Irritable Bowel Syndrome In Children Research Articles

Children And Adolescents With Irritable Bowel Syndrome: Treatment And Management.

Irritable bowel syndrome (IBS) is a disorder that causes stomach pain in children and adolescents. It may also impact one's quality of life. IBS is linked to gastrointestinal issues such as diarrhoea and constipation. Despite the identification of several potential pathophysiological pathways, the aetiology of IBS remained unknown. The aim of this paper is to discuss the diagnosis, pathogenesis, case studies and treatment of Irritable bowel syndrome in children and adolescents. This systematic review covered relevant papers from the previous ten years that were accessible in Science Direct, Elsevier, NCBI, and Web of Science related to the pathophysiology and function of pharmacological drugs such as antidepressants, antispasmodics, prokinetics, and antibiotics in children with irritable bowel syndrome. Only a few prospective therapy techniques have been investigated in children, and even fewer of those have been demonstrated to be effective. This article presents case studies including 50-59 children, which demonstrate a favourable acceptable impact that is more effective than a placebo in terms of reducing symptoms and improving the overall quality of life in children who have irritable bowel syndrome. Furthermore, the majority of the pathophysiological explanations and treatment options discussed are based on adult studies. These major issues arose when treating paediatric IBS, and they must be addressed in order to properly treat children with IBS. Trials that focus on many combinations of pharmacological and non-pharmacological therapies seem to be more helpful. In recent years, a number of systematic reviews have been conducted to evaluate the efficacy of medication treatments in children for IBS; however, the dependability of these systematic reviews needs to be further investigated owing to the various experimental designs and levels of evidence used. This article highlights paediatric therapy options, including pharmaceutical medications such as antidepressants, antispasmodics, prokinetics, and antibiotics. The goal is to alleviate IBS symptoms while also enhancing the quality of life for children with this illness.

Irritable bowel syndrome in childhood: treatment in accordance with international guidelines

Irritable bowel syndrome (IBS) is diagnosed accor­ding to the Rome IV criteria for functional gastrointestinal di­sorders. It is estimated that 10–15 % of older children and adolescents suffer from IBS. IBS causes abdominal discomfort and pain and can worsen quality of life in children. The article provides an analysis of changes in ideas about pathogenetic mechanisms, approaches to the diagnosis and treatment of IBS in children. Once the diagnosis of IBS is made, it is important to explain to the pa­rents and children that there is no serious underlying disease. This reassurance may be effective treatment in many cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics, laxatives, and antidiarrheals, they play a positive role in severe cases.

Irritable bowel syndrome in children: pathogenetic significance of disorders of intestinal microbiota

Irritable bowel syndrome (IBS) is the most common functional disorder of the intestine in children. In recent years, IBS has been defined as functional pathology of the intestine, manifested by visceral recurrent pain that occurs at least once per week, characterized by the following two or more signs: associated with defecation; with changes in the frequency and shape of stools. These symptoms had to be noted in the patient for the last 3 months, with a total duration of at least 6 months, without signs of organic damage to the gastrointestinal tract (GIT). The gut microbiota is of particular importance in the pathogenesis of IBS. In patients with IBS, an increase in Enterobacteriaceae, Ruminococcus, Clostridium, Dorea species and a decrease in the number of Lactobacillus, Bifidobacterium and Faecalibacterium species were found. At the same time, a similar microbial profile was found in patients with different subtypes of IBS. The established patterns of changes in the composition of the microbiota in IBS in children and adults indicate IBS and functional disorders of the GIT to have a pronounced microbial pathogenesis. In this regard, the personalized use of prebiotics, probiotics, synbiotics, and fecal microbiota transplantation can effectively affect the intestinal microbiome in IBS. 
 Conclusion. Correction of disorders of intestinal microbiota is the most important method of treating IBS in children. Determining the patterns of formation of changes in the intestinal microbiome in IBS children creates new opportunities for improving methods of their correction.

Nutraceuticals and Pain Disorders of the Gut-Brain Interaction in Infants and Children: A Narrative Review and Practical Insights.

Different nutraceuticals are often considered by parents of infants and children with abdominal pain and disorders of the gut-brain interaction. Herb extracts and natural compounds have long been used in traditional medicine, but clinical pediatric trials are very limited. This narrative review based on relevant studies identified through a search of the literature in Pubmed and Medline updated to October 2023 focused on the effect of nutraceuticals in infantile colic, functional abdominal pain, and irritable bowel syndrome in children and adolescents. Significant reductions in colic episodes and crying time were reported in two studies on fennel (seeds oil or tea), in three studies on different multiple herbal extracts (all including fennel), in one study on Mentha piperita, and in at least two double-blind randomized controlled studies on Lactobacillus reuteri DSM 17938 and Bifidobacterium lactis BB-12 (108 CFU/day for at least 21 days) in breast-fed infants. Compared to a placebo, in children with functional abdominal pain or irritable bowel syndrome, a significant reduction in pain was reported in two studies supplementing peppermint oil capsules or psyllium fibers, and in one study on corn fiber cookies, partial hydrolyzed guar gum, a specific multiple herbal extract (STW-5), or vitamin D supplementation. To date, there is moderate-certainty evidence with a weak grade of recommendation on Lactobacillus reuteri DSM 17938 (108 CFU/day) in reducing pain intensity in children with functional abdominal pain and for Lactobacillus rhamnosus GG (1-3 × 109 CFU twice daily) in reducing pain frequency and intensity in children with IBS. Further large and well-designed pediatric studies are needed to prove the efficacy and safety of different herbal extracts and prolonged use of studied products in infants and children with pain disorders of the gut-brain interaction.

Irritable bowel syndrome in children: the placebo response rate and influencing factors a meta-analysis.

Irritable bowel syndrome is common in children and exhibits a high placebo response. This study was to explore the placebo response rate and its influencing factors in children with irritable bowel syndrome. A systematic search was performed on Pubmed, Embase, MEDLINE, Cochrane Library, CNKI, Wanfang, and CBM from database inception to March 2022. Randomized controlled trials of irritable bowel syndrome in children were included in the study. The primary outcome was the placebo response rate of improvement. Thirteen studies were included, with 445 patients in the placebo group. The rate of improvement and abdominal pain disappearance were 28.2% (95% CI, 16.6-39.9%) and 5% (95% CI, 0-18.4%). The placebo response based on the abdominal pain score was 0.675 (95% CI, 0.203-1.147). The mode of administration (P < 0.01), dosing schedule (P < 0.01), and clinical outcome assessor (P = 0.04) have a significant impact on the magnitude of placebo effect. The placebo response rate for pediatric irritable bowel syndrome was 28.2%. In clinical trials, reducing dosing frequency, selecting appropriate dosage forms, and using patient-reported outcomes can help mitigate the placebo effect. This is the first meta-analysis to assess the placebo response rates for improvement and disappearance in children with IBS. The finding suggested that the mode of administration, dosing schedule, and clinical outcome assessor could potentially influence the magnitude of the placebo effect in children with IBS. This study would provide a basis for estimating sample size in clinical trial design with a placebo control.

Lactobacillus rhamnosus for treating irritable bowel syndrome in children – a systematic review with meta-analysis

Lactobacillus rhamnosus for treating irritable bowel syndrome in children – a systematic review with meta-analysis

Irritable bowel syndrome in children and intestinal microbiota: pathogenetic aspects and clinical guidelines

Irritable bowel syndrome (IBS) is one of the most common functional conditions among children and adults. At the basis of IBS, as well as other functional disorders of the digestive system, is the disorder of brain-gut-microbiota axis. In recent years, the latter has been given particular importance not only in post-infectious IBS, but also in classic stress-induced IBS. The intestinal microflora determines the state of the enteric nervous system, visceral sensitivity, intestinal motility. In addition, the intestinal microbiota interacts through the transmitters it produces with the central nervous system, which also affects intestinal motility and the state of the microflora. Updated guidelines for the diagnosis and treatment of IBS in children of the Russian Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists in the treatment section include psychotherapeutic correction, diet therapy and drug therapy. Correctors of intestinal motility (trimebutine), probiotics and antispasmodics have proven effectiveness. The efficacy and safety of use in IBS in children Lactobacillus rhamnosus GG, L. acidophilus LA­5, B. infantis, B. animalis, L. plantarum, L. casei, L. bulgaricus, Bifidobacterium lactis BВ­12, B. breve, B. longum, S. thermophilus, Saccharomyces boulardii CNCM I­745. In this case, it is advisable to use multi-strain probiotics. Thus, the intestinal microbiota is directly involved in the pathogenesis of IBS, and the need for the use of probiotics as part of complex therapy is beyond doubt. Their effectiveness has been proven in many serious studies, which was the reason for their inclusion in practical recommendations for the treatment of IBS in children and adults.

The Use of Fibers, Herbal Medicines and Spices in Children with Irritable Bowel Syndrome: A Narrative Review.

The pathophysiology of irritable bowel syndrome in children involves multiple factors. Thus, treatment options are variable, targeting both diet and the child's and parents' behavior via pharmacological and psychological interventions or neuromodulation. Parents are increasingly interested in complementary and alternative therapies for children with irritable bowel syndrome, especially when other treatments have been tried without relieving the child's symptoms. This paper examines current evidence for the benefits and side effects of herbal remedies and spices in pediatric patients with IBS. The benefits of peppermint oil, STW5, psyllium fiber, Curcuma, ginger, and other herbal medicines are discussed based on findings in the current literature.

Therapeutic Outcome of Irritable Bowel Syndrome in Children: Role of Pro/Post-Biotics Mixture

Background Irritable bowel syndrome (IBS) is a common pediatric functional gastrointestinal disorder (FGID) with upper and lower gastrointestinal symptoms and extra-intestinal symptoms. It has a significant impact on daily activities, education and health related quality of life of affected children. The healthcare consultation rate is high in affected children and it leads to a significant annual healthcare cost. Aim of the Work Define the magnitude of response to treatment of IBS, identify the effect of pro/post biotics in treatment of IBS and define the time needed to reach a controlled IBS. Patients and Methods This study was a randomized add-on study with open label interventional study. This study was carried from July 2020 till collecting an adequate sample size. It was conducted on 70 patients who were diagnosed as IBS. each patient was subjected to three phases of the study: Phase I: Primary assessment: history taking, examination, and assessment score of pain, diarrhoea, constipation and quality of life. Phase II: Patients were divided into two equal groups: A and B. All patients in both groups received the standard treatment (diet modification, antispasmodic). Pro/post-biotics was added only to the treatment plan in group A.Phase III: reassessment of the patients using same assessment scores after 3 weeks, and after 3 months of receiving the treatment. Through comparing these scores before and after the treatment, we were able to evaluate the effect of each method of treatment on the patient’s symptoms Results Analysis of pain during this study showed that pain was 80% colicky in character and 78.6% at periumbilical area, with duration in range of 3 months up to 36 months. Analysis of symptoms of irritable bowel syndrome in children ranged from 4 - 16 years old showed that vomiting occurred only in 8.6%, diarrhea occurred in 42.9%, constipation occurred in 41.4%, and distention occurred in 70 %. Concerning the intervention comparison, abdominal pain improved in patients who received postbiotics and standard treatment improved by 83.21 % by the end of study compared to 69.57% in patients who received standard treatment only. Regarding diarrhea, patients who received postbiotics and standard treatment improved by 84.76 %, while patients who received standard treatment only improved by 68.16 % by the end of the study. Regarding quality of life, patients who received postbiotics and standard treatment improved by 84.11 % after 3 months, while patients who received standard treatment only improved by 74.46% by the end of the study. Comparison of intervention effects according to IBS subtypes regarding pain showed significant amelioration of abdominal pain (61.86%) in IBS-D group in comparison to (45.5%) in IBS-C group and (43.28%) in IBS-U group after 3 weeks. Regarding quality of life there was improvement in QOL in IBS-D group (52%), IBS-C group (42.5%) and in IBS-U group (50.64%) after 3 weeks. After 3 months of diet modification there was more improvement rate in IBS-D (73.6%), IBS-C (69.2%) and IBS-U (76.1%) which means that all the groups (IBS-C, IBS-D and IBS-U) had significant QOL improvement in similar rates. Conclusion Our data suggest that the standard therapy of IBS (especially FODMAP diet) is very effective alone for amelioration of IBS symptoms. Addition of postbiotics is very helpful to achieve early improvement of symptoms and quality of life of the IBS patients. This early effect is expected to be very important to avoid the non-compliance effect of delayed response.

Irritable bowel syndrome in children with chronic gastrointestinal symptoms in primary care.

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder in children. However, in primary care, it is still unknown whether there are differences in the prognosis of children with IBS compared to other diagnostic subgroups. Therefore, our aim was to describe the course of symptoms and health-related quality of life (HRQoL) for children with chronic gastrointestinal symptoms who either do or do not fulfil the Rome criteria for IBS in primary care. Second, we compared the diagnosis of the general practitioner (GP) with the Rome criteria. We conducted a prospective cohort study with 1-year follow-up, including children aged 4-18 years with chronic diarrhoea and/or chronic abdominal pain in primary care. During follow-up, the Rome III questionnaire, Child Health Questionnaire, and symptom questionnaires were completed. A total of 60/104 children (57.7%) fulfilled the Rome criteria for IBS at baseline. Compared to children without IBS, children with IBS were more commonly referred to secondary care, used more laxatives, and more often developed chronic diarrhoea and low physical HRQoL during 1 year. The diagnosis "IBS" from the GP matched the Rome criteria for only 10% of children, as most were diagnosed with "Constipation." There seems to be a difference in the treatment and prognosis of symptoms and HRQoL between children with and without IBS in primary care. This suggests that it is relevant to differentiate between these groups. The evaluation and use of feasible criteria to define IBS in different healthcare settings remains subject for further studies.

Irritable bowel syndrome in children: evolution of manifestations

The article provides an analysis of changes in ideas about pathogenetic mechanisms, approaches to the diagnosis and treatment of irritable bowel syndrome in children. Current data on the pathophysiological mechanisms of IBS are presented. Algorithms for the management of children with this pathology are presented, based on the new positions of the Rome IV criteria and Russian recommendations for the diagnosis and treatment of functional disorders of the digestive system in children.

Response to Letter to the Editor: Severity Assessment Scores for Irritable Bowel Syndrome in Children: Are We There Yet?

Senior Resident, Division Of Paediatric Gastroenterology, Post Graduate Institute Of Medical Education & Research, Chandigarh 160012, India. Current affiliation : Consultant, Department of Pediatric gastroenterology & hepatology, Dr Rela institute & medical centre, Chrompet, Chennai 600044, India Senior Resident, Division Of Paediatric Gastroenterology, Post Graduate Institute Of Medical Education & Research, Chandigarh 160012, India. Current affiliation : Consultant - Paediatric Gastroenterology And Hepatology, Manipal Hospitals, Airport road, Bangalore 560017, India Conflicts of interests : Nil Funding : Nil

Мікросоціальні (сімейні) фактори ризику та протекції у виникненні синдрому подразненого кишечника в дітей

Irritable bowel syndrome (IBS) is a stress-sensitive gastrointestinal disorder, which occurs as a result of the complex interaction of individual physiological, psychological and psychosocial factors. A tendency of IBS to cluster in families is caused not only by genetic predisposition but also by epigenetic mechanisms of psychosocial transmission of somatic symptoms from parents to children. Purpose - to determine the role of certain microsocial risk factors in the development of IBS in children. Materials and methods. The study involved 54 patients aged 6 to 12 years old with a diagnosis of IBS established in accordance with the Rome IV criteria, as well as 50 practically healthy children from the control group. For a detailed study of perinatal and microsocial risk factors and prevention of IBS, the developmental histories of children were analyzed and the «family history» method was used (descriptive and phenomenological collection of life history from the patient’s parents). Data were processed using Microsoft Excel 2016 and analyzed with GraphPad (Prism 5.0). Results. Perinatal risk factors that can lead to the development of IBS in children are birth from the first in order of delivery, caesarean section, breastfeeding for less than 3 months. There is also a correlation between an increased risk of IBS in children and the presence of psychosomatic disorders in infants and young children, a tendency to somatization in the mother; the frequency of visits to doctors by the child and mother more than 6 times a year; authoritarian parenting style by the mother and hyperprotective parenting style by the father; frequent overeating and food intolerances. On the contrary, birth from a multigravid woman, absence of psychosomatic disorders of infants and toddlers, parental emotional warmth and democratic parenting may be protective of the development of IBS in children. Conclusions. A number of microsocial factors have been identified that are associated with an increased risk of IBS. Awareness of those factors and consequently their correction may be important for the prevention of IBS in children. 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 interests was declared by the authors.

Trait anxiety and somatization levels in children with irritable bowel syndrome

Background. According to the biopsychosocial model of medicine, irritable bowel syndrome (IBS) is a heterogeneous disorder that occurs as a result of the complex interaction of biological, psychoemotional and psychosocial factors. Their combination is individual for each patient. The study aims to evaluate the psychoemotional features (anxiety and somatization) in children with IBS depending on the predominant bowel habit and the trigger factor in the development of the disorder. Materials and methods. We enrolled 55 children aged 6–12 years with a verified diagnosis of IBS, following Rome IV Criteria. The control group included 45 children of the same age and gender. The levels of anxiety and somatization were assessed by the Children’s Manifest Anxiety Scale and the Somatoform Symptom Screening, respectively. Results. Children with IBS had significantly higher level of anxiety (р &lt; 0.0001) and somatization (р &lt; 0.0001) in comparison to the control group. We have not found any significant differences in these parameters according to the predominant bowel habit. However, the analysis based on the nature of the trigger factor in the onset of the disorder revealed remarkably higher levels of anxiety (р = 0.0006) and somatization (р = 0.05) in children with stress-associated IBS. Moreover, a direct correlation between the studied parameters (r = 0.69, p &lt; 0.0001) proves their close connection and a tendency to augment each other. Conclusions. Our study confirms a heterogeneity of IBS in children. As psychoemotional factors play a crucial role in the occurrence of IBS, it is necessary to consider them in the development of personalized care planning.

Prevalence of irritable bowel syndrome and functional abdominal pain disorders in children with inflammatory bowel disease in remission.

Despite evidence of an increased prevalence of irritable bowel syndrome (IBS) in adults with inflammatory bowel disease (IBD) compared with the general population, the prevalence of IBS in children with IBD is unclear. In this review, we aimed to identify the reported prevalence of IBS or functional abdominal pain disorders (FAPDs) in children with IBD in remission. A search of three databases (MEDLINE, Embase, and PubMed) was performed to identify studies reporting the prevalence of IBS or FAPDs in pediatric patients with IBD in remission. A total of 60 studies were identified, with four eligible studies remaining following abstract screening. In children with IBD in remission, the overall prevalence of IBS ranged between 3.9 and 16.1%, and the overall prevalence of FAPDs ranged between 9.6 and 29.5%. The prevalence of FAPDs in patients in biomarker-based remission was generally higher than those in clinical remission (range 16-22.5% vs 9.6-16.7%, respectively). There is a paucity of literature reporting on the prevalence of IBS or FAPDs in children with IBD in remission. Despite the differences in criteria used to define IBD remission in the included articles, there seems to be an increased overall prevalence of IBS or FAPDs in children with IBD.

Infantile Colic and the Subsequent Development of the Irritable Bowel Syndrome.

Background/AimsLittle is known about the association between infantile colic and the later onset of irritable bowel syndrome (IBS).MethodsThis study examined all 917 707 children who were born in Korea between 2007 and 2008. Infantile colic was defined with 1 or more diagnoses of ICD-10 code R10.4 or R68.1 at the age of 5 weeks to 4 months, and infants with a diagnosis of infantile colic and without were allocated into the infantile colic group and the control group. IBS was defined as 2 or more diagnoses of ICD-10 code K58.X after 4 years of age. Each child was traced until 2017. The risk of IBS with infantile colic was evaluated using a Cox proportional hazards model with propensity score inverse probability of treatment weighting (IPTW).ResultsAfter IPTW, 363 528 and 359 842 children were allocated to the control group and the infantile colic group, respectively. The infantile colic group had a higher risk of developing IBS in childhood (hazard ratio [95% CI], 1.12 [1.10 to 1.13]) than the control group. Moreover, the subgroup analyses according to the feeding status, birth weight, sex, or economic status, showed that the risk of IBS with former infantile colic remained statistically significant.ConclusionsChildren with a diagnosis of infantile colic during the infant period had a significant risk of developing IBS after 4 years of age. Understanding the pathogenesis of infantile colic in the neonatal period may reduce the prevalence and severity of functional gastrointestinal disorders from childhood to adolescence to adulthood.

Висока частота гомозиготного генотипу 472АА COMT (Val158) гена катехол-О-метилтрансферази (COMT) у дітей із синдромом подразненого кишечника

Following the biopsychosocial model of medicine, the pathophysiological basis of irritable bowel syndrome (IBS) is a combination of biological, psychoemotional, and psychosocial factors, the contribution of each of them to the development of this disorder remains unclear. Psychoemotinal factors, which are involved in the pathogenesis of IBS, are caused not only by the environment but also by the metabolism of catecholamines, particularly by the functional activity of catechol-O-methyltransferase (COMT). Purpose - to determine the role of Val158Met COMT polymorphism in development of IBS in children; to identify associations between genotype and clinical variant of the disorder and the nature of the provoking factor. Materials and methods. The material for the molecular genetic study were DNA samples obtained from nuclear cells of venous blood of 54 patients aged 6-12 years with diagnosed IBS. In 48 practically healthy children of the same age DNA samples were isolated from buccal epithelial cells. Molecular genetic study of single nucleotide polymorphism rs4680 of COMT gene was performed by polymerase chain reaction followed by analysis of restriction fragment length polymorphism. Microsoft Excel 2016 and GraphPad Prism 5 software were used for statistical analysis. Results. We have revealed significant differences in the distribution of Val158Met COMT genotypes in children with IBS in comparison with the control group. There was established that the 472GА COMT is more prevalent in healthy children and has a protective role in the development of IBS. In contrast, homozygous genotypes 472GG and 472AA, which are associated with changes in functional activity of enzyme COMT, may be considered as the risk factors for IBS (p≤0.0001). Conclusions. Genotype 472АА COMT was mostly detected in сhildren with stress-associated IBS, which is more related to dysnociception, disorders of cognition, and emotional disturbances. The higher prevalence of 472GA COMT heterozygotes among children with postinfectious IBS and IBS associated with antibiotic therapy indicates a less important role for the psychoemotional component and nociceptive disorders in the onset of this disorder (p=0.03). 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 all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Heart rate variability and trait anxiety in children with irritable bowel syndrome: is there a link?

Aim. The aim of current study was to evaluate parameters of heart rate variability and their correlation with the levels of anxiety in children with irritable bowel syndrome. Materials and methods. We enrolled 22 children aged 6–12 years with verified diagnosis of irritable bowel syndrome according to the Rome criteria IV. The control group included 10 children of the same age and sex. The CMAS (Children’s Manifest Anxiety Scale) test was used for evaluation of the trait anxiety level. A non-invasive method of heart rate variability is used as a transdiagnostic biomarker of neurohumoral regulation and, thus, of the stress resistance. Time and frequency domain parameters of heart rate variability were studied in 5 min ECG-recordings in supine position. Data were processed using Microsoft Excel 2016 and analyzed with GraphPad (Prism 5.0). Results. Children with irritable bowel syndrome had significantly 1.7-fold higher levels of trait anxiety and 2.2-fold lower values of heart rate variability parameters as compared to the control group. In addition, reduced sympathetic (LF) activity was accompanied by upregulation of neurohumoral component (VLF) and parasympathetic (HF) activity. A positive correlation between parameters of heart rate variability and trait anxiety was found in children with irritable bowel syndrome. Conclusions. Children with irritable bowel syndrome were shown with increased levels of trait anxiety. Reduction in heart rate variability and changes of its spectral structure were suggestive about the dysregulation in the gut-brain axis with reduction of the autonomic activity and predominance of neurohumoral regulation. In summary, our study has provided important information about the pathophysiology of irritable bowel syndrome in children.

Ефективність застосування пробіотиків у дітей з синдромом подразненого кишечника: питання оптимальної тривалості лікування

Following the biopsychosocial model of medicine, irritable bowel syndrome (IBS) is a heterogeneous disorder, which is caused by multiple factors in different combinations. However, in most clinical cases probiotics are included in the treatment of IBS due to their influence on intestinal bacterial colonization, and immune, metabolic and motoric activity of the gut. The purpose - to evaluate the efficiency of probiotics (Lactobacillus reuteri DSM 17938) in children with IBS and to determine the optimal duration of the treatment. Materials and methods. We examined 108 children aged 6-12 years with a verified diagnosis of IBS, according to Rome criteria IV. Assessment of the main clinical symptoms was obtained by 4-point Likert scale. Enzyme immunoassay RIDASCREEN Calprotectin (R-Biopharm AG, Germany) was used for the quantitative determination of calprotectin in stool samples. Data were processed using Microsoft Excel 2016 and analysed with GraphPad (Prism 5.0). Results. Our study revealed the heterogenety of IBS in children not only according to clinical subtype, but also due to the trigger factor of the disorder. Patients with stress-related IBS were characterized by the higher level of asthenic syndrome and autonomic dysfunction (р=0.0003). In contrast, children with post-infectious IBS had higher concentration of fecal calprotectin, which is a result of low-grade intestinal inflammation (р=0.0003). After 10 days and 1 month since the beginning of treatment, we have observed a significant decrease in the severity of clinical syndromes, but the level of fecal calprotectin remained elevated. Conclusions. The efficiency of probiotics was confirmed by positive dynamics of clinical signs and the level of fecal calprotectin in children with various clinical subtypes of IBS. Even in the absence of any symptoms, the optimal duration of the use of Lactobacillus reuteri DSM 17938 in children with IBS should be 1-3 months. 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 all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Cerebral intestinal interaction in children with autism spectrum disorder

Background. Autism spectrum disorders (ASD) in children are associated with features of neuropsychological development, characterized by socio-communicative, emotional, and behavioral problems. The processes of interaction between the central and enteric nervous systems, taking into account the inherent RAS reactions of autonomic maladaptation, endogenous stress, eating behavior determine the pathophysiological mechanisms underlying the comorbid pathology of the digestive system. The study was aimed to analyze the cerebral intestinal interaction signs in children with ASD, taking into account the role of NSE and S-100 neurotransmitters. Materials and methods. Sixty-six children with ASD were examined, out of which 45 children had concomitant functional disorders of the digestive system (FDDS). Clinical manifestations of ASD were assessed by the CARS scale; FDDS was diagnosed based on the Rome IV criteria. Serum levels of NSE neurotransmitters and S-100 protein were measured immunochemically. The patients were examined after obtaining informed consent in compliance with the principles of bioethics. Results. According to the data obtained in children with ASD, the frequency of concomitant FDDS is 68.20 %. In this case, ASD in combination with functional disorders of the biliary tract (FDBT) is observed in 22.7 %, with irritable bowel syndrome (IBS) — in 27.30 %, with syntropic FDDS — in 18.20 % of patients. The study traced the association between severe ASD and concomitant FDDS, in particular ASD with isolated IBS (p = 0.004), ASD with isolated FDBT (p = 0.009), ASD with syntropic functional disorders (p = 0.041). Increased serum concentrations of the NSE and S-100 neurotransmitters have been observed in children with concomitant FDDS. The level of S-100 protein and clinical manifestations of FDDS reveal a correlation, the degree of which increases in the following sequence: IBS (r = 0.34), and syntropic FDDS (r = 0.48). Conclusions. Peculiarities of cerebral intestinal interactions in ASD determine the high frequency of FDDS, in the structure of which IBS dominated. The presence of concomitant pathology impacts the clinical manifestations of ASD, complicating its course to a greater extent in cases of syntropic FDDS. Involvement of enteric glial structures in ASD is accompanied by the NSE and S-100 neurotransmitters level increase on the background of concomitant FDDS. The diagnostic value of S-100 protein in IBS in children with ASD is shown.