The Aspects of Clinical Manifestation and Diagnostics of Irritable Bowel Syndrome in Infants

Abstract

The work deals with the present conceptions concerning irritable bowel syndrome (IBS) in infants. IBS is a functional intestinal disorder when abdominal pain or discomfort are associated with defecation, or changes of the intestinal function and peculiarities of defecation. It is the only disease with various variants of the course connected with disorders of a regulating role of the central nervous system and vegetative dysfunctions resulting, first of all, in the development of motor disorders of the large intestine and is manifested by defecation disorders, changes of frequency and quality of stools, and is accompanied by abdominal pain. The main aspects of etiopathogenesis are: compromised heredity, increased sensitivity of the large intestine to extension, enzymatic insufficiency and imbalance of neuroendocrine mechanisms, disorders of the intestinal endocrine system, leading to the intensification of the intestinal motor function, secretion, activation of the kinin system, occurring of pain impulses, regulative disorders of psychic and sensory functions. The main factors playing their role in IBS pathogenesis are: disorders of a regulating role of the CNS and development of vegetative dysfunctions; motor disorders and disorders of intestinal biocoenosis, which can be treated as a target mechanism of IBS and/or as the consequence of the disease. Diagnostic criteria, approaches to interpret the findings of the study and the principles of IBS treatment in infants are estimated. The initial diagnosis of IBS is made on the basis of clinical signs, the final diagnosis – on the basis of a combined estimation of clinical and paraclinical examinations. Proctosigmoidoscopy is a compulsory examination which should be performed to make or exclude the diagnosis of IBS. The results of clinical-paraclinical examinations of infants with clinical signs of IBS, aged 3-4 years, are presented. Much more considerable level of albumin, A1-AT, calprotectin and sIgA were found in their evacuations as compared to the infants of the control group which is indicative of a local inflammation, increased permeability of the intestinal mucus and local allergic reaction, which can be a predictor to develop further atopic dermatitis. The changes mentioned above are accompanied by considerable alterations of intestinal microbiocoenosis, which is manifested by a decreased content of physiological microflora with prevailed colonies of opportunistic microorganisms. The diagnosis of IBS is the diagnosis of exclusion, it can be verified only in case other diseases are excluded (first of all, inflammatory intestinal diseases).The treatment of IBS requires a comprehensive therapy with the use of medicines of a combined regulation action, it should be accurately differentiated considering a clinical variant of its course and individual reaction of the patient, substantiated and well-considered administration of medicines, keeping to the essential period of treatment to prevent relapsed signs.