the terminal apparatus of the common bile duct.

3. Hopespasmolytics:

Synthetic (halidor, no-spa, papaverine); » Extracted from medicinal plants (valerian root,

St. John's wort grass, mint leaves, sage leaves);

Combination drugs (nikoshpan, picovsrin, papazole);

Choliolitics (atropine sulfate, belloid, platifillin). Have a predominant effect on the release of bile into

intestines. They have an antispasmodic effect on extrahepatic bile sphincters.

The division of these drugs is quite arbitrary, since choleretic drugs, especially herbal ones and combined ones, have both holistic and cholekinetic effects.

Drug therapy is prescribed differentiated, depending on the OG form of DRBT.

For the hypertensive type, DRBT is prescribed:

1. Cholespasmolytics;

2. Sedatives;

3. Choleretic agents with antispasmodic effect; no codine, oxafenamide;

4. Mineral waters of low mineralization: Slavyanovskaya, Smirnovskaya. Essentuki No. 4, Marzan - hot or heated 5-6 times a day (per dose 5 ml/kg body weight

6. Herbal medicine: collection (chamomile flowers, peppermint in 2 parts, licorice root, valerian, motherwort herb, fruits dill - 1 part each).

At hypotonic type DRBT is prescribed:

1. Tonics (extracts of eleutherococcus, leuzea, tincture of ginseng, aralia, Chinese lemongrass;

2. Vitamins B|, Bb, B)2 ;

3. Choleretic agents;

4. Mineral waters of high mineralization (Essentuki No. 13, Dovolenskaya, Arzni - room temperature or slightly warmed for 30-60 minutes before meals);

5. Electrophoresis with magnesium sulfate on the right hypochondrium, faradization of DCT, SMT, galvanization, salt baths, tonic exercise therapy:

6. Herbal medicine (infusions and decoctions of herbs - corn silk, immortelle flowers, nettle leaves, as well as beet juice, cabbage, vegetable oil, egg yolks).

For dyscholia and intrahepatic cholestasis, it is recommended to carry out tubages with mineral water 1-2 times a week.

Treatment of DRBT should be carried out until the signs of cholstasis and dyscholia are completely eliminated, achieving normalization of the motor function of the biliary tract and gallbladder.

If the clinical signs are severe, then 10-14 days of treatment in a hospital and then in a local sanatorium are recommended.

Clinical examination, health activities, observation in the clinic for at least 2 years.

The digestive organs take part not only in processing food, but are also responsible for the process of absorbing nutrients from foods and removing processed residues from the body. That is why it is important to maintain the normal functioning of the entire digestive system, because its well-coordinated work is the key to health.

Causes of digestive diseases

It is worth noting that diseases of the gastrointestinal tract are not uncommon in childhood. The root cause is poor ecology. We breathe polluted air and eat polluted air harmful products, containing mass hazardous substances for good health. In addition, the following factors can provoke such diseases:

1. Wrong diet. Problems arise not only from unnatural products, but also from improperly organized food consumption. For example, infants are often not introduced to complementary foods in a timely manner or are transferred to artificial feeding. There are cases when parents do not control their children’s eating habits, especially for schoolchildren. Many of them spend their pocket money on fast food, crackers, chips, etc. It is for this reason that when using junk food and without organizing their daily diet, children risk facing serious health problems.
2. Congenital pathologies, which can form in a child during the period of intrauterine development. For example, sometimes the fetus develops a short esophagus, which subsequently provokes the appearance of diseases of other organs of the gastrointestinal tract (GIT). As a rule, treatment for such a diagnosis is ineffective and is aimed at eliminating symptoms.
3. Malignant tumors. Unfortunately, cancer often provokes disturbances in this system. If a tumor appears on one of the digestive organs, this entails a malfunction of the entire body.
4. Infectious diseases and the proliferation of bacteria on the walls of the stomach and intestines. Any infectious disease suffered can lead to complications that affect the digestive system. That is why doctors advise that if the body is affected by an infection, adhere to bed rest. This significantly reduces the risk negative consequences. As for bacteria that multiply on the walls of the stomach or intestines, this can be caused by the banal consumption of unwashed foods (especially vegetables and fruits that we eat with the skin on). As a result, the child runs the risk of becoming infected with helminths, which contribute to disruption of the gastrointestinal tract if left untreated.
5. Use of antibiotics. A child can take antibacterial drugs only as prescribed by a doctor, but, unfortunately, such treatment sometimes leads to bad consequences. Frequent use of antibiotics risks causing the baby to develop whole line gastrointestinal disorders. Most often this is intestinal dysbiosis, which can cause more serious pathologies. That is why after taking such drugs it is worth taking care of restoring the intestinal microflora.
6. Intoxication of the body. Poisoning often leads to illness. Eating low-quality food, violating its storage conditions or improper processing cause the development of disorders. If this happens to your baby quite often, there is a high risk that he will develop gastritis.
7. Bad habits. Perhaps this is most relevant in adolescence, when children, going through a difficult transition period, sometimes take rash actions. They begin to try alcohol, become addicted to smoking, and try drugs. These substances are very dangerous for a weak child’s body, and provoke various problems in the body’s functioning.

Symptoms of digestive diseases in children

• Nausea, which in some cases is accompanied by vomiting.
• Constipation or frequent loose stools. There may be blood and mucus in the stool.
• Impaired passage of food through the esophagus.
• Flatulence.
• Changes in the child’s appetite: it may increase or, conversely, decrease. Also, after eating, the child complains of bad taste in the mouth.
• Frequent belching and heartburn after eating.

Prevention of digestive diseases in children

Try not to give your child very often fatty foods. Instead, he should eat healthy home-cooked food. For the health of the gastrointestinal tract, it is necessary to consume soups every day. Make sure your child has a light and healthy breakfast. Food in the morning should give you energy and strength for the whole day. Ideally, these are milk porridges, cottage cheese, fresh fruits or fresh juices.

It is advisable that the child eats at the same time. This will not only contribute proper operation digestive organs, but will also develop the habit of correctly drawing up a schedule, adhering to general order in life.

Be sure to teach your children to wash their hands thoroughly with soap every time before eating. Most harmful microbes enter the human body through the hands. Then the bacteria disrupt the natural intestinal microflora, and in the future this becomes a cause of health problems. When consuming vegetables or fruits, wash them thoroughly to remove any possible bacteria.

Equally important in prevention is the emotional state. It has been proven that large emotional stress negatively affects the digestion process. Therefore, distribute your child’s schedule in such a way that he keeps up with his studies and does not experience constant fatigue from this process. Many parents try to enroll their children in different clubs, but it is difficult for them to withstand this emotionally. Therefore, in such matters, consult your child first.

As you can see, there are a lot of reasons for diseases of the digestive system in childhood: it can be either a nutritional disorder or serious illness. That is why it is worth teaching your baby to eat healthy from early childhood, and also pay attention to any changes in his health in a timely manner. Knowing the basic rules will help protect the health of the child and give parents peace of mind!

More information about functional disorders motility of the digestive organs in children is told by S. V. Belmer:

Abdominal pain is the leading symptom. Features of these pains, as well as some associated symptoms allow us to presumably determine the nature of the disease. To clarify disorders and prescribe targeted treatment, as a rule, an additional examination is necessary, during which a number of special techniques are selectively used. The examination is carried out in the morning on an empty stomach.

What methods are used when examining children with gastrological diseases?

Fractional intubation of the stomach- determination of the amount and acidity of gastric juice, sucked out for two hours through a probe inserted into the stomach.
Esophageal and gastric pH-megrya- study of the acidity and intensity of acid formation in different parts of the esophagus and stomach using electrodes inserted into the digestive tract on a thin (1 mm) conductor. Used in the mode of single-stage research, two-hour and daily monitoring.
Electrogastrography- registration of gastric biopotentials from the surface of the abdomen, reflecting the rhythm and intensity of motor activity of the stomach.
Esophagogastroduodenoscopy (EGDS)- examination of the mucous membrane of the upper digestive tract using fiber optics (the diameter of the part introduced to the child is 8-12 mm). Allows you to identify changes in the mucous membrane, motility disorders and anomalies of the esophagus, stomach and duodenum. The duration of the study is 3-5 minutes.

Detection of stomach infection with Helicobacter:

• examination of a piece of the gastric mucosa or parietal gastric mucus taken during endoscopy using microscopy and special tests (liquid urease test, CLO test, Denol test, etc.);
• respiratory helix test - detection, if Helicobacter is present in the stomach, of an increase in the amount of ammonia in the exhaled air after taking a urea solution;
• detection of anti-Helicobacter antibodies in blood serum and Helicobacter antigen in feces;
• detection of Helicobacter DNA in feces.

Contrast radiography of the esophagus, stomach and duodenum- X-ray examination of the upper parts of the digestive tract after taking a suspension of “chalk” (barium sulfate).
Ultrasound examination (ultrasound) abdominal organs allows you to evaluate the structure of the liver, pancreas, gallbladder, spleen. After taking choleretic drugs, it makes it possible to study motor function gallbladder.
Biochemical blood test from a vein ( functional indicators liver, pancreas, indicators of inflammatory activity) and urine (bile pigments, amylase).
Radioisotope research liver, spleen, pancreas - registration of accumulation and removal from organs of intravenously administered short-lived isotopes.
Duodenal sounding- study of the quantity and composition of contents obtained on an empty stomach using a probe from the duodenum. Allows you to identify giardiasis, evaluate the secretion of bile and study its composition.
Cholecystography- X-ray examination, allowing after the dacha contrast agent through the mouth, evaluate the excretory function of the liver, the shape and contractility of the gallbladder.
Scatological research- macro- and microscopic examination of feces with assessment of the remains of undigested food, mucus and blood, search for eggs of worms and protozoa.
Colonoscopy, sigmoidoscopy- examination using fiber optics of the lower intestines after a thorough bowel movement (usually after enemas). Allows you to detect changes, pathological formations of the mucous membrane, structural anomalies;
Irrigography- X-ray examination of the colon after the introduction of a suspension of barium sulfate into it as an enema. Allows you to evaluate the relief of the mucous membrane, intestinal motility, identify anomalies, tumors, etc.
Bacteriological examination of stool- assessment of the microbial flora of the colon, identification of dysbiosis - a violation of the composition of the intestinal microflora.
Most techniques are painless and harmless. Before carrying out probe techniques, psychological preparation of the child is required.

A healthy digestive process is the key to a child’s normal well-being. But parents often remember this too late, as statistics confirm. last years does not give comforting forecasts. According to doctors, today there is an increase in gastrointestinal pathologies among newborns and older children. Why does this happen and what should you be wary of?

Photo: Increase in gastrointestinal pathologies among children of different ages

Causes

The development of pathological processes in the gastrointestinal tract is influenced by a number of factors:

• Unfavorable environmental conditions
• Endocrine system disorders
• Low quality products
• Violation of food preparation rules
• Neurocircular dysfunctions
• Heredity

Photo: Malfunctions of the immune system

As you can see, the list of factors dangerous to the normal functioning of the gastrointestinal tract is quite extensive. This means that the slightest fluctuations in the child’s condition should contribute to parents’ concern and subsequent contact with specialists. Immediate diagnosis of pathologies can protect the baby from serious complications and discomfort that interferes with his full life.

Pediatric gastroenterologists tend to identify two peaks of gastrointestinal pathologies in children, based on age - 5-6 years and 9-11 years.

Photo: Pediatric gastroenterologist

Symptoms

In order to be able to help their child in a timely manner, every parent should become familiar with the most common pathological signs affecting the gastrointestinal tract.

Diarrhea

Diarrhea is not an independent disease at all. This is a symptom that, meanwhile, should not be ignored. Often diarrhea indicates that the child’s body has been attacked by OCI. The latter may be accompanied by a rise in temperature, abdominal pain, and general weakness of the body. Another is poisoning that develops after a child consumes low-quality products or harmful substances.

Diarrhea is extremely dangerous for a child of any age, as it leads to dehydration.

Perhaps this is no less a compelling argument for seeing a doctor than diarrhea. may indicate various disorders, be aching or cramping, sharp or dull. Sometimes you can accurately determine the location of the pain, in other cases the picture remains blurred.

Photo: Abdominal pain

Often, when a child complains of abdominal pain, parents try to relieve the discomfort through antispasmodics. Doctors warn that self-medication can end very badly!

Vomiting, nausea

According to medical statements, these signs are observed in children in the presence of chronic gastrointestinal diseases. But their presence cannot be excluded during infections. A specialist can determine the origin of vomiting by the nature of its process.

Photo: Nausea in gastrointestinal diseases

The following points may indicate the development of a particular gastrointestinal disease in childhood:

• loss of appetite;
• change in saturation;
• thirst;
• swallowing disorder;
• flatulence;
• constipation.
• dry mouth;
• feeling of discomfort in the abdomen;
• increased salivation.

Common gastrointestinal diseases in children

The list of pathologies often diagnosed in childhood is long, but we will focus on those that appear with noticeable frequency.

It is an inflammation of the gastric mucosa. As a rule, the disease occurs at school age, when the child first becomes acquainted with truly harmful foods and develops eating habits. The disease also develops for other reasons:

• mental and physical stress;
• systemic autoimmune-allergic and infectious-toxic reactions;
• Helicobacter pylori infection.

Photo: Gastritis

The acute form of the disease comes with vomiting, pain and general weakness. With immediate diagnosis, complications can be avoided. In addition to taking medications (sorbents, gastrocytoprotective and enzyme drugs), nutrition appropriate for the diagnosis is required. At severe pain the child is prescribed Riabal, Papaverine, No-shpa, that is, antispasmodics.

This disease should be understood as an organic or functional digestive disorder. Pathology manifests itself as a feeling full stomach with early satiety, nausea and vomiting, unusual stool, heartburn. Characterized by an acute onset with an increase in temperature.

Dyspepsia can be simple and toxic. In the first case, the functioning of the gastrointestinal tract suffers, in the second there is a malfunction in the functioning of the metabolic system. Toxic dyspepsia follows from simple dyspepsia if it has not been properly treated.

Photo: Dyspepsia

Children with weak immune systems are often susceptible to dyspepsia.

The disease occurs when:

• violation of the complementary feeding regime;
• Irregular intake of food by the child;
• overheating of the body;

Diagnosis of dyspepsia should be carried out by a pediatric gastroenterologist. The child is prescribed an ultrasound of the abdominal cavity, radiography of the stomach, laboratory tests of stool, liver tests, tests for pancreatic enzymes in urine and blood, examination of stool for worm eggs, coprogram, electrogastrography.

Taking antibacterial drugs and vitamins. The child is indicated for rehydration assistance (saline and plasma replacement solutions) and diet.

It is considered one of the most dangerous pathologies of the pancreas. Characterized by its inflammation. Doctors assure that the predisposition to the disease is congenital. Causes of pancreatitis also include:

• poor nutrition;
• binge eating;
• congestion in the intestines;
• food poisoning;
• helminthic infestations;
• irregular use of medications;
• vaccinations.

Photo: Pancreatitis

An obvious symptom pathological condition is vomiting after eating a heavy meal. The phenomenon occurs unexpectedly, but goes away quite hard. Next comes dehydration and an increase in temperature. There is intoxication: loss of appetite, lethargy, pale skin. The stool becomes greasy.

The diagnosis is made based on the results of ultrasound and laboratory research . should be performed in a hospital under the vigilant supervision of physicians and be symptomatic. A special diet is required.

The disease is characterized by a violation of the outflow of bile into the duodenum due to inconsistency of contractions of the cystic ducts, gallbladder and sphincter apparatus. Its development is caused by a dysregulation of the organ in which the functional disorder occurred.

Predisposing factors are:

• stress;
• low quality nutrition;
• physical inactivity;
• binge eating;
• gastrointestinal infections;
• systemic pathologies of the digestive tract;
• heredity.

Photo: Biliary dyskinesia

The disease has two forms - hypertensive and hypotonic. The main symptom in the first case is pain in the right side, radiating to the right shoulder blade. Nausea, vomiting, and stool disturbances are present. In the second form of the disease, the pain is cramping in nature and radiates to the peri-umbilical region.

An important point in diagnosis is an increase in liver size, which occurs due to stagnation of bile. To make a correct diagnosis, diagnostic techniques are carried out: ultrasound of the gallbladder and liver, examination of bile and blood, coprogram, duodenal scanning.

Inflammatory disease of the gastrointestinal tract localized in the colon and small intestine. The disease is characterized by dysfunction of the intestines.

Taking antibiotics often leads to the development of pathology. Other provoking factors include acute intestinal infections, food allergies, and disturbances in the normal functioning of the stomach, pancreas and gall bladder.

Photo: Enterocolitis

If enterocolitis is diagnosed in babies, the cause of development may be an intrauterine infection called staphylococcal enterocolitis.

The disease manifests itself as abdominal discomfort, diarrhea, and flatulence. After some time, symptoms of dehydration begin, including weight loss.

Therapy is aimed at restoring previously impaired functions, suppressing growth and destroying the pathogen. Also, the goal of treatment is to prevent exacerbation of the disease. During treatment, the child is prescribed a diet. Fatty, salty and smoked foods are excluded. The child is prescribed antibiotics, antispasmodics, enzymes and enterosorbents. Taking probiotics is equally important.

Parents should understand that preventing any of the gastrointestinal tract ailments listed in the article is much easier than curing them. As a preventive measure, it is recommended to visit children’s specialists in a timely manner and monitor the child’s nutrition!