Жовчнокам'яна хвороба в дітей

Abstract

The prevalence of gallstone disease among children is 0.13-1.9%. Cholelithiasis in children is a multifactorial disorder. Scientific data analysis indicates a diversity of pathogenetic mechanism of gallstone formation. The purpose of the review is to summarize the scientific data about risk factors, clinical features, diagnosis and treatment of gallstone disease in children. Based on the literature data, the main factors for the disease are genetic, metabolic, low-calorie diet, nutritional disorders, liver and small intestine diseases. The main pathogenetic mechanisms of gallstone formation are liver dyscholia, disorders of enterohepatic circulation of bile acids, increased erythrocyte hemolysis and erythrocyte enzyme system insufficiency, a decrease in hepatic enzyme activity, impairment of gallbladder motility due to decreased sensitivity to cholecystokinin. Most children undergo asymptomatic gallstone disease: clinical features are absent, concrements in the gallbladder or bile ducts appear as accidental findings during ultrasound examination. The first stage of diagnosing cholelithiasis is an abdominal ultrasound examination. In case of absence of concrements during ultrasound examination and presence of typical clinical picture of cholelithiasis, endoscopic ultrasound and magnetic resonance cholangiopancreatography are prescribed. To reduce biliary pain, non-steroidal anti-inflammatory drugs and analgesics are required. The only way to treat symptomatic form of gallstone disease is cholecystectomy. The asymptomatic form is subject to observation without treatment. For the treatment and prevention of cholelithiasis, it is not recommended to take bile acid preparations due to the low effectiveness and frequency of relapses in the formation of stones after their complete dissolution. Conclusions. The incidence of gallstone disease among children and adolescents increases and more than half of patients has asymptomatic form. During the treatment of patients with cholelithiasis, cholecystectomy or observation tactics are used, depending on the clinical form of the disease. Prevention of gallstone disease relies on healthy lifestyle, weight loss for the obese children, physical activity, diet high in fiber and calcium. The authors declare that they have no conflicts of interest.