Gastrointestinal Tract In Children Research Articles

Pediatric Gastrointestinal Interventions

AbstractImage-guided interventions are increasingly being used in the management of many pediatric disease processes since they provide safe and effective minimally invasive treatment options. This review article attempts to provide an overview of the commonly performed interventions in the gastrointestinal tract in children. These include esophageal balloon dilatation, establishment and maintenance of gastroenteral access, and hepatobiliary interventions (liver biopsy, percutaneous cholangiogram, and biliary drainage).

Analysis of risk factors, clinical and somatometric characteristics and vitamin D availability in infants with transient lactose intolerance

The study of perinatal risk factors and the clinical and somatometric condition of infants with primary transient lactose intolerance, as well as their vitamin D supply, was carried out. The 48 children of the first six months of life were examined. Risk factors were identified in the mothers of the examined infants, which, in our opinion, were the basis for the formation of morphofunctional immaturity of the gastrointestinal tract in children (the mother’s age is more than 30 years old, iron deficiency anemia, the threat of termination of pregnancy, operative delivery, etc.). When assessing the condition of infants, somatometric status disorders were diagnosed in 54.2% of cases, of which malnutrition was detected in 76.9% of cases, and abnormal weight gain in 23.1% of cases. We have established the important fact that morphofunctional immaturity of the gastrointestinal tract and inadequate drug enteral support led in 61.5% of cases to insufficient vitamin D supply, determining metabolic disorders. We have refined a two-stage algorithm for nutritional support for patients with nutritional status disorders, including the mandatory use of micellar solutions of cholecalciferol.

A foreign body complicated by tracheal perforation in the esophagus of a two-year-old child (clinical observation)

Foreign bodies in the gastrointestinal tract remain one of the significant problems in pediatric practice. Ingestion of foreign bodies is typical for children of all ages, but especially for the first 5 years of life. Due to the anatomical features of children, foreign bodies are often located at the level of the first physiological narrowing – in 68% of cases. The mortality rate from foreign bodies is 1%, but with the development of severe complications, this figure increases to 45%. A disc-shaped battery is the most dangerous one for health, as it is capable of causing local infiltrative-necrotic changes, perforation of the esophagus. Disc-shaped batteries as FB (foreign body) form up to 10% of the total number of foreign bodies of the gastrointestinal tract in children. Unfortunately, parents do not immediately seek medical help, since the symptoms indicating the presence of FB are often absent or may manifest as non-specific symptoms. Endoscopic examination serves as a key method in the diagnosis of ingested FB among children and its removal less than 24 hours after ingestion, since any delay reduces the probability of successful intraluminal extraction. This article discusses the clinical observation of a prolonged presence of a foreign body in the esophagus of a toddler child. The clinical course manifested itself in the form of nonspecific symptoms, a foreign body was detected only after a number of studies and was removed by endoscopic method. During the examination of the patient, in addition to the chest X-ray, esophagogastroduodenoscopy and a number of bronchoscopies were performed. Accessible and highly informative methods of instrumental diagnostics available in each clinic of the regional scale, today remain the first stage of the diagnosis of foreign bodies.

Functional disorders of the gastrointestinal tract in children of different age groups (a literature review)

In recent years, diseases of the gastrointestinal tract are becoming more common with economic and social impacts. It is believed that in terms of frequency, they rank second both among the adult and pediatric population, second only to respiratory system diseases. Due to significant morphological and physiological changes in individual organs and systems during the period of intensive development of a child, the formation of gastroenterological pathology occurs most often at the age of 5–6 or 9–12 years, that gives rise to various functional disorders of the gastrointestinal tract. There is an opinion that among older children, such functional disorders are often bordering on pathology, prompting pediatricians to an increased interest in their etiology, pathogenesis and current therapy. Aim. To highlight the state of the problem associated with the most frequent functional disorders of the gastrointestinal tract in children at the present stage. According to the recent recommendations, it has been recommended to consider functional changes as disorders of the interaction between the brain and the gastrointestinal tract (disorders of gut-brain interaction).The underlying disorders are abnormal motility, visceral hypersensitivity, the state of the gastrointestinal mucosa and local immune factors, intestinal microflora, activity of the central and autonomic nervous system. Most researchers tend to think about the key role of impaired autonomic regulation of sphincter activity in the pathogenesis of motor-evacuatory dysfunction of the alimentary canal in children, buoyed by the fact that often the lack of gastrointestinal organic lesions in motility disorders indicates their dysregulatory character. Conclusions. Functional disorders of the gastrointestinal tract have an extraordinary brightness of pain syndrome perception (no organic pathology would give such a wide array of symptoms as functional disorders) and a variable pattern of symptoms, so it becomes clear why these diseases impose a major economic burden, and it is this characteristic enables them to be classified as socially significant disorders. This requires a physician at various levels of medical care to provide timely diagnosis, differential diagnosis between organic gastrointestinal diseases, and timely correction of functional disorders.

Enteral oxygen therapy: new approaches to rehabilitation for chronic gastroduodenal pathology in children

Purpose. Studying the effect of enteral oxygen therapy (EOT), in the process of rehabilitation, on the regenerative process of the mucous membrane of the gastrointestinal tract in children with chronic gastroduodenal pathology (CGDP). Methods. The clinical observation was based on a randomized study. We examined 286 children with CGDP. The research methods fibrogastroduodenoscopy (FGDS), and tests for Helicobacter pylori infection. Results. Based on the results of the FGDS, we developed a scoring scale for the regeneration process (SSRP) without morphological biopsy. According to the results of the SSRP, in patients with inflammatory processes, after a course of standard inpatient treatment, there was a 3rd degree of regeneration, with ulcerative lesions - 4th degree. After a single rehabilitation course, using EOT, a transition to 1-degree regeneration was noted (6.6±0.77 points), without the use of EOT for 2-degree (10.9±1.23 points). The data indicated a more than 63% increase in reparative-regenerative processes when using EOT. Against this background, there was up to a 2.5-fold decrease in Helicobacter pylori carriage. Conclusions. The use of EOT helps to accelerate regenerative mechanisms of the gastric mucosa by up to 63%, and the implementation of a comprehensive rehabilitation program using EOT contributes to a significant decrease in Helicobacter pylori carriage.

Foreign bodies of the gastrointestinal tract in children: a retrospective analysis of medical cases

Foreign bodies of the gastrointestinal tract in children are a fairly common reason for seeking help in surgical departments. Purpose. The study aims at identifying dependencies between the type of foreign bodies, the tactics of their detection and removal in different age periods. Material and methods. Retrospective analysis of 100 case histories of patients with a diagnosis of «Foreign body of the gastrointestinal tract”; 64 boys included. Results. Preschool children were more often diagnosed with «Foreign body of the gastrointestinal tract.» The children rarely complained. The most commonly used diagnostic method is overview radiography, and the method of extracting a foreign body is endoscopy. The most frequent finds were coins. Magnetic balls and batteries led to injury of the organ where they were located. Conclusion. When contacting a medical and preventive institution in the first hours after swallowing the object, the risk of complications is minimal. If the foreign body is a magnetic ball, magnet, or battery, the presence of which is associated with high risks of complications, it is necessary to remove them from the body as soon as possible.

Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia.

Aerodigestive disorders encompass various pathological conditions affecting the lungs, upper airway, and gastrointestinal tract in children. While advanced care has primarily occurred in specialty centers, many children first present to general pediatric gastroenterologists with aerodigestive symptoms necessitating awareness of these conditions. At the 2021 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the aerodigestive Special Interest Group held a full-day symposium entitled, Pediatric Aerodigestive Medicine: Advancing Collaborative Care of Children with Aerodigestive Disorders. The symposium aimed to underline the significance of a multidisciplinary approach to achieve better outcomes for these complex patients. The symposium brought together leading experts to highlight the growing aerodigestive field, promote new scientific and therapeutic strategies, share the structure and benefits of a multidisciplinary approach in diagnosing common and rare aerodigestive disorders, and foster multidisciplinary discussion of complex cases while highlighting the range of therapeutic and diagnostic options. In this article, we showcase the diagnostic and therapeutic approach to oropharyngeal dysphagia (OPD), one of the most common aerodigestive conditions, emphasizing the role of a collaborative model. The aerodigestive field has made significant progress and continues to grow due to a unique multidisciplinary, collaborative model of care for these conditions. Despite diagnostic and therapeutic challenges, the multidisciplinary approach has enabled and greatly improved efficient, high-quality, and evidence-based care for patients, including those with OPD.

The influence of selenium on the course of inflammatory diseases of the upper gastrointestinal tract in children

Background. Impaired homeostasis of the essential microelements in the body of children plays a significant role in the etiology, pathogenesis and therapy of a number of diseases. Studies on the exchange of bioelements in gastrointestinal diseases, in particular, the content of selenium (Se), have not been conducted enough. Aim: to evaluate selenium influence on the course of inflammatory diseases of the upper gastrointestinal tract in children. Materials and methods. The study included 112 school-age children with inflammatory diseases of the upper gastrointestinal tract (55 with chronic gastritis (CG), 57 with chronic gastroduodenitis (CGD)) as the main group and 20 practically healthy children of the corresponding age as the comparison group. Verification of CG and CGD diagnosis was based on clinical and endoscopic data according to the Houston modification of the Sydney classification of chronic gastritis (1996) with assessment of topography and morphology. Quantitative determination of Se in blood plasma was carried out using mass spectrometry. Results. The average level of Se in blood plasma of children with inflammation of the gastric and duodenal mucosa was (75.82 ± 11.23) μg/l, in children of the comparison group — (85.42 ± 9.44) μg/l (p > 0.05). We did not find gender and age differences in Se plasma levels. Deficiency of Se in the blood of children with CG and CGD was found in 78 cases (69.6 %), while in the comparison group, a decrease in Se level was observed in only 4 children (20 %). There were no significant differences in the content of Se in children with CG and CGD. However, the analysis of indicators depending on the activity of the inflammatory process revealed probable differences: with the first degree of the activity of the inflammatory process in the mucous membrane, the level of Se in the blood plasma was significantly lower ((66.2 ± 6.1) μg/ml), while with the second it was (78.5 ± 7.3) μg/ml (p < 0.05) and with the third — (86.9 ± 9.3) μg/ml (p < 0.01). Conclusions. The concentration of selenium, the essential trace element, in the blood plasma of children with chronic inflammatory diseases of the upper gastrointestinal tract was found to be probably lower than that of healthy children. The level of selenium in the blood plasma of these children probably positively correlated with the degree of inflammation in the mucous membrane of the gastroduodenal region. Changes in the concentration of selenium can affect the general condition of children, the duration and severity of the disease, which must be taken into account during the treatment of inflammatory diseases.

COVID-19 and the gastrointestinal tract in children.

This is an overview of the effects of COVID-19 in the gastrointestinal tract in children, and current evidence of the impact of COVID-19 in pediatric patients with chronic gastrointestinal conditions, including inflammatory bowel disease (IBD), chronic liver disease, and disorders of the gut-brain interaction. Children with COVID-19 have a milder course and more favorable outcomes than adults, even in those with immunosuppression due to IBD or liver transplantation. Children with chronic gastrointestinal conditions do not have worse clinical outcomes than healthy children and infection itself has not been linked to an increased incidence of conditions such as IBD and celiac disease, but results regarding post-infectious irritable bowel syndrome are mixed. Research specific to pediatrics is needed, particularly in post-infectious disorders of the gut-brain interaction (PI-DGBIs) and long COVID-19. Data extrapolated from adult trials may not apply to children, as their clinical course is different. PI-DGBIs and long COVID-19 require special attention, as they represent a major morbidity burden in children.

Selenium plasma levels in children with Helicobacter pylori-associated diseases of the upper gastrointestinal tract

Despite the success of the treatment of infected individuals, Helicobacter pylori infection remains the most common human bacterial pathogen, infecting half of the world’s population. In a large part of people, H. pylori causes gastroduodenal diseases, in particular, chronic antral gastritis and ulcer disease. The possible role of selenium in the course of chronic inflammatory H. pylori-associated pathology of the upper gastrointestinal tract in children has not yet been fully investigated and understood. The aim is to determine selenium plasma levels in children with Helicobacter pylori-associated diseases of the upper gastrointestinal tract. Materials and methods. The study included 135 school-age children with Helicobacter pylori-associated diseases of the upper gastrointestinal tract, who made up the main study group (55 children with chronic gastritis (CG), 57 children with chronic gastroduodenitis (CGD), 23 children with duodenal ulcer (DU), and 20 practically healthy age-matched children were the comparison group. Quantitative measurements of plasma selenium were performed using inductively coupled plasma mass spectrometry (MS-ICP) on an Optima 2000 DV spectrometer (Perkin Elmer, USA). Results. The lowest level of plasma selenium was registered in children with H. pylori-negative DU (67.81 ± 2.67 μg/l), while in children with H. pylori-associated DU, its level was higher – 73.56 ± 2.34 μg/l (p < 0.05), however, it did not reach the level in children of the comparison group. A similar direction of changes in the selenium plasma concentration was observed in children with CGD: higher levels of selenium were detected in children with H. pylori-positive CGD compared to H. pylori-negative CGD (75.61 ± 2.48 μg/l and 70.99 ± 2.31 μg/l, respectively, p < 0.05). Conclusions. Significantly lower levels of plasma selenium in children with chronic destructive-inflammatory diseases of the upper gastrointestinal tract were found, which could be explained by the acute phase of inflammation in the mucous membrane of the stomach and duodenum resulting in a decrease in selenium absorption. In H. pylori-positive children, the level of selenium was significantly higher compared to H. pylori-negative children indicating a possible role of selenium in the pathogenesis and further progression of H. pylori-associated diseases.

A foreign body of the omentum bag due to a covered perforation of the stomach in a 2-year-old child

Foreign bodies (FB) in the gastrointestinal tract are found in children of all age groups, but most often these are patients 1–4 years old. A description of a clinical case of the detection of an omentum bag due to a covered perforation of the stomach in a 2-year-old child is presented. The tactics of child management, a set of diagnostic methods of examination, methods of surgical treatment are described. It has been shown that the clinical picture of FB in the upper gastrointestinal tract in children is nonspecifi c and may not manifest itself in the early stages. FB of the stomach can migrate into the omentum bag without developing a clinical picture of perforation of the hollow organ and peritonitis. Laparoscopic removal is the method of choice for surgical treatment of a FB that has migrated outside the stomach, and timely diagnosis contributes to achieving positive results both in the treatment and in the prevention of complications.

Частота постинфекционных функциональных нарушений желудочно-кишечного тракта у детей после кампилобактериоза

Кампилобактериоз является одной из наиболее распространенных кишечных инфекций как у взрослых, так и у детей. В нашей стране данные о заболеваемости кампилобактериозом остаются разрозненными и не позволяют в полной мере оценить распространенность данного заболевания. Помимо проблемы высокой заболеваемости детского населения, существует высокий риск развития постинфекционных функциональных гастроинтестинальных расстройств (ПФГИР). Цель исследования. Установить частоту и структуру функциональных гастроинтестинальных расстройств у реконвалесцентов кампилобактериоза. Материалы и методы. В исследование было включено 200 детей, проходивших лечение в специализированном отделении ДНКЦИБ ФМБА России в период 2018–2021 гг. в связи с кампилобактериозом. Осуществлялось клиническое наблюдение за пациентами в условиях стационара с последующим катамнестическим наблюдением в течение 12 месяцев. В процессе наблюдения детей по данным опроса и объективного обследования выявляли постинфекционную ПФГИР. Оценку результатов наблюдения осуществляли с учетом Римских критериев IV пересмотра. Определение предикторов формирования осуществляли с помощью дискриминантного анализа статистического пакета Statistica for Windows. Результаты. Полный срок наблюдения прошли 180 (90%) пациентов. На момент начала катамнестического наблюдения только у 26 (13%) детей имелись жалобы на состояние здоровья: боли в животе при приеме пищи (n=15; 7,5%), метеоризм (n=19; 9,5%), кашицеобразный стул, снижение аппетита (n=5; 2,5%), запоры (n=10; 5,0%). Наиболее часто жалобы со стороны органов пищеварения появлялись в период с 90-го по 180-й дни. Среди симптомов, выявляемых у детей после кампилобактериоза, наиболее часто отмечалось появление периодических болей, дискомфорта в животе (n=64, 32%) и запоров (n=53; 26,5%). В старшей группе диагностированы: синдром раздраженного кишечника (n=19; 51,4%), функциональная диспепсия (n=14; 37,8%) и функциональные запоры (n=4; 10,8%). В младшей возрастной группе диагностированы функциональные запоры (n=18; 60,0%) и функциональная диарея (n=12; 40,0%). Выводы. Проведенное динамическое диспансерное наблюдение за реконвалесцентами кампилобактериоза позволило диагностировать ПФГИР у 67 (33,5%) детей. На основании проведенного исследования была разработана математико-статистическая модель прогнозирования ПФГИР, позволяющая на основании оценки клинических и анамнестических признаков выделить детей, относящихся к группе риска. К предикторам ПФГИР у детей, перенесших кампилобактериоз, вошедшим в модель прогноза, можно отнести: поступление в стационар на поздних сроках болезни с тяжелой степенью кампилобактериоза по шкале Кларка, назначение нескольких курсов антибактериальных препаратов, вынужденный перевод на искусственное вскармливание, возраст, наличие гемоколита, выраженность дегидратации. Campylobacteriosis is one of the most common intestinal infections in both adults and children. In our country, data on the incidence of campylobacteriosis remain scattered and do not fully allow the prevalence of this disease. In addition to the problem of high morbidity in the child population, there is a high risk of developing post-infectious functional gastrointestinal disorders (PFGID). Theaimofthestudy.To establish the frequency and structure of functional gastrointestinal disorders in campylobacteriosis convalescents. Materials and methods. The study included 200 children who were treated in a specialized department of the DNNCIB FMBA of Russia in the period 2018–2021. associated with campylobacteriosis. Clinical observation of patients was carried out in a hospital, followed by follow-up observation for 12 months. In the process of observation of children, according to the survey and objective examination, post-infectious PFGIR was detected. The evaluation of the results of observation was carried out taking into account the Rome criteria of the IV revision. The formation predictors were determined using the discriminant analysis of the statistical package Statistica for Windows. Results. 180 (90%) patients passed the full observation period. At the time of the start of the follow-up observation, only 26 (13%) children had complaints about health conditions: abdominal pain when eating (n=15: 7.5%), flatulence (n=19; 9.5%), mushy stools, loss of appetite (n=5; 2.5%), constipation (n=10; 5.0%). Most often, the appearance of complaints from the digestive organs appeared in the period from 90 to 180 days. Among the symptoms detected in children after campylobacteriosis, the most common were the appearance of periodic pain, abdominal discomfort (n=64, 32%) and constipation (n=53; 26.5%). The older group was diagnosed with: irritable bowel syndrome (n=19; 51.4%), functional dyspepsia (n=14; 37.8%) and functional constipation (n=4; 10.8%). In the younger age group, the following were diagnosed: functional constipation (n=18; 60.0%) and functional diarrhea (n=12; 40.0%). Conclusions. Thus, the dynamic dispensary observation of campylobacteriosis convalescents made it possible to diagnose PFGIR in 67 (33.5%) children. On the basis of the study, a mathematical and statistical model for predicting PFGIR was developed, which allows, based on the assessment of clinical and anamnestic signs, to identify children at risk. The predictors of PFGIR in children who have had campylobacteriosis included in the prognosis model include: admission to the hospital at a late stage of the disease with severe severity of campylobacteriosis on the Clark scale, the appointment of several courses of antibacterial drugs, forced transfer to artificial feeding, age, the presence of hemocolitis, the severity of dehydration.

Foreign body in the gastrointestinal tract in children: A tertiary hospital experience.

Foreign body (FB) ingestion in the gastrointestinal tract (GIT) in children is common. Although most foreign bodies will pass spontaneously, surgical intervention is required when they fail to pass. The aim of this study was to evaluate our experience in the management of children who presented with FB in the GIT. This was a retrospective study of children that underwent laparotomy for the removal of FB in the GIT at the paediatric surgery unit of Enugu State University Teaching Hospital, Enugu over a 10-year period. A total of 272 children presented with FB in the GIT during the study period, out of which 30 patients had laparotomy. This gave an operative incidence rate of 11%. There was a slight male predominance and the ages of the patients ranged from 6 months to 5 years (median 3 years). About half of the patients had no symptoms and all the patients were investigated with an abdominal radiograph. Only one-third of the patients had a predisposing factor that could have led to FB impaction. FB impaction was the most common indication for surgery, and enterotomy with FB removal was the most performed surgical procedure. The most common FB removed were tiny parts of toys, and the most common post-operative complication was surgical site infection. There was no mortality. FB in GIT in children could be associated with complications that require surgical treatment. FB ingestion is preventable. Focus should be placed on caregivers preventing children from ingesting FB.

Состояние желудочно-кишечного тракта у детей при новой коронавирусной инфекции и в постковидный период. Роль синбиотика в коррекции клинических симптомов, кишечной микробиоты и проницаемости кишечной стенки

Background: studying the consequences of novel coronavirus infection is currently relevant. Many observations demonstrate that SARS- CoV-2 affects the gastrointestinal tract, gut microbiota composition, and intestinal permeability. Aim: to assess whether Maxilac® Baby synbiotic effects qualitative and quantitative composition of gut microbiota and intestinal permeability in children aged 3–14 with mild-to-moderate COVID-19. Patients and Methods: an open, observational, prospective, single-center study with minimal intervention was conducted. Group 1 included 16 children who received Maxilac® Baby 4 weeks after recovery. Group 2 children did not receive synbiotics after recovery. History and complaints were assessed, gut microbiome composition was determined, and fecal zonulin was measured at disease onset, time of recovery (day 14), and 4 weeks after recovery. Results: at disease onset, abdominal pain and diarrhea were reported in 16 children (50%), nausea in 8 children (25%), and vomiting in 1 child (3.1%). At the time of recovery, only abdominal pain was reported in both groups (4 patients each). Thirty days after recovery, re-appearance of intestinal symptoms was reported in group 2. No significant differences in the microbiome diversity profile at birth level were revealed between children with the COVID-19 at onset and healthy age-matched children. Taxa (species) whose predominance was typical for each group were identified. Conclusions: post-COVID-19 syndrome in children aged 3–14 diagnosed with mild-to-moderate disease who received Maxilac® Baby for 1 month after recovery is characterized by the lack of nausea, vomiting, and diarrhea, less abdominal pain, no changes in fecal zonulin levels, and biodiversity of gut microbiome, including those assessed by Shannon diversity index. KEYWORDS: SARS-CoV-2, COVID-19, intestinal permeability, gut microbiome, 16s rRNA sequencing, zonulin, novel coronavirus infection, post-COVID-19 syndrome. FOR CITATION: Novikova V.P., Polunina A.V., Bannova S.L., Balashov A.L., Dudurich V.V., Danilov L.G., Blinov A.E., Varlamova O.N. Gastrointestinal tract in children with novel coronavirus infection and post-COVID-19 syndrome. The role of synbiotics for improving clinical symptoms, gut microbiota, and intestinal permeability. Russian Journal of Woman and Child Health. 2023;6(3):283–289 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-10.

Down-Regulation of Double C2 Domain Alpha Promotes the Formation of Hyperplastic Nerve Fibers in Aganglionic Segments of Hirschsprung's Disease.

Hirschsprung’s disease (HSCR) is a common developmental anomaly of the gastrointestinal tract in children. The most significant characteristics of aganglionic segments in HSCR are hyperplastic extrinsic nerve fibers and the absence of endogenous ganglion plexus. Double C2 domain alpha (DOC2A) is mainly located in the nucleus and is involved in Ca2+-dependent neurotransmitter release. The loss function of DOC2A influences postsynaptic protein synthesis, dendrite morphology, postsynaptic receptor density and synaptic plasticity. It is still unknown why hyperplastic extrinsic nerve fibers grow into aganglionic segments in HSCR. We detected the expression of DOC2A in HSCR aganglionic segment colons and established three DOC2A-knockdown models in the Neuro-2a cell line, neural spheres and zebrafish separately. First, we detected the protein and mRNA expression of DOC2A and found that DOC2A was negatively correlated with AChE+ grades. Second, in the Neuro-2a cell lines, we found that the amount of neurite outgrowth and mean area per cell were significantly increased, which suggested that the inhibition of DOC2A promotes nerve fiber formation and the neuron’s polarity. In the neural spheres, we found that the DOC2A knockdown was manifested by a more obvious connection of nerve fibers in neural spheres. Then, we knocked down Doc2a in zebrafish and found that the down-regulation of Doc2a accelerates the formation of hyperplastic nerve fibers in aganglionic segments in zebrafish. Finally, we detected the expression of MUNC13-2 (UNC13B), which was obviously up-regulated in Grade3/4 (lower DOC2A expression) compared with Grade1/2 (higher DOC2A expression) in the circular muscle layer and longitudinal muscle layer. The expression of UNC13B was up-regulated with the knocking down of DOC2A, and there were protein interactions between DOC2A and UNC13B. The down-regulation of DOC2A may be an important factor leading to hyperplastic nerve fibers in aganglionic segments of HSCR. UNC13B seems to be a downstream molecule to DOC2A, which may participate in the spasm of aganglionic segments of HSCR patient colons.

Internal picture of the disease and medical-psychological support as a component of clinical pediatrics in psychosomatic diseases in children

The aim of the work is to systematize current data on the peculiarities of the internal picture of the disease and the need for medical and psychological support of psychosomatic illnesses in children with different types of responses to the disease. The article is devoted to studying the internal picture of the condition as an integral part of the internal picture of health in pediatric practice. Types of patients' attitudes to the disease are considered. The types of disease responses from the standpoint of medical psychology are given. The typology of psychological response to the disease or personality types (harmonious, indifferent, hyperpathic, hypopathic, labile) in diseases of the gastrointestinal tract in children is described. Peculiarities of non-psychotic mental disorders in young children have been identified. It is noted that the development of differential programs of psychological support, taking into account the typology of psychological response to the disease, will accelerate the process of recovery and rehabilitation of patients. Conclusions. Increasing professional competence in an internal picture of the disease will improve communication links in the chain "health worker - sick child - parents". The timely organization of medical and psychological support at all levels of medical care for psychosomatic diseases in children will help prevent and reduce the incidence of neurotic and neurosis-like mental and behavioral disorders.

ANALYSIS OF RISK FACTORS AND CLINICAL AND PARACLINICAL MANIFESTATIONS OF GASTROINTESTINAL DYSFUNCTION IN NEWBORNS IN PERINATAL PATHOLOGY

In recent decades, there has been a worldwide trend toward increasing rates of functional and organic pathology of the gastrointestinal (GI) tract in children. Presently, diseases of digestive organs rank second in frequency among pathologies of the pediatric population after acute respiratory diseases. Development of functional disorders of the gastrointestinal tract in children in the first year of life is mainly caused by anatomic and physiological characteristics of the digestive system, as well as high sensitivity and ease of damage of all its parts. Current literature suggests that children born to mothers during difficult pregnancy or childbirth are at increased risk for developing this pathology.Objective of the study: To determine perinatal risk factors and clinical and paraclinical features of gastrointestinal functional disorders in newborns with perinatal pathology.Materials and methods. The study enrolled 82 full-term infants with severe perinatal pathology, with clinical manifestations of gastrointestinal dysfunction (Group I), and 50 healthy infants (Group II) as a comparison group. Exclusion criteria for the study were: congenital malformations, low birth weight, clinical manifestations of infection. To assess metabolic disorders, a comprehensive assessment of the biochemical blood spectrum with the level of total protein and albumin, total bilirubin and its fractions, glucose, urea and uric acid, cholesterol and triglycerides; activity of AlAT, AsAT, LDH, LF, GGTP. Biochemical studies were performed using a Cormay ACCENT biochemical analyzer (Poland, Cormay reagents).Results and discussion. Disorders of postnatal adaptation of newborns are noted in the conditions of mothers’ somatic disadvantages, implementation of unfavorable factors during pregnancy and labor. Analysis of somatic anamnesis, antenatal and intrapartum problems has made it possible to identify the main causes of neonatal adaptation disorders in the early neonatal period. The most important, taking into account maternal anamneses, in the patients of the main group were: cardiovascular system pathology in 30 (36, 59%) cases, urinary system pathology in 22 (26, 83%) cases, endocrine system pathology in 17 (20, 73%) cases, digestive system pathology in 11 (13, 41%) cases, and respiratory system pathology in 8 (9, 76%) cases; gynecological pathology was diagnosed in 16 (19, 51%). The antenatal period was complicated by: placental dysfunction in 10 (12.20%) cases, hydramnios in 8 (9.76%) cases, fetal distress in 10 (12.20%) cases, and cord entanglement around the neck in 5 (6.10%) cases. Overall, there were 14 (17.07%) cases with a poor obstetric history. Caesarean section was performed in 24 (29.27%) cases, vacuum-assisted delivery in 4 (4.88%) cases.The list of diseases responsible for the severity of the newborn's condition was presented according to the main diagnosis: 66 (80.5%) cases had central nervous system involvement in the form of hypoxic-ischemic lesion/neonatal encephalopathy, 27 (32.9%) cases had severe respiratory distress, 13 (15.9%) cases had moderate asphyxia and 11 (13.4%) cases had severe asphyxia, 10 (12.2%) cases had moderate respiratory distress and 2 (2.4%) cases had hemolytic disease in newborn. All patients of the main group also had concomitant diagnoses. The condition of the main group neonates was characterized by more severe somatic and neurological status disorders, formation of MOD syndrome with the development of signs of food intolerance due to complex disorders of the gastrointestinal system. Complex disorders of food tolerance were observed in 71 (86,59%) children, regurgitation/stasis - in 66 (80,49%) neonates, paresis/weak intestinal peristalsis - in 47 (57,32%) patients, flatus - in 3 (3,66%) cases, meconium retention - in 3 (3.66%) cases, isolated absence of sucking reflex/ wobbly sucking was found in 3 (3.66%) cases, enlargement of liver and spleen - in 1 (1.22%) patient. The complex of serum biochemical studies showed significant dysmetabolic changes, which to some extent explain the pathophysiological mechanisms of gastrointestinal dysfunction. In particular, revealed violations of protein-synthetic function of the liver and delays in the production and excretion of bile, enzyme deficiency and cytolytic syndrome.Conclusions. Disorders of the digestive system in newborns is one of the manifestations of general body dysfunction in conditions of hypoxia with the implementation of unfavorable factors of pregnancy and childbirth in the mother.Clinical signs of food intolerance in newborn infants are regurgitation/stasis, paresis/weak intestinal peristalsis, flatus, meconium retention, absence of sucking reflex/wobbly sucking, enlarged liver and spleen.Complex serum biochemical studies in newborns with gastrointestinal disorders showed impaired protein-synthetic liver function, delayed production and excretion of bile, enzymatic insufficiency and cytolytic syndrome.

Metastasis of gastric cancer in the femur in a 17-year-old patient (case report)

Primary gastric cancer is an extremely rare finding in young people. This applies to both children and adolescents [7, 9] and is true even for a sample of patients up to 40 years of age. According to McGill et al. [8], gastric cancer accounts for only 0.05% of malignant tumors of the gastrointestinal tract in children and adolescents. It is generally accepted that the manifestations of stomach cancer in young people practically do not differ from those in older age groups. Usually, developing gastric carcinoma proceeds under the guise of peptic ulcer and the correct diagnosis is made only in the later stages, which determines an extremely unfavorable prognosis for this disease. Histologically, gastric cancer in such patients is most often an undifferentiated adenogenic cancer with a diffuse-infiltrative type of growth.

Review of paediatric gastrointestinal physiology relevant to the absorption of orally administered medicines.

Despite much progress in regulations to improve paediatric drug development, there remains a significant need to develop better medications for children. For the design of oral dosage forms, a detailed understanding of the specific gastrointestinal (GI) conditions in children of different age categories and how they differ from GI conditions in adults is essential. Several review articles have been published addressing the ontogeny of GI characteristics, including luminal conditions in the GI tract of children. However, the data reported in most of these reviews are of limited quality because (1) information was cited from very old publications and sometimes low quality sources, (2) data gaps in the original data were filled with textbook knowledge, (3) data obtained on healthy and sick children were mixed, (4) average data obtained on groups of patients were mixed with data obtained on individual patients, and (5) results obtained using investigative techniques that may have altered the outcome of the respective studies were considered. Consequently, many of these reviews draw conclusions that may be incorrect. The aim of the present review was to provide a comprehensive and updated overview of the available original data on the ontogeny of GI luminal conditions relevant to oral drug absorption in the paediatric population. To this end, the PubMed and Web of Science metadatabases were searched for appropriate studies that examined age-related conditions in the oral cavity, esophagus, stomach, small intestine, and colon. Maturation was observed for several GI parameters, and corresponding data sets were identified for each paediatric age group. However, it also became clear that the ontogeny of several GI traits in the paediatric population is not yet known. The review article provides a robust and valuable data set for the development of paediatric in vitro and in silico biopharmaceutical tools to support the development of age-appropriate dosage forms. In addition, it provides important information on existing data gaps and should provide impetus for further systematic and well-designed in vivo studies on GI physiology in children of specific age groups in order to close existing knowledge gaps and to sustainably improve oral drug therapy in children.

Эндоскопическая характеристика верхних отделов желудочно-кишечного тракта у детей с аллергопатологией

Общепризнанной является взаимосвязь между поражениями желудочно-кишечного тракта (ЖКТ) и аллергическими заболеваниями. Известно и действие медиаторов аллергии, которые способствуют развитию воспаления ЖКТ. Цель исследования: изучить состояние верхних отделов ЖКТ для улучшения качества оказания медицинской помощи детям с аллергопатологией.Материалы и методы. Проанализировано 61 эндоскопическое исследование детей в возрасте от 6 мес. до 17 лет с аллергопатологией. Результаты обработаны методами вариационной статистики.Результаты и их обсуждение. В структуре аллергических заболеваний 43 % — дети с сочетанной аллергопатологией, 31 % — с аллергическим ринитом, 18 % — с бронхиальной астмой (БА), 8 % — с ангиоотеком. Деструктивные изменения ЖКТ выявлены у 23 % больных. Деструкция всех отделов ЖКТ чаще наблюдалась у больных БА, двенадцатиперстной кишки (ДПК) — у 31 % детей с сочетанной патологией. Эритематозные изменения желудка выявлены у 91 % больных БА и 85 % больных с сочетанной аллергопатологией. Эритематозные поражения ДПК отмечались у 82 % больных БА и у 58 % — с сочетанной аллергопатологией. Эритематозные поражения пищевода выявлены у 27 % больных БА и 20 % детей с ангиоотеком. У 32,8 % обследованных отмечалась лимфоидная гиперплазия различных отделов ЖКТ. Дуоденогастральный рефлюкс диагностирован у 44,2 % пациентов. Выводы. 1. У детей с аллергопатологией поражения органов пищеварения составляют: 15 % — пищевода, 67 % — желудка, 60 % — ДПК. 2. Деструктивные формы, представленные эрозиями, составляют 23 %. 3. Наиболее неблагоприятной патологией для развития поражения ЖКТ является БА и ее сочетания. 4. У 32,8 % больных отмечается лимфоидная гиперплазия ЖКТ. 5. Дуоденогастральный рефлюкс выявлен у 44,2 % обследованных.