Digestive Tract In Children Research Articles

Treatment of motility disorders of the upper digestive tract in children with autonomic dysfunction

Background. Recently, there has been an increase in the prevalence of the autonomic nervous system (ANS) dysfunction and, against this background, motility disorders of the upper digestive tract (UDT), which, in turn, is the basis for the formation of chronic pathology of the digestive organs in children. The purpose was to improve the treatment of children with ANS dysfunction by studying the type of motility disorders of the UDT and prescribing therapy schemes depending on the type of disorders. Materials and methods. The article presents the results of clinical and anamnestic, laboratory, instrumental and psychological research of 109 children aged 6–16 years with autonomic dysfunction. Results. All surveyed children were divided into two representative groups: group I (main one, n = 87) — patients with autonomic dysfunction and impaired motility of the UDT who by type of motor function were divided into two subgroups: IA — with the acceleration of this function (n = 18) and IB — with its slowdown (n = 69); group II (comparison one, n = 22) — children with autonomic dysfunction without motility disorders of the UDT. In order to treat patients in subgroup IA, they, in turn, were divided into two therapeutic subgroups: IA1 — only basic therapy for autonomic dysfunction, and IA2 — in addition to basic therapy for autonomic dysfunction, correction of motility disorders of the UDT was performed. Patients of subgroup IB were also divided into two subgroups: IB1 — only basic therapy for autonomic dysfunction, and IB2 — in addition to basic therapy for autonomic dysfunction, correction of motility disorders of the UDT was conducted. The effectiveness of treatment for autonomic dysfunction syndrome has been proven, taking into account the type of motility disorders of the UDT. Different treatment regimens were proposed for children with ANS dysfunction without disorders and with the presence of motility disorders. The use in the comprehensive treatment of children with autonomic dysfunction syndrome of drugs that affect the motor function of the upper alimentary canal significantly increases its effectiveness during treatment for 30 days (89.0 versus 57.0 % when motor function slows down). Conclusions. The effectiveness of the comprehensive treatment for autonomic dysfunction has been proven, taking into account the type of motility disorders of the UDT. It reliably reduces the risk of recurrence of clinical manifestations of gastrointestinal pathology in children.

Modern trends in the formation of comorbid pathology of the esophagus and gastroduodenal zone in children

The article presents modern views on trends and controversial issues in the formation of combined pathology of the gastroduodenal zone and esophagus in children. The purpose of the authors of this study: to identify the features of the formation, course and outcomes of gastroesophageal reflux disease (GERD) in children with pathology of the gastroduodenal zone (GDZ) based on endoscopic and morphological comparisons. Own long-term observations were analyzed depending on the type of pathology, the severity of motor disorders, endoscopic and morphological picture, infection Helicobacter pylori. Possible options for the formation of gastroesophageal reflux disease in children and adolescents with various diseases of the gastroduodenal zone were determined. It has been established that the combined nature of the pathology of the esophagus and gastroduodenal zone in children occurs in more than 75% of patients. The nature and severity of esophageal disorders depend on the nature of the nosology of the gastroduodenal zone and, as a rule, are secondary. The increase in the frequency of GERD in modern children, the increase in the proportion of its complicated variants (including ulcers and Barrett's esophagus), make it a priority in the study of diseases of the upper digestive tract in children at the present time. For this contingent of young patients, it is urgent and urgent to develop clear diagnostic criteria (including endoscopic and morphological criteria), therapy tactics, and a strategy for cancer prevention.

РАСПРОСТРАНЕННОСТЬ ХРОНИЧЕСКОГО ГАСТРОДУОДЕНИТА СРЕДИ ДЕТЕЙ, ПРОЖИВАЮЩИХ В ГОРОДЕ ЯРОСЛАВЛЕ

Chronic gastroduodenitis (CGD) is one of the most common diseases in children. Current data on the prevalence and incidence of CGD in children vary greatly from different sources, and therefore it is difficult to form strategies aimed at preventing CGD at an early age, which leads to an increase in the number of patients with late diagnoses, as well as a decrease in the quality of life of patients and their families, and has significant socio-economic consequences. The aim of the study was to assess the prevalence of CGD among children living in the large administrative center of the Central Federal District, the city of Yaroslavl. A retrospective analysis of the clinical, endoscopic and morphological status of the upper digestive tract in children with chronic digestive diseases examined in the conditions of the consultative and diagnostic center (CDC) of the Regional Children's Clinical Hospital (RCCH) for the period 2017-2021 was carried out. Based on the data obtained, the following statistical indicators were calculated: gender-age composition of patients with CGD, morbidity, prevalence for specific annual indicators and age groups. At the time of the retrospective analysis, 2,416 children were diagnosed with CGD. In 2021, the incidence was 4.92 per 1,000 children, and the prevalence was 20.61 per 1,000 children, these indicators change every year in waves. Our data on the prevalence of CGD in the city of Yaroslavl are underestimated and have a wide spread in different age categories. The problem raised in our study requires in-depth study on additional samples of children in this region.

Clinical features of the doubling of the digestive tract in children

The aim of the study is to study the features of diagnosis and treatment of children with doubling of the digestive tract. Materials and methods. The 50-year experience of treating 46 children with a doubling of the digestive tract was analyzed. Results. Of all the children with a doubling of the digestive tract, 39 were diagnosed with intestinal obstruction. The diagnosis is most often established during surgery and after histological examination. A clinical observation is given. Conclusion. There is no typical clinical picture of the doubling of the digestive tract in children. Most children with a doubling of the digestive tract are diagnosed with intestinal obstruction. The double and the main organ have a common wall and a common blood supply, which creates difficulties and risks of damage to the main organ during surgery.

Gastroesophageal refl ux disease and broncho- obstructive syndrome in children — a “vicious circle” or comorbidity?

This article is devoted to the comorbidity of diseases of the digestive tract and respiratory system in children. Comorbidity (polymorbidity) in the pathology of the gastrointestinal tract is widely described in modern scientific literature, however, the relationship between the digestive and respiratory systems seems to be less studied.The purpose of the study was to analyze the endoscopic signs of refl ux pathology of the digestive tract in children with a comorbid condition — GERD and respiratory diseases occurring with broncho-o bstructive syndrome (BOS).Materials and methods. An in-depth examination of 180 children from 6 to 16 years old with comorbid pathology (respiratory diseases with BOS and GERD) was carried out. Performed: X-ray examination, spirometry, intracavitary pH-metry, EFGDS and ultrasound of the gastrointestinal tract. To study the morphological features of the esophageal mucosa in this comorbidity, biopsies were examined 1 cm above the Z-line; at the same time, a biopsy of the mucosa of the antrum of the prepyloric part of the stomach was performed.Results. Respiratory diseases with biofeedback in the examined groups of patients were most often (43.9%) combined with GERD at the age of 12–14 years. The predominance of endoscopically positive grade 1 GERD is typical for patients with broncho- obstructive syndrome caused by moderate and severe persistent BA, acute and prolonged pneumonia, and recurrent bronchitis. Infl ammatory diseases of the digestive system (chronic gastritis, chronic gastroduodenitis) in BA were detected in 40.6% of patients, in pneumonia — in 45.7%, in recurrent bronchitis — in 33.3% of patients. Based on the data of a general morphological study of biopsy specimens, regardless of age and type of bronchopulmonary pathology, two variants of infl ammation were identifi ed, which are more common than others — with a predominance of dystrophic changes and with a predominance of infl ammation itself, which largely depended on the duration of the disease. In patients suff ering from both BA and pneumonia with biofeedback, morphological changes in the esophageal mucosa corresponded to the catarrhal nature of the infl ammation.

Динаміка експресії генів факторів транскрипції Т-клітин та інтерлейкінів на тлі пробіотичної терапії хронічних гастродуоденітів у дітей

Chronic gastroduodenitis (HGD) in children is one of the most common diseases of the digestive tract in children, the treatment of which needs to be improved. Purpose - to study the effectiveness of Lactobacillus rhamnosus GG ATCC 53103 (LGG) in the treatment of children with chronic gastroduodenitis and the effect of treatment on the expression of pro- and anti-inflammatory cytokines and T-lymphocyte transcription factors in the buccal mucosa. Materials and methods. We examined 39 children with chronic gastroduodenitis aged 10-14 years, of which 2 comparison groups were formed. The main group (n=21) included patients for whose treatment, in addition to traditional therapy, a probiotic drug was containing 5×109 lyophilized viable bacteria LGG. The control group (n=18) was represented by patients receiving only traditional therapy. The duration of treatment with probiotic LGG was 14 days. To prove the effectiveness of LGG in therapy, the level of mRNA expression of transcription factors (Tbet, RORyt, FOXP3) of T cells and interleukins (IL-1β, IL-17α, IL-10) was determined by polymerase chain reaction with reverse transcription. Results. The period of CGD exacerbation was characterized by an increase in the expression level of mRNA of the RORyt transcription factor of Th17-cells and mRNA of IL-1β, IL-17α in the buccal mucosa. After standard therapy in children with CHD, there was a significant increase in the activity of mRNA expression of the transcription factor Tbet of Th1-cells and a decrease in the activity of mRNA expression of the RORyt of transcription factor Th17-cells. After treatment with combination therapy using a probiotic preparation containing LGG, there was also a decrease in the activity of mRNA expression of the RORyt transcription factor of Th17-cells, but in contrast to children who received standard therapy, there was a low level of mRNA of the transcription factor Tbet of Th1-cells and mRNA IL-17α; in combination with an increased level of mRNA of the FOXP3 transcription factor of Treg-cells. Conclusions. The appointment of a combination therapy using a probiotic preparation containing Lactobacillus rhamnosus GG in children with chronic gastroduodenitis contributes to the rapid regression of the clinical manifestations of pain, dyspeptic syndromes. The administration of LGG leads to a more rapid decrease in the level of expression of the IL-17 genes due to an increase in the activity of mRNA expression of the FOXP3 of Treg-cells. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: chronic gastroduodenitis, children, transcription factors, interleukins, probiotic therapy, Lactobacillus rhamnosus GG.

Probiotics and Its Effects on the Cognitive Development in Children: A Meta-Analysis

Background: Due to its high morbidity and mortality rate, diarrhea is still a major health problem among children, particularly toddlers, in developing countries. One of the causes of diarrhea in children is the side effect of antibiotics or known as antibiotic-associated diarrhea (AAD). Evidences of studies conducted in several countries indicated the high use of antibiotics among children that put the group at a high risk of enduring AAD. Probiotics has shown efficacy in preventing and curing various medical conditions, especially those involving digestive tract in children. Subject and Method: It was a systematic review and meta- analisis study. Data collection was conducted by obtaining from databases, namely: Google Scholar, PubMed, Scopus and Science Direct. The study was analyzed by using RevMan 5.3 software. Inclusion criteria used were full paper in English with Randomized controlled trial design during the period of 2000-2022. Keywords used were “Probiotic” AND “Antibiotic Associated Antibiotic” AND “Child” AND “Randomized Controlled Trial”. Results: Meta-analisis was conducted to 9 primary studies from several countries such as Poland, Italy, Korea, Iran, and Australia. Mata-analysis concludes that there were effects of probiotics toward antibiotic-associated diarrhea. Children who were given probiotics had one-third time risk of diarrhea episodes compared to those who were not given probiotics (RR= 0.32; 95% CI= 0.23 to 0.44; p<0.001). Heterogeneity of between-study effect estimates of the meta-analysis data was (I2= 0%; p= 0.096) therefore, calculation of effect estimates was written by using fixed effect approach. Funnel plot did not identify the occurrence of publication bias out of the meta-analysis. Therefore, the funnel plot did not identify the occurrence of publication bias. Conclusion: Probiotics have effects in reducing antibiotics-associated diarrhea incidences in children. Keywords: probiotics, diarrhea, antibiotics. Correspondence:Anggraini Ambarsari. Masters Program in Public Health, Sebelas Maret University. Jalan Ir. Sutami 36A, Surakarta 57126, Jawa Tengah, Indonesia. Email: Aanggraini.ambarsari29@gmail.com. Mobile: 085600184363 Indonesian Journal of Medicine (2022), 07(02): 232-241 https://doi.org/10.26911/theijmed.2022.07.02.11

Risk Factors for the Formation of Inflammatory Diseases of the Upper Digestive Tract in Children in the Republic of North Ossetia-Alania

In recent years, cases of diseases of the digestive tract among preschool and school-age children have become significantly more frequent. This article analyzes the influence of various factors (heredity, living conditions, age, gender, lifestyle) on the likelihood of morbidity.
 Chronic pathology of the upper digestive tract in the vast majority of children begins at preschool age with further significant growth from the moment they attend school. Close attention is required by children whose parents and immediate relatives suffer from gastroenterological diseases.
 Modern diagnosis of the disease will reduce the risk of development and progression of the most common pathology of the digestive organs of childhood and avoid the development of severe complications.

Роль пробіотиків у формуванні мікрофлори в дітей, що вигодовуються штучними сумішами

У статті представлені сучасні уявлення про значення грудного молока в процесі первинного бактеріального заселення травного тракту в дітей. Відображено особливості девіації становлення мікробіоти кишечника при вигодовуванні дітей штучними сумішами і ризик виникнення асоційованих із мікробіотою порушень стану здоров’я у дітей. Представлені докази профілактичної дії бактерій Bifidobacterium animalis subsp. lactis BB-12, що запобігає виникненню гострих інфекційних захворювань респіраторного і травного тракту і алергічних захворювань.

Состояние слизистой оболочки верхних отделов пищеварительного тракта у детей при сочетанных ГЭРБ и хронической гастродуоденальной патологии

Актуальность. Согласно данным литературы, частота гастроэзофагеальной рефлюксной болезни (ГЭРБ) в популяции составляет от 7 до 60 %, а у детей, по данным различных авторов, колеблется от 2–4 до 8,7–49 %. У детей ГЭРБ часто формируется на фоне хронической гастродуоденальной патологии. Цель. Изучение эндоскопической картины верхних отделов пищеварительного тракта при их сочетанном поражении у детей. Материалы и методы. Под наблюдением находилось 120 детей с сочетанными ГЭРБ и хронической гастродуоденальной патологией. Диагнозы верифицированы с помощью эзофагогастродуоденоскопии. Дети были разделены на группы в зависимости от характера поражения слизистой пищевода. В I группу вошли 35 детей с эрозивным и язвенным эзофагитом; во II группу включены 43 ребенка с катаральным эзофагитом; III группу составили 42 ребенка с ГЭРБ без эзофагита. Результаты. Частота гастроэзофагеального рефлюкса III степени достоверно чаще встречается у детей с ГЭРБ и эрозивно-язвенным эзофагитом. При умеренно выраженной гиперемии и отеке слизистой оболочки желудка у детей достоверно чаще (p < 0,05) формируется ГЭРБ без эзофагита. При ярко выраженных воспалительных изменениях слизистой желудка достоверно чаще (p < 0,05) имеет место гастроэзофагеальный рефлюкс с воспалительным поражением слизистой пищевода и формированием как катарального, так и эрозивного эзофагита. Деструктивные изменения слизистой в пищеводе и в луковице двенадцатиперстной кишки (ДПК) не коррелируют между собой. Выводы. При сочетанных ГЭРБ и хронической гастродуоденальной патологии степень выраженности эзофагита зависит от характера поражения слизистой желудка и ДПК.

Dynamics of Diseases of the Upper Digestive Tract in Children

In the Russian Federation, there is a tendency to increase the incidence of a number of nosologies, the prevalence of chronic diseases and the deterioration of health among children and adolescents. Diseases of the digestive organs occupy a leading place in the structure of somatic pathology of childhood.
 According to the statistical data of the Ministry of Health of the Republic of North Ossetia – Alania (RNO – Alania), for seven years the prevalence of pathology of the digestive organs, including inflammatory bowel diseases, among children and adolescents has increased in the republic as a whole and regions separately. By 2022, it is predicted that the level of general and newly detected morbidity among children with pathology of the upper digestive tract will increase by 1.5-2 times.

Intestinal ultrasound in pediatrics

Ultrasonography is the imaging technique of choice for studying the digestive tract in paediatric patients from the neonatal period to adolescence. Its dynamic character, absence of radiation, and scant preparation required make ultrasonography preferable to contrast-enhanced fluoroscopy, computed tomography, or magnetic resonance imaging. Technical advances in ultrasound, including high-resolution multifrequency probes, panoramic studies, colour Doppler, Doppler with microvascularization, elastography, and contrast agents for use in children, have increased the sensitivity and specificity of this technique.Intestinal ultrasound is indicated for conditions with diverse etiologies and pathogenesis: congenital, infectious, inflammatory, tumor-related, and vascular. Knowledge of embryological development and the normal characteristics of the digestive tract help in identifying, recognizing, and interpreting the ultrasound findings of the different conditions in paediatric patients.This paper aims to show the indications for ultrasound studies of the digestive tract in children, the findings on these studies, and the management of the most common gastrointestinal conditions in paediatric patients.

Спайкова кишкова непрохідність як ускладнення дивертикула Меккеля в дітей

Meckel’s diverticulum (DM) is a formation of the ileum caused by incomplete obliteration of the omphalomesenteric duct in the developing embryo. This is one of the most common anomalies of the digestive tract in children. Most DM develops completely asymptomatically. Clinical symptoms develop in only 16% of cases, and 50–60% of them are children under 10 years, an average of 2.5 years of age. The severity of clinical symptoms in DM is associated with the development of complications: intestinal bleeding, intestinal obstruction (intussusception, strangulation intestinal obstruction), diverticulitis with perforation and peritonitis, etc. The article presents a clinical case of adhesive intestinal obstruction in an 8-year-old, which occurred after DM in the anamnesis. As the adhesive intestinal obstruction is an extremely rare complication of DM in children, the presence of patients with acute surgical pathology of the abdominal cavity requires pediatric surgeons to clearly understand the occurrence of such complications in the perspective of the development of intestinal tube defect – DM and the need for the immediate radical treatment tactics in the event of this problem. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, Meckel’s diverticulum, complications, adhesive intestinal obstruction.

Management of functional gastrointestinal disorders in children. Focus on restoring intestinal microenvironment and motility

Functional gastrointestinal disorders in children are one of the most common reasons why parents visit a pediatrician. Functional gastrointestinal disorders include various persistent combinations of chronic or recurrent gastrointestinal symptoms in the absence of any organic pathology in the gastrointestinal tract (structural abnormalities, inflammatory changes, infections, or tumours) and metabolic disturbances. The article presents details on the mechanisms of development, clinical manifestations, diagnostic criteria and approaches to the treatment of functional gastrointestinal disorders. Clinical manifestations of functional gastrointestinal disorders vary depending on age and characteristics of physical and intellectual development. In more than half of children, they are observed in various combinations, less often as one isolated symptom. The drug therapy should consider the main components of pathogenesis and facilitate the solution of the following issues: improvement of digestion; restoration of intestinal microenvironment and motility; reduction of visceral hypersensitivity. Special attention is paid to the management of motor disorders and restoration of intestinal microenvironment using symbiotics. When choosing a supplement, it is advisable to focus on the composition of probiotic strains, which should comply with the WGO global guidelines (Bifidobacterium bifidum, Lactobacillus acidophilus, etc.).Prescription of peripheral δ-, μ- и κ-receptor agonists – trimebutine and pre- and probiotics combinations to children with functional gastrointestinal disorders results in decreased signs of functional disorders of the digestive tract. By acting on the enkephalinergic system, trimebutine regulates the bowel activity, improves motility, and reduces visceral hypersensitivity. Trimebutine is included in the Russian guidelines for the diagnosis and treatment of functional disorders of the digestive tract in children, as well as in the clinical guidelines for the treatment of irritable bowel syndrome, functional dyspepsia, and functional abdominal pain.

Ecografía intestinal en pediatría

Ultrasonography is the imaging technique of choice for studying the digestive tract in pediatric patients from the neonatal period to adolescence. Its dynamic character, absence of radiation, and scant preparation required make ultrasonography preferable to contrast-enhanced fluoroscopy, computed tomography, or magnetic resonance imaging. Technical advances in ultrasound, including high-resolution multifrequency probes, panoramic studies, color Doppler, Doppler with microvascularization, elastography, and contrast agents for use in children, have increased the sensitivity and specificity of this technique.Intestinal ultrasound is indicated for conditions with diverse etiologies and pathogenesis: congenital, infectious, inflammatory, tumor-related, and vascular. Knowledge of embryological development and the normal characteristics of the digestive tract help in identifying, recognizing, and interpreting the ultrasound findings of the different conditions in pediatric patients.This paper aims to show the indications for ultrasound studies of the digestive tract in children, the findings on these studies, and the management of the most common gastrointestinal conditions in pediatric patients.

Взаимосвязь адгезивности буккальных эпителиоцитов для Candida albicans с особенностями пищеварительного тракта у детей с рекуррентными респираторными заболеваниями

Взаимосвязь адгезивности буккальных эпителиоцитов для Candida albicans с особенностями пищеварительного тракта у детей с рекуррентными респираторными заболеваниями

Bezoar gastrointestinal disease in children (literature review and interpretation of clinical observation)

The article presents data on the causes of the formation of various types of bezoars in children, traces the causes of their complicated course in the form of bezoar disease. Modern issues of diagnostics, methods of treatment and formation of foreign bodies of the digestive tract in children are covered in the article. A clinical case of a giant trichobezoar of the stomach and duodenum in a 14-year-old girl is presented and analyzed. in a histological examination of the gastric wall.

COMPARATIVE CHARACTERISTICS OF OUTCOMES AFTER SURGICAL TREATMENT OF THE HIRSCHPRUNG’S SHORT FORM DISEASE IN CHILDREN

Actuality. The Hirschsprung’s disease is one of the leading pathologies in the digestive tract in children. Despite the variety of diagnostic techniques for this disease, none of them has an absolute certainty when the short form disease is suspected, and only the assessment of findings after complex examination plus clinical picture can result in establishing a reliable diagnosis. The authors analyze outcomes of surgical treatment of the Hirschspring’s short form disease in children when the technique of dosed dissection of the internal anal sphincter under ultrasound control was applied and compare these results with those when conventional surgical techniques were used. Material and methods. 83 children aged 1-17.5 y.o. with the established diagnosis of Hirschsprung’s disease and an ultrashort aganglionic segment were taken into the study. Patients were divided into two groups. Group 1 (41 patient) who had surgical correction by the Lynn technique; Group 2 ( 42 children) who were operated on by the new developed technique. Results. 74% (31 patient) of children who were operated on by the dosed dissection of the internal anal sphincter under ultrasound control had good results in their late postoperative period; 10 patients (24%) had satisfactory results; unsatisfactory outcome was seen in 1 patient (2%). In children , who were operated on by the Lynn technique, good results were in 23 patients (57%); satisfactory results in 15 patients (37%) and unsatisfactory result in 3 patients (6%). Conclusion. The rectal form of Hirschsprung’s disease with a short and ultrashort segment requires surgical treatment in the vast majority of cases. In this case, surgery with dosed dissection of the internal anal sphincter under ultrasound control can be a method of choice.

Endoscopy treatment on gastrointestinal tract foreign body in children

As a common disease in pediatric outpatient and emergency departments, foreign bodies in digestive tract of children can occur in all ages.Foreign bodies in digestive tract is swallowed accidently or deliberately, which can neither be digested nor be absorbed in gastrointestinal tract.Early and timely diagnosis of foreign bodies in digestive tract which failed to pass spontaneously through the gastrointestinal tract or caused gastrointestinal tissue damage should be fully assessed and perfect auxiliary examination.Emergency endoscopic treatment with high success rate, less complications and quick recovery of organ function has become the best treatment for foreign bodies in digestive tract and is worth for extensive application in the clinic. Key words: Children; Foreign body; Endoscopy

Functional evaluation of the inferior digestive tract in children – anorectal manometry

Functional evaluation of the inferior digestive tract in children – anorectal manometry