Functional Constipations Research Articles

Современный взгляд на функциональные запоры у детей раннего возраста: особенности вскармливания и принципы немедикаментозной коррекции

Статья посвящена проблеме хронического запора у детей. Даны рекомендации по профилактике этого состояния. Подчеркнуто, что к медикаментозной терапии рекомендуют прибегать только при отсутствии эффекта от диетотерапии, которая сводится не к строгой диете или соблюдению определенного лечебного стола, а к физиологическому рациону питания. В настоящее время доступны смеси, соответствующие рекомендациям Европейского союза относительно питания специального медицинского назначения, сочетающие в себе одновременно несколько функциональных компонентов, что позволяет решить проблему функциональных запоров у детей раннего возраста, находящихся на искусственном вскармливании. Примером такой инновационной смеси является Нутрилон Комфорт.

Досвід застосування суміші «Ненні-1» із пребіотиками у дітей першого півріччя життя з функціональними запорами

Актуальність. Актуальність теми пов’язана зі зменшенням кількості дітей, що знаходяться на грудному вигодовуванні, та з вибором замінника грудного молока. Особливості складу і властивостей сучасної адаптованої суміші на основі козячого молока «Ненні-1» з пребіотиками дозволяють використовувати її в харчуванні дітей першого півріччя життя. Мета роботи: оцінити клінічну ефективність суміші «Ненні-1» з пребіотиками у дітей першого півріччя життя з функціональними запорами. Матеріали та методи. Під наглядом було 64 дитини віком від 1 до 6 місяців із функціональними запорами, які перебували на штучному вигодовуванні. Діти були розподілені на 2 групи: 32 дитини отримували адаптовану суміш на основі козячого молока «Ненні-1» з пребіотиками (1-ша група) і 32 дитини отримували суміш на основі коров’ячого молока з пребіотиками (2-га група). Обстеження включало лабораторні дослідження, оцінку масо-зростових показників, динаміку функціональних гастроінтестинальних розладів. Результати. У пацієнтів обох груп відзначалося стабільне збільшення маси тіла і прибавка зросту. Через місяць прийому суміші «Ненні-1» з пребіотиками знизилася частота функціональних порушень травлення у немовлят першої групи. Кількість дітей із позитивною динамікою гастроінтестинальних розладів, які отримували суміш на основі коров’ячого молока, була меншою, ніж в 1-й групі. У більшості немовлят при вживанні суміші на основі козячого молока зі вмістом пребіотичного комплексу відбувалося регулярне м’яке звільнення кишечника, покращувалась консистенція випорожнення, кількість дефекацій склала 1–3 на добу, запори зберігалися у 15,6 % дітей. У групі дітей, що отримували суміш на основі коров’ячого молока, запори збереглися у 9 немовлят (28,1 %). Висновки. Використання суміші «Ненні-1» з пребіотиками в харчуванні грудних дітей сприяє їх нормальному фізичному розвитку та зменшенню частоти функціональних запорів і інших гастроінтестинальних порушень.

Функциональный запор у детей раннего возраста в свете Римских критериев IV пересмотра. Международные рекомендации

В настоящее время запор у детей, особенно первых лет жизни, является одной из основных жалоб, которые предъявляют родители как на приеме у педиатра, так и у гастроэнтеролога. Несмотря на разработку современных международных рекомендаций по ведению данной группы больных, у отечественных педиатров до сих пор наблюдается искаженное представление о терапии и профилактике запоров у детей. В статье обсуждаются вопросы диагностики и терапии функциональных запоров у детей. Описаны рекомендации по диагностике и комплексной профилактике и лечению функциональных запоров у детей с включением слабительных препаратов, приводятся собственные наблюдения и опыт применения полиэтиленгликоля 4000 (макрогол) в терапии запоров у детей.

Functional Disorders of Digestive System in Children. Guidelines of Society of Pediatric Gastroenterology, Hepatology and Nutrition. Part 3

The clinical guidelines for the diagnosis and treatment of the3 functional disorders of the digestive system in children were preparedby a Group of Experts, domestic leading specialists in the field of the pediatric gastroenterology, who generalized the foreign guidelines and domestic experience, suggesting the tactics for the pediatrician actions in the everyday practice. Part 3 of the Guidelinesdiscusses the billiard tract dysfunctions and functional constipations. There are no biliary tract dysfunctions in the Pediatric Sectionsof Rome Consensus IV; however, the Russian pediatric school of thought has always considered them as important in terms of oneof the causes for abdominal pain in children. This attitude was supported by the experts, and it is maintained in these Guidelines.The functional constipations are common in the children of different ages, and they present not only a medical problem, but alsoa serious social one for both children and their parents. That is why the considerable attention has been paid to this pathology considering the psychosocial aspects of the correction.

Загустители в составе антирефлюксных смесей: сравнительная оценка

Approaches to the therapy of regurgitation syndrome in children at the first year of life were considered. It was shown that use of children’s milk mixtures with viscosity improver, which change the mixture consistence and increasing its viscosity, helps overcome functional gastrointestinal disorders, such as regurgitations, intestinal colic, functional constipations. Variants of anti-reflux milk mixtures were suggested.

Effectiveness and safety of natural mineral water rich in magnesium and sulfates for the intestinal function

A randomized, placebo-controlled, double-blind trial Objective. The present randomized placebo-controlled double-blind trial was conducted to examine whether natural mineral water with a high content of magnesium sulfate and sodium sulfate (Donat Mg) contributes to improvement of the bowel function. Methods. A total of 106 healthy subjects with functional constipations were randomized in groups to receive 500 ml natural mineral water for the 6-week course and a comparison group who took placebo water. Trial participants recorded in a diary each complete spontaneous bowel movement, the number of spontaneous bowel movements per week overall, consistency of stool, gastrointestinal symptoms and general wellbeing. The change in the number of complete spontaneous bowel movements was defined as the primary outcome of the trial. Results. In 75 trial participants in groups that took 500 ml the change in the number of complete spontaneous bowel movements per week after 6 weeks., as a rule, was higher in the active treatment group compared with the placebo group (T2 = 1.8; P-value= 0.036; one-sided criterion). The average number of complete spontaneous bowel movements significantly increased during the trial, with significant differences between trial groups, taking into account the duration of the trial in general (F-criterion = 4,743; R time × group = 0,010, a two-sided criterion). Intake of mineral water, compared with placebo considerably improved the stool consistency at spontaneous bowel movements (p < 0.001), subjectively perceived signs of constipation significantly decreased (p = 0.005). Conclusion. Daily intake of natural mineral water, rich in magnesium sulfate and sodium sulfate, has increased frequency of bowel movements and improved stool consistency in people with functional constipations. In addition, assessment of the participants in the trial of quality of life associated with the condition improved. Clinical trial registration number in the EudraCT database: No. 2012-005130-11.

Запоры у детей раннего возраста: причины и особенности диетологической коррекции

Constipations in infants of the first months of life are an important problem due to their high prevalence. There is no organic cause of constipation in 90–95% of all cases, so the most common are functional constipations. As the main target in treatment of constipations in infants is normalization of the intestinal contents consistency and its movement through the large intestine, in order to correct this condition a complex approach should be provided with dietary treatment and as required — medicinal treatment and mechanical evacuation of the intestine contents. One of the main methods of constipations correction in infancy is dietary treatment, which has its own special characteristic according to the type of feeding and further when additional food is introduced. If infants are on breast feeding their mothers are recommended to add vegetable oils and dietary fibers into their diet. Children on artificial feeding are switched to milk formulas according individual clinical situation and associated manifestations — such as regurgitation, colic and cow milk protein intolerance. Patients with functional constipations are indicated medicinal mixtures and additional food with prebiotics (dietary fibers, lactulose, inulin). Clinical efficacy of children food enriched with prebiotics in treatment of constipations is confirmed in various studies.

Diagnostics Features and Results Estimation of Chronic Colostasis Investigation in Children

The purpose of the research is the applications of various methods of research and study of their results at chronic colostasis in children. Material and Methods: In the Republican Research Centre of Emergency Medical Care in Tashkent since 2006 till the present time in the branch of children’s surgery, 75 children were treated with chronic colostasis at the age of from 3 months till 14 years. With the purpose of the confirmation of the diagnosis, the children were examined according to the standards accepted at the centre: USG, coprological analysis, identification of the intestinal microflora, rectal manual examination, colonofibrocopy, histological investigation of the colon biopsies samples, roentgenocontrast investigation of the colon irrigography, multisliced computed tomography (MSCT) of the colon, definition of anal muscles contractile function. Results and Discussion: In 35 (46.7%) studied children, there was diagnosed dolichosigma, in 14 (18.7%) —dolichocolon or dolichomegacolon, in 14 (18.7%)—Hirschsprung’s disease, in 1 (1.3%)—congenital narrowing of the anal channel, in 1 (1.3%)—Pair’s syndrome, in 10 (13.3%)—functional constipations. Conclusions: Any of known methods at the isolated application does not give absolute reliance of correctness of verification of the diagnosis, especially in heavy cases, at a divergence of clinical findings and data of the patient investigation. Each of methods has the restrictions at application and interpretation of results. The examination of children with chronic constipations should be complex and gradual, and at the subsequent diagnostic stage, the clinician should determine individually in each concrete case.

Типы толстой кишки, выявляемые методом гидроэхоколонографии при хронических запорах у детей

Retrospective cross research of results of a hydrocolonic echography (HCE) in 263 children with a constipations aged from 14 days till 17 years is carried out. The obtained data correlated to clinical manifestations. Seven types of echographic picture of the colon were revealed. The first four types corresponded to clinical forms of a functional constipations: compensated, subcompen-sated (dolihocolon) and decompensation (dolihomegacolon and megarectum), two types reflected features of fixing (Payr´s illness) or function of the colon (spastic colitis), and also type, characteristic for Hirschsprung´s disease. Secondary changes due to constipation are identified: thickening and "lamination" of a wall of a gut, lengthening (additional loops of the colon), dilatation of the lumen, smoothness or absence of the haustra, decrease in activity of a peristalsis, incomplete emptying of the colon, incontinence. Secondary changes didn´t depend on the constipation reason, and were a consequence of violation of depletion of the colon.

CURRENT DATA ON GASTRO-INTESTINAL DYSFUNCTIONS IN CHILDREN

Digestive dysfunctions are common in infants of the 1 st year of life. Pediatricians often recommend shifting one milk formula to another, but usually it has no positive results, only complicating the managing of such patients. The article demonstrates the modern views on etiology, pathophysiological mechanisms and principles of dietary therapy of regurgitations, functional constipations, intestinal colic and other gastro-intestinal dysfunctions in infants. One of the special characteristics of these disorders is the fact that they rarely occur as isolated symptoms and much more often — in different combinations with each other. On clinical examination of children with functional disorders neither morphological changes in gastro-intestinal tract, nor disturbances in enzyme-secretory function are found. At the same time minimal digestive dysfunctions have negative effect on life quality of the family, development rate and nutritive status of the child. One of the most effective methods of correction of such conditions is dietary measures.

NATURAL MINERAL WATER ENRICHED WITH MAGNESIUM IN CHILDREN WITH CONSTIPATIONS

Characteristics of medicinal mineral waters as well as the role of magnesium in human organism activity and normal functioning of the gastrointestinal tract are discussed in this article. Aim : to study the influence of mineral water enriched with magnesium on stool of children suffering from constipations, to determine the appropriate dosage and tolerance to such water and to research the effect of the combination of mineral and artesian drinking water on the functioning of the intestines of children with constipations . Patients and methods : 60 patients with chronic constipations (30 — in the study group and 30 — in control group) were included into the first study. Children from the study group were administered mineral water at the dosage of 3 – 5 ml/kg of the body weight 3 times per day, the treatment course was 10 days at hospital and after that — for 3 weeks in outpatient conditions. The second study included 45 children at the age of 3 – 15 years old, suffered from chronic constipations, who received sanatorium-and-spa treatment. Patients were divided into 2 groups: 25 were included into the main group, they were administered simultaneously medicinal mineral and artesian water. Mineral water was given at the dosage of 3 – 5 ml/kg of the body weight 3 times per day before eating. Artesian drinking water was given at the dosage of 6 ml/kg of body weight after eating . The duration of combination treatment was 21 days. Comparison group consisted of 20 children, receiving moderate mineral water. During the first study clinical examination of children was performed, the number of defecation was assessed and the blood samples were performed. During the second study clinical effect of mineral water in the form of regular formed stool was assessed. Results : data from the first study allow to recommend mineral water in treatment of children with chronic constipations as laxative agent at the dosage of 3–5 ml/kg of the body weight. It should be received 15 – 20 minutes before eating at the full dosage 3 times per day. The course of treatment of chronic functional constipations in children must be at least 4 weeks. According to the results of the second study, combination administration of mineral and artesian water led both to normalization of the stool frequency and consistence and arresting of dyspeptic symptoms and abdominal syndrome, which often accompanied functional chronic constipations, as well as appetite improvement. Conclusions : including of mineral water into the scheme of treatment of chronic constipations and its combination with artesian water significantly increase the efficacy of therapy. Key words : children, mineral water, artesian water, gastrointestinal tract, chronic constipation, magnesium, mineralization, spa Rogashka Slatina, efficacy of treatment.

OSMOTIC LAXATIVES IN TREATMENT OF CHRONIC CONSTIPATIONS IN CHILDREN

A comparative trial including 80 patients at the age of 1–16 years old was performed in order to evaluate efficacy and safety of osmotic laxatives polyethylene glycol with molecular mass of 4000 kDa and lactulose (46 children received polyethylene glycol, 34 — lactulose) in children with chronic functional constipations. The observation period during the treatment lasted for 2 weeks, clinical and laboratory evaluation of the therapy efficacy and safety was carried out. The normalization of stool was achieved on the average in 3 days of treatment in both groups, pain and dyspepsia were arrested in the majority of the patients. Stool consistency was normalized. No side-effects were registered. However in the first days of lactulose treatment there were reliably more complaints on flatulence and rumbling, which passed spontaneously. Lactulose and polyethylene glycol were shown to be effective and safe in treatment of chronic functional constipations in children and can be recommended for usage even in infants. Keywords : children, constipations, lactulose .