Digestive disorders in young children: the possibility of correction with functional foods. Functional digestive disorders in infants Functional digestive disorders in children treatment

Acute indigestion in infants is a fairly common pathology, which rightfully takes second place after acute respiratory diseases. The high prevalence of acute digestive disorders in children of the first year of life is due to the anatomical and physiological characteristics of the digestive canal.

At the VIII All-Union Congress of Pediatricians in 1962, the classification of gastrointestinal diseases proposed by G.N. Speransky. According to this classification, there are: 1) diseases of functional origin: a) dyspepsia (simple, toxic (intestinal toxicosis), parenteral); b) dyskinesia and dysfunction (pylorospasm, atony of various parts of the alimentary canal, spastic constipation); 2) diseases of infectious origin (bacterial dysentery, amoebic dysentery, salmonellosis, intestinal infection, intestinal form of staphylococcal, enterococcal, mycotic infections, viral diarrhea, intestinal infection of unknown etiology); 3) malformations of the digestive tract (pyloric stenosis, megaduodenum, megacolon, atresia (esophagus, intestines, anus), diverticulum, other malformations of the digestive canal).

SIMPLE DYSPEPSIA is an acute indigestion of a functional nature, characterized by vomiting, diarrhea without significant disturbance of the general condition.

ETIOLOGY. In etiology, the leading factors are the alimentary factor, care defects (overheating, violation of the feeding regimen), as well as the infectious factor (most often E. coli). Predisposing factors are: early artificial and mixed feeding, rickets, exudative catarrhal diathesis, malnutrition, prematurity.

PATHOGENESIS. When overfeeding or feeding food that is not appropriate for age due to insufficient enzymatic activity and low acidity of gastric juice in young children, the food is not processed enough in the stomach, which causes an overstrain of the stomach function. Insufficiently prepared food enters the small intestine. The normal course of digestion is disturbed. Since the intestines have an alkaline environment, bacteria begin to multiply intensively in the food bolus, and the pathogenic properties of the constant intestinal microflora increase.

Bacterial breakdown by putrefaction and fermentation in the intestine promotes the formation of toxic products (indole, skatole, acetic acid) and gases (Fig. 8).

Irritation of the receptors of the mucous membrane of the stomach and intestines with toxic products leads to the appearance of protective reactions in the form of regurgitation, vomiting, increased intestinal motility, increased secretion of mucus by the intestinal glands and diarrhea. Fatty acids, which were formed as a result of improper breakdown of fat in the intestines, are neutralized by the intake of calcium, magnesium, sodium, and potassium salts from the intercellular fluid and tissues of the body. These salts react with fatty acids to form fatty acid soaps.

CLINICAL MANIFESTATIONS. The disease begins acutely. Appetite decreases, lethargy appears, sleep is disturbed. The main symptoms are single or double vomiting and loose green stools with mucus and white lumps. Chair 5-8 times a day. The stools have a sour smell. Green stool is due to the accelerated transition of hydrobilirubin to biliverdin in an acidic environment, and white lumps are soaps formed as a result of the neutralization of fatty acids with calcium, magnesium, sodium, and potassium salts.

In addition, periodically the child has intestinal colic due to gases accumulated in the intestines, after which the child calms down. Body temperature is often normal, but sometimes subfebrile can be observed.

When viewed outside an attack of intestinal colic, the child's condition is relatively satisfactory. There is some pallor of the skin, coated tongue, sometimes thrush on the oral mucosa. The abdomen is swollen, rumbling on palpation, diaper rash in the anus (feces are acidic, which causes skin irritation).

The diagnosis is not difficult. Correctly collected anamnesis (violation of the diet, overfeeding, overheating, etc.), epidemiological history (lack of contact with patients with diarrhea), as well as the clinical picture, make it possible to correctly diagnose. But it is necessary to differentiate with such diseases as dysentery, intussusception, appendicitis. Therefore, first of all, it is necessary to exclude those diseases that require urgent surgical care.

TREATMENT. Includes bowel lavage, the appointment of a water-tea diet for 6-8 hours (using rehydron, oralit, saline sodium chloride solution, 2% glucose solution, boiled water, tea in the amount of 150 ml per 1 kg of body weight per day), diet therapy.

Usually on the 1st day, 70-80 ml of women's milk is prescribed while maintaining the feeding regimen or applied to the breast for 3-4 minutes (usually a child sucks out 20 ml in 1 minute). In the absence of women's milk, adapted sour-milk mixtures or kefir are used in a 2: 1 dilution with rice water. Every day the amount increases, and by the 5th day the volume of food should reach the volume that the child consumed before the disease. From the 6th day from the onset of the disease, complementary foods can be introduced if the child received it, but introduced gradually. Grated apple and juices are prescribed from the 6-7th day.

For oral rehydration in acute digestive disorders in infants, the Austrian company "HIPP" produces a medicinal product - carrot-rice broth "HIPP ORS 200". The main ingredients of this product are carrot, rice, glucose, salt, sodium citrate, potassium citrate, citric acid. Carrot-rice water "HIPP ORS 200" is a homogenized, sterile, ready-to-eat food. 100 ml of the product contains 0.3 g of protein; 0.1 g fat; 4.2 g carbohydrates; 120 mg sodium; 98 mg potassium; 145 mg chloride; 135 mg citrate; energy value - 19 kcal / 100 ml; osmolarity - 240 mOsm / l.

The pectin substances contained in HIPP ORS 200 have the ability to adsorb microbial toxins, gases, products of incomplete hydrolysis and fermentation of nutrients. Rice mucus and starch, due to the enveloping action, contribute to the regeneration of the intestinal mucosa and the restoration of digestion processes.

The recommended amount of "HIPP ORS 200" with a mild degree of dehydration is 35-50 ml per 1 kg of the child's body weight per day, with an average degree - 50-100 ml per 1 kg per day. Repeated vomiting in infants is not a contraindication for the use of HIPP ORS 200 therapeutic nutrition. A prerequisite for using "HIPP ORS 200" for vomiting is its use in small amounts at short intervals, for example, every 10 minutes, 1-2 teaspoons of "HIPP ORS 200".

Be sure to use enzyme therapy. Usually hydrochloric acid with pepsin is used. Creon (pancreatin with minimal activity of lipase, amylase and proteases) has a good therapeutic effect, which ensures the digestion of food ingredients, facilitates their absorption, stimulates the release of the digestive tract's own enzymes, improves its functional state and normalizes digestion processes. The drug is prescribed 1 capsule 3-4 times a day with meals with a small amount of water. You can mix the contents of the capsule with a small amount applesauce drink juice or warm tea. With insufficient effectiveness, you can increase the daily dose to 6-12 capsules.

It is recommended to prescribe likrease. Newborns are prescribed 1 - 2 capsules per day (maximum dose - 4 capsules per day). Capsules can be previously opened and diluted in milk. Children under 5 years old are prescribed 2-4 capsules per day, from 5 to 10 years old - 4-6 capsules, over 10 years old - 6-8 capsules per day.

You can also use festal, mezim forte, pancreatin, digestal and other enzyme preparations, but since their children's forms are absent, the dosage of the drugs should be approached carefully.

Antibacterial drugs are prescribed only if an infectious etiology is suspected or confirmed: furazolidone (10 mg / kg per day 4 times a day after meals), polymyxin (100,000 IU / kg per day 4 times a day).

Symptomatic treatment includes, with severe flatulence, the removal of gases through a gas outlet tube, the appointment of white clay (0.25 g 3 times a day), carbolen (0.25 g 3 times a day), smecta (1 sachet per day in 50 ml of boiled water, give during the day). With intestinal colic, a compress is used on the stomach, therapeutic enemas with valerian (1 drop of valerian for a month of a child's life), a 1% solution of bromine with valerian is prescribed. Subsequently, eubiotics are indicated to restore normal intestinal microflora.

Intestinal dysbacteriosis

With intestinal dysbacteriosis, already from the first days of the child's arrival from the maternity hospital, under the supervision of a pediatrician, a number of symptoms are noted, which can subsequently lead to impaired health of the baby. This is an insufficient increase in body weight, growth retardation, the development of rickets and deficiency anemia. The presence of the disease may also be indicated by such symptoms as a change in the nature of the stool, alternating constipation with diarrhea, intestinal colic, flatulence, frequent regurgitation, which affects the change in behavior: the baby becomes restless. In severe cases, there is a delay in psychomotor development.

The root cause of the above symptoms is a violation of the ratio of the quantitative and qualitative composition of normal and conditionally pathogenic intestinal microflora, as well as the addition of pathogenic microflora, which determines the so-called intestinal dysbacteriosis.

The intestines of the child are populated by natural microflora immediately from the moment of birth, and its main source is the mother. In the first hours of life, during the first breastfeeding, the intestines of the child are colonized by lacto-, bifidobacteria. The so-called bacterial ecosystem of the department and attendants of the maternity hospital, in which the newborn is in the first hours of life, is also of direct importance in the formation of the normal microflora of the intestines of the child.

There are many causal factors affecting the incorrect formation of the ratios of normal, opportunistic and pathogenic microflora. The most relevant diseases of the mother, both infectious and non-infectious nature (chronic pyelonephritis, chronic tonsillitis, diseases of the gastrointestinal tract, genitourinary system, complicated childbirth ( cesarean section, fetal hypoxia), the use of antibacterial agents by a woman in the ante- and postnatal period. The incorrect formation of the intestinal microflora of the child at a later date is affected by artificial feeding with unadapted mixtures, unfavorable living conditions, exposure of the child to radioactive contamination, toxic substances, salts of heavy metals.

Unfortunately, the diagnosis of intestinal dysbacteriosis in outpatient settings in most cases relies only on clinical data. The analysis of feces for dysbacteriosis due to the high cost of enrichment media for growing microflora often becomes an unaffordable luxury for many families, especially those with an unfavorable social status. Despite this, the task of identifying the disease in time, correcting the child's nutrition, and prescribing the right treatment is before every pediatrician and is his responsibility.

For the formation of a diagnosis in the treatment of a disease, the most convenient is the classification proposed by Professor K. Ladodo in 1991 and supplemented by P. Shcherbakov in 1998, which is still used today. According to this classification, there are four degrees of dysbacteriosis.

The first degree - the latent phase, the so-called compensated dysbacteriosis, is characterized by the predominance of anaerobes over aerobes, while the level of bifidus and lactobacilli remains within the normal range. It develops in a healthy child and manifests itself only after the influence of certain negative factors, in particular, a violation of the diet or quality of nutrition. There is no bowel dysfunction.

The second degree is the starting phase. When analyzing feces for intestinal dysbacteriosis, the condition of the intestine is determined, in which the number of anaerobes is equal to or exceeds the number of aerobes, while the level of bifidus and lactobacilli is very low. In some cases, hemolyzing cocci and rods are detected.

Clinically, this phase is characterized by a decrease in appetite, a slow increase in body weight, a change in the nature of the stool: frothy stools alternate with normal ones.

The third degree is the phase of disinhibition and aggression of microbial associations. When analyzing feces for intestinal dysbacteriosis, the number of anaerobes is lower than aerobes. The processes of digestion and absorption in the intestine are disturbed, gas formation and intestinal motility increase. The general condition of the child is slightly disturbed. But at the same time, frequent regurgitation appears, body weight increases slowly or does not change. The character of the stool is frothy with an admixture of greenery and mucus. Periodically there are rashes on the face and extremities. The second and third degree of dysbacteriosis can be represented as subcompensated.

The fourth degree is the phase of associated (decompensated) dysbacteriosis. At this stage of the disease in the analysis of feces for intestinal dysbacteriosis there are no bifidobacteria and lactobacilli, there is a significant increase in opportunistic microorganisms (staphylococci, proteus, clostridia and others). Clinically, dyspeptic disorders are persistently growing, in which the child has bloating, frequent regurgitation, loss of appetite, the stool has a sharp unpleasant odor, liquid, with a green tint. At this stage of the disease, hypovitaminosis, deficiency anemia, rickets, and allergic dermatitis develop, which can subsequently lead to the formation of childhood eczema.

Treatment of dysbacteriosis At the moment, the baby food market in our country has a large assortment of such products, a feature of the therapeutic effect of which is the content in infant formulas of bifidobacteria, lactobacilli, lactulose, which are necessary for the formation of normal microflora in the intestines of the child. In the third and fourth degree of the disease, the parents of the child are not recommended to use diet therapy as an independent type of treatment. In these cases, pre- and probiotics are prescribed by the pediatrician to correct the normal intestinal microflora. Well proven prebiotics containing lactulose, which stimulates and activates digestion, has a bifidogenic factor. On the market of medicines in our country, probiotics are represented by various forms of living microorganisms, in particular, lyophilisates of bifidus and lactobacilli, colibacilli, spore-forming strains of the natural intestinal microflora (a combination of live lactic acid bacteria, a concentrate of metabolic products of symbionts of the small and large intestines), as well as specific bacteriophages ( coliproteic, staphylococcal).

The most optimal method for the treatment of dysbacteriosis today is a complex treatment, which includes not only diet therapy, but also the appointment of specific drugs that improve motor and secretory function. gastrointestinal tract. As additional funds, you can use decoctions of chamomile, fennel, dill water. If the treatment prescribed by the doctor is followed, spastic pains, flatulence are eliminated, along with the use of enzyme preparations, the secretory function of the pancreas improves, and stool normalizes. If treatment with probiotics is not effective enough and opportunistic microflora is isolated during repeated crops, it is necessary to use intestinal antiseptics, the peculiarity of which is the targeted effect on opportunistic microflora, while not affecting the natural intestinal microflora.

This information is intended for healthcare and pharmaceutical professionals. Patients should not use this information as medical advice or recommendations.

Functional disorders of the digestive system in children

S.V. Belmer, T.V. Gasilina, A.I. Khavkin, A.S. Eiberman

Introduction

Traditionally, all pathological conditions that occur in any system of the human body are divided into organic and functional. Organic pathology is associated with damage to the structure of a particular organ, the severity of which can vary over the widest range from a gross anomaly to a subtle enzymopathy. With functional disorders, these injuries are not found, which led to a double interpretation of the essence of this group of conditions. According to the widely accepted definition of functional disorders according to D.A. Drossman (1994), they are "a diverse combination of gastrointestinal symptoms without structural or biochemical disorders." Close in meaning is the definition of functional disorders, presented in the so-called. "Rome criteria II", international consensus on functional diseases of the digestive system 1999 . The vulnerability of such a definition of physical activity lies in its dependence on the current level of our knowledge and the possibilities of research methods that do not allow us to identify certain structural disorders, casting doubt on the very existence of this group of diseases. On the other hand, functional disorders are "disturbances in the functions of an organ, the causes of which lie outside the affected organ and are associated with an altered regulation of the impaired function." It is this definition that seems to be the most acceptable both for practical activities and for theoretical understanding of the diversity of pathological processes in the human (and not only human) body.

So, the cause of functional disorders is associated with dysregulation, nervous or humoral. The most typical example of such a condition is gastrointestinal motility in a patient with autonomic dysfunction. Psychogenic motor disorders also mediate through the autonomic nervous system and are also an example of dysregulation. Functional disorders can also include motor disorders of the digestive organs in patients with organic damage to the nervous system, which may or may not be included in the structure of the underlying disease, for example, with injuries or tumors of the brain or spinal cord and many other conditions. Another option is associated with endocrine diseases, for example, intestinal dyskinesia in violation of the thyroid gland. In all these cases, disorders of the motility of the digestive organs are not associated with direct structural changes in the digestive organs, but are associated with a violation of their regulation. Another thing is that it is not always advisable to single out these disorders from the structure of the underlying disease, however, approaching objectively, all these are also functional disorders.

At present, speaking of functional disorders of the digestive organs, motor disorders are implied, however, in fairness, it should be noted that in addition to the motor function, the digestive organs also have the functions of secretion, digestion, absorption, and some others, which can also be impaired both due to organic and and for functional reasons. However, due to the established tradition, the understanding of functional disorders turned out to be narrowed, but it does not seem appropriate to break this tradition at present.

Pathogenesis

All motor disorders of the digestive tube can be grouped as follows:

• Change in propulsive activity:
  • decrease - increase
• Change in sphincter tone:
  • decrease - increase
• The appearance of retrograde motility
• The occurrence of a pressure gradient in adjacent sections of the digestive tract.

These disorders can be associated with a disease of the organ itself (anomalies, inflammation, etc.), as well as with a violation of the nervous and humoral regulation, i.e. be functional. In this regard, the most studied are disorders of nervous regulation, which in many aspects are connected with psychosomatic disorders.

The somatic symptoms (complaints) of the patient are, in essence, the patient's interpretation of information from receptors located in the internal organs, the formation of which is influenced not only by the pathological process as such, but also by the characteristics of the patient's nervous system and mental organization. The real complaint presented in this way to the doctor is determined by the nature of the pathology, the sensitivity of the receptors, the characteristics of the conduction system, and, finally, the interpretation of information from the organs at the level of the cerebral cortex. At the same time, the last link often has a decisive influence on the nature of complaints, leveling them in some cases and aggravating them in others, as well as giving them an individual emotional coloring.

The flow of impulses from peripheral receptors is determined by the level of their sensitivity or hypersensitivity to the action of damaging stimuli, which is manifested by a decrease in the threshold of their activation, an increase in the frequency and duration of impulses in nerve fibers with an increase in the afferent nociceptive flow. At the same time, stimuli that are insignificant in strength (for example, stretching of the intestinal wall) can provoke an intense flow of impulses to the central parts of the nervous system, creating an image of a severe lesion with a corresponding autonomic response.

Therefore, we can distinguish three levels of formation of a somatic symptom (complaint), for example, pain: organ, nervous, mental. The symptom generator can be located at any level, but the formation of an emotionally colored complaint occurs only at the level of mental activity. At the same time, a pain complaint generated without damage to an organ may not differ in any way from one that arose as a result of a true injury.

As in the case of pain, complaints associated with dysmotility of the gastrointestinal tract can be formed at the level of the affected organ (stomach, intestines, etc.), may be associated with dysregulation of these organs by the nervous system, but also can be generated, regardless of the state of the organ, due to the peculiarity of the patient's psycho-emotional organization. Compared with the mechanism of pain, the difference is only related to the direction of nerve impulses: in the case of pain, there is an "ascending" direction, and the overlying level without the participation of the underlying one can become the generator of the complaint, while in the case of impaired motility of the gastrointestinal tract, the opposite situation is observed: "descending" impulsation with the possibility of generating a symptom by the underlying organ without the participation of the overlying one. Finally, it is possible to generate a descending stimulus at the segmental level in response to an abnormal ascending impulse, for example, in the case of receptor hyperreactivity. Mechanisms associated with a decrease in the sensitivity threshold of intestinal receptors in combination with its stimulation from the upper regulatory centers, which are activated against the background of psychosocial influences, are observed, in particular, in irritable bowel syndrome.

Thus, any symptom (complaint) becomes such from disparate nervous impulses only at the level of mental activity. A true somatic complaint is determined by the lesion of one or another internal organ, and various parts of the nervous system perform the functions of a link and primary data processing, transferring the latter to the level of the psyche or vice versa. At the same time, the nervous system itself and its higher departments can be the generator of somato-like complaints. At the same time, the mental level is absolutely self-sufficient, and complaints that do not have their prototype at the somatic level, but are indistinguishable from true somatic symptoms, can “emerge” here. Differentiation of the primary level of a symptom (complaint) is of fundamental importance for the correct diagnosis and selection of the optimal treatment plan.

Motility disorders of the digestive organs of any origin inevitably cause secondary changes, the main of which is a violation of the processes of digestion and absorption, as well as a violation of the intestinal microbiocenosis. These violations exacerbate motor disorders, closing the pathogenetic "vicious circle".

Forecast with functional disorders is ambiguous. Although the "Rome criteria" indicate the stable and favorable nature of their course, practice shows their possible and frequent evolution into organic pathology. Thus, diseases accompanied by gastroesophageal reflux can evolve into gastroesophageal reflux disease, functional dyspepsia - into gastritis, and irritable bowel syndrome - into colitis. Thus, the attitude to functional diseases should be quite serious, and treatment measures should be adequate.

Classification

All classifications of functional disorders can be divided into two groups: topical (according to the affected organ) and clinical (according to the leading symptom). The disadvantage of the classifications of the first group is the difficulty of identifying the leading body. For example, in case of swallowing disorders, the pharynx, esophagus, and stomach are also involved in the process. Moreover, functional disorders initially have a generalized character with a predominance of symptoms from one or more organs. Clinical classifications are also not ideal, since similar symptoms may be associated with damage to various organs and even systems. Nevertheless, the latter are today recognized as more convenient for everyday practical activities.

The latest classification of functional disorders of the digestive system in children in our country was adopted in 2004 at the XI Congress of Pediatric Gastroenterologists of Russia (Moscow) as part of the "Working protocol for the diagnosis and treatment of functional disorders of the digestive system in children." The basis for this classification was the classification proposed by the pediatric expert group working within the framework of the Rome Criteria II project.

Working classification of functional diseases of the digestive system in children

(XI Congress of Pediatric Gastroenterologists of Russia, Moscow, 2004)

1. Functional disorders that manifest
   1. Regurgitation.
   2. Rumination.
   3. Cyclic (functional) vomiting.
   4. Aerophagia.
2. Functional disorders manifested by pain:
   1. functional dyspepsia.
   2. Irritable bowel syndrome.
   3. Functional abdominal pain, intestinal colic.
   4. Abdominal migraine.
3. Functional defecation disorders:
   1. functional diarrhea.
   2. Functional constipation.
   3. Functional stool retention.
   4. Functional encopresis.
4. Functional disorders of the biliary tract:
   1. Dysfunction (dyskinesia) of the gallbladder and (or) (dystonia) of the sphincter of Oddi.
5. Combined functional diseases.

General principles for the diagnosis and treatment of functional disorders

Diagnosis functional diseases are based on clinical data (including a carefully collected anamnesis) and additional laboratory and instrumental examinations. The main difficulty in diagnosing functional disorders is the need to exclude all possible organic pathology. Only after that it is possible to speak with confidence about the functional nature of the disease.

Symptoms in functional disorders are diverse, but complaints should be observed over a long period of time. According to the "Rome II criteria", such a period is 12 months or more (not necessarily continuously!) during the last year.

Speaking of clinical and laboratory symptoms, it should be noted the so-called. "symptoms of anxiety", in the presence of which a functional impairment seems unlikely and a serious examination is required to identify their cause.

"Symptoms of anxiety" include:

• Fever
• Unmotivated weight loss
• Dysphagia
• Vomiting blood
• Blood in stool
• Anemia
• Leukocytosis
• ESR increase

Because Functional disorders are almost always associated with certain disorders of the nervous system. Consultations of a neuropathologist, psychologist, psychoneurologist should always be included in the examination of such patients.

Based on the concept of the pathogenesis of functional disorders the main directions of their treatment are:

• Treatment of the cause that led to their development. Correction of psychoneurological status. Elimination of provoking factors. Treatment concomitant diseases aggravating the course of functional disorders.
• Correction of impaired motility of the digestive organs.
• Correction of disorders caused by impaired motor skills.

Characteristics of the main groups of functional disorders of the digestive system in childhood

Functional disorders manifested by vomiting

The basis of functional disorders, manifested by regurgitation and vomiting, is gastroesophageal reflux(GER), retrograde movement, leakage or reflux of gastric and / or intestinal contents into the esophagus, which in a number of classifications, incl. and ICD-10 (XI, K21) is often considered as an independent nosological unit. At the same time, GER is a normal physiological process that is also observed in healthy individuals, and pathological GER is a pathogenetic mechanism underlying a number of diseases. In addition, pathological GER can be associated not only with a violation of regulatory mechanisms, i.e. be a purely functional phenomenon, but also develop against the background of organic processes, for example, against the background of anomalies of the esophagus, stomach, duodenum. In this case, GER is a manifestation of these diseases or their complication.

For the diagnosis of GER, the most informative is the daily intragastric pH-metry, which allows you to determine total number episodes of reflux during the day and their duration. Normally, the pH in the esophagus is 5.5-7.0, and a decrease in pH below 4 is considered a reliable criterion for GER. observation period.

The basis of any GER is a decrease in the tone of the lower esophageal sphincter (or the impossibility of its closing in a number of organic diseases) and an increase in intragastric pressure. Lowering the pH of gastric contents plays a supporting role and is more important for damage to the esophageal mucosa. The development of an inflammatory process in the esophagus (reflux esophagitis) or extraesophageal pathological processes associated with functional GER (damage to the respiratory tract, oral cavity and teeth as a result of high reflux of gastric contents, as well as the occurrence of pathological reflexes as a result of irritation of the esophageal mucosa) marks the formation of gastroesophageal reflux diseases (GERD) and the transition from functional to organic pathology. Further evolution of GER through GERD may include metaplasia of the esophageal mucosa against the background of long-term persistent inflammation with the formation of Barrett's esophagus, which in turn is fraught with the development of esophageal cancer. The presented hypothetical chain of events completely rejects the attitude to functional diseases as transient and not having serious consequences.

One of the most common diseases in this group is regurgitation (regurgitation)(ICD-10, XVIII, R11) - reverse reflux of food chyme shortly after ingestion of food eaten. In children of the first months of life, regurgitation can be regarded as a physiological condition if it is rare, mild and occurs no later than one hour after feeding. On the contrary, at this age it is considered pathological if it occurs more than twice a day, occurs one hour or later after eating, and is abundant. The development of regurgitation in children during the first months of life is predisposed by structural features of the upper digestive tract and the immaturity of the neurohumoral regulation of the sphincter apparatus and motility of the gastrointestinal tract. Often regurgitation is caused by inadequate feeding (aerophagia, overfeeding, violation of the feeding regimen, inadequate selection of mixtures, etc.), but also by perinatal damage to the central nervous system.

To regurgitation, in some cases, leads to the presence of pylorospasm (ICD-10, XVIII, R19) - difficult emptying of the stomach due to spasm of the pylorus muscles. From the first days of life, with pylorospasm, regurgitation is noted, as the volume of nutrition increases, vomiting appears, "delayed", curdled acidic contents without bile, not exceeding the volume of food eaten. The child, despite vomiting, gains weight, although not enough, and if the treatment is not started in time, malnutrition may develop. Radiological pathology is not determined, although when viewed after 2 hours, there may be a delay in the evacuation of the contrast mass. An endoscopic examination reveals a pylorus closed in the form of a gap, through which it is always possible to pass with an endoscope, which excludes organic causes of pyloroduodenal obstruction.

Rumination(ICD-10, XVIII, R19) is recurring periodic attacks of contraction of the abdominal muscles, diaphragm and tongue, leading to the reflux of gastric contents into the oral cavity, where it is again chewed and swallowed. The onset is characteristic at the age of 3-8 months and the absence of the effect of changing the nature of nutrition, feeding through a nipple or gastrostomy. There are no signs of discomfort. May be a symptom of deprivation or a sign of severe organic damage to the central nervous system.

Cyclic (functional) vomiting(ICD-10, XVIII, R11) - acute attacks of nausea and vomiting, lasting from several hours to several days, interspersed with asymptomatic periods lasting for weeks or months. May be chronic with symptoms lasting at least 3 months (or intermittently for a total of 3 months within a year). It occurs mainly in children older than 3 years and requires a thorough neurological examination.

Aerophagia- swallowing air, leading to repeated belching and flatulence, observed for 12 months. and more (not necessarily continuously) during the last year. Moderate aerophagia is a common occurrence in children during the first months of life due to the immaturity of the nervous regulation of the swallowing process. To a greater extent, aerophagy is expressed in premature and immature children at the time of birth. Aerophagy is facilitated by talking during meals, hasty eating, chewing gum, drinking carbonated drinks. Persistent aerophagia in children older than 1 year of age requires the exclusion of neurological pathology.

Treatment of the listed diseases is built in accordance with the general principles of treatment of functional disorders and begins with the elimination of the root cause, which often requires the involvement of a neuropathologist, psychologist or psychoneurologist.

Correction of dysmotility in GER includes regimen, nutritional and drug interventions.

Patients with GER are advised to sleep with the head end of the bed raised by at least 15 cm, avoid tight clothing and tight belts, exercise associated with overexertion of the abdominal muscles, deep bends, prolonged stay in a bent position, lifting weights of more than 8-10 kg for both hands.

In the diet, you should limit or reduce the content of animal fats, increase the protein content, avoid irritating foods, carbonated drinks, reduce the one-time volume (you can increase the frequency) of food intake. Also, don't eat before bed. Obese patients are advised to reduce weight.

In the nutrition of children in the first months of life who are bottle-fed, special anti-reflux mixtures should be used, a feature of which is a change in the ratio of casein and whey proteins towards casein, as well as the inclusion of thickeners in their composition (most often, locust bean gum, E410) .

If possible, you should avoid taking drugs that reduce the tone of the lower esophageal sphincter, incl. sedatives, hypnotics, tranquilizers, theophylline, anticholinergics, beta-agonists.

If smoking, it must be stopped.

Drug therapy includes the use of prokinetics (domperidone) and antisecretory drugs that increase the tone of the lower esophageal sphincter (H2-histamine receptor blockers and proton pump blockers).

The action of domperidone (motilium), as well as methaclopramide (cerucal), is associated with their antagonism in relation to the dopamine receptors of the gastrointestinal tract and, as a result, increased cholinergic stimulation, leading to an increase in sphincter tone and acceleration of motility. Unlike domperidone, methaclopramide penetrates well through the blood-brain barrier and can cause serious side effects (extrapyramidal disorders, drowsiness, fatigue, anxiety, and galactorrhea associated with an increase in prolactin levels in the blood), which makes it avoid its use in pediatric practice. Motilium is prescribed at a dose of 2.5 mg per 10 kg of body weight 3 times a day for 1-2 months. Side effects of motilium (headache, general fatigue) are rare (0.5-1.8% of patients).

The use of antisecretory drugs is indicated only in severe cases of GER that cannot be eliminated in other ways, in older children and in adult patients. The effectiveness of drugs of this group in GER is associated not only with a decrease in gastric secretion, but, first of all, due to an increase in the tone of the lower esophageal sphincter. Usually, indications for their appointment arise already in the case of GERD that has formed.

Currently, there are two approaches to the choice of therapeutic tactics for GER. In the first case (the so-called "step-up" therapy), treatment begins with the organization of the regimen and nutrition of the patient, and in case of ineffectiveness, prokinetics are introduced into the therapy, and then antisecretory drugs. With an alternative (so-called "step-down") scheme, treatment begins with a full range of remedies and is further weakened against the background of obtaining the effect.

Functional disorders accompanied by abdominal pain

The understanding of the term "dyspepsia" has undergone a significant evolution in recent decades. Traditionally, dyspepsia in domestic medicine meant the so-called. alimentary dyspepsia, which most clearly corresponds to the translation of this term (“digestion disorder”), i.e. inconsistency of the capabilities of digestive enzymes with the volume and / or composition of the food taken. The concept of alimentary dyspepsia was most often used in pediatric practice in relation to children of the first year of life, however, it is competent to describe the condition of patients of any age.

At the end of the 20th century, a new understanding of dyspepsia, which came from Western practice, appeared in Russian literature.

dyspepsia syndrome in accordance with the definition of the Committee on Functional Diseases of the World Congress of Gastroenterologists (1991) is a complex of disorders, including pain or discomfort in the epigastrium, a feeling of fullness in the epigastric region after eating, early satiety, nausea, vomiting, belching, heartburn. Subsequently, in 1999, dyspepsia with heartburn was attributed to gastroesophageal reflux disease, and pain or discomfort in the abdomen, combined with defecation disorders, to irritable bowel syndrome.

Dyspepsia syndrome is a preliminary concept used at the initial stages of diagnosis or when it is impossible to conduct an in-depth diagnostic process. In the case of further examination, it can be decoded into organic dyspepsia, i.e. gastritis, peptic ulcer, etc., or in functional dyspepsia relating to functional impairment. In essence, at present, functional is understood as those cases of dyspepsia, when, with a thorough gastroenterological examination, its cause cannot be established. Functional dyspepsia is based on motor disorders of the stomach and duodenum as a result of a violation of the nervous and / or humoral regulation, incl. caused by visceral hypersensitivity.

functional dyspepsia(ICD-10, XI, K30) - a symptom complex isolated in children older than 1 year and including pain, discomfort or feeling of fullness in the epigastric region, associated or not associated with eating or exercise, early satiety, bloating, nausea, regurgitation, intolerance to fatty foods, etc. for at least 12 weeks in the last 12 months, in which no organic disease can be detected during the examination. It is also important that the symptoms are not associated with defecation or changes in the frequency and nature of the stool.

The following variants of functional dyspepsia are distinguished: ulcer-like (localized pain in the epigastrium, "hungry" pain that disappears after eating, antacids or antisecretory drugs), dyskinetic (discomfort in the upper abdomen, aggravated by eating) and non-specific (complaints are difficult to attribute to a specific option).

Mandatory component functional dyspepsia therapy is the normalization of the vegetative status and psycho-emotional state, consultation of a psychoneurologist, psychologist.

The diet for functional dyspepsia is largely determined by individual food tolerance. Also excluded are all foods that can cause epigastric pain, heartburn, belching: fatty foods, smoked sausages, strong meat, fish and mushroom broths, cabbage soup, borscht, rye bread, fresh pastries, pancakes, carbonated drinks, coffee, radishes, spicy seasonings . Patients are allowed to eat white bread, better than yesterday's, white bread crackers, dry unbread cookies, vegetarian soups and soups on weak broths, mashed soups, boiled meat, steam cutlets, meatballs (beef, chicken, rabbit, turkey), boiled fish, porridge (semolina, rice, buckwheat, oatmeal) with the addition of milk, pasta, soft-boiled eggs, steam omelettes, whole and condensed milk, cottage cheese, kefir, yogurt, mild cheese, jelly, jelly, compotes from sweet varieties of berries and fruits, boiled vegetables (beets, potatoes, zucchini, pumpkin, cauliflower) raw grated carrots, sweet pears without peel, bananas, baked apples. It is recommended to eat 4-5 times a day.

Antacids and antisecretory drugs are indicated for an ulcer-like variant of functional dyspepsia. Antacids may be prescribed if their use reduces the severity of clinical manifestations. Antisecretory drugs are prescribed taking into account the nature of gastric secretion.

Prokinetics are prescribed, first of all, to patients with a predominance of such symptoms as a feeling of fullness, rapid satiety after eating, bloating (dyskinetic variant of dyspepsia). The drug of choice for the dyskinetic variant of functional dyspepsia is domperidone, administered at a dose of 2.5 mg per 10 kg of body weight 3 times a day for 1-2 months.

Antispasmodic drugs are prescribed for spastic conditions: myotropic antispasmodics - mebeverine (Duspatalin) is used in capsules of prolonged action from the age of 12 at a dose of 200 mg x 2 times. Papaverine (for children, depending on age, 0.005-0.06 x 2 times a day), drotaverine - for children under 6 years old, inside 0.01-0.02 g 1-2 times a day, children 6-12 years old 0.02 1-2 times a day.

Mebeverine is currently considered a highly effective antispasmodic, more information about which is presented in the section on the treatment of irritable bowel syndrome.

It is important to take into account the patient's vegetative status and prescribe appropriate drugs, in particular anticholinergics, for vagotonia.

It is now recognized as rational to divide the diagnosis and treatment of dyspepsia into two stages. At the first stage, the doctor, relying on clinical data (including excluding the symptoms of "anxiety") and screening examination (complete blood count, scatological examination, fecal occult blood test, ultrasonography), with a high degree of probability assumes the functional nature of the disease and prescribes treatment for a period of 2-4 weeks. The lack of effect from the ongoing therapy is considered as an "alarm signal" and serves as an indication for a thorough gastroenterological examination in a consultative center or a specialized hospital. This approach is justified not only from a medical, but also from an economic point of view.

irritable bowel syndrome(ICD-10, XI, K58) is also associated with dysregulation of intestinal motility, and in recent years, special attention has been paid to visceral hypersensitivity in its pathogenesis.

Irritable bowel syndrome is characterized by pain or discomfort in the abdomen for at least 3 months of the last year, which: improves after a bowel movement, is associated with a change in the frequency of stools (more than 3 times a day or less than 3 times a week) and / or the form stool (either hard, dry lumps - like "sheep feces", or - unformed, mushy). Additional symptoms may be difficulty in defecation or a feeling of incomplete emptying of the rectum, copious mucus, rumbling or bloating.

According to the Rome II criteria, clinical signs that speak in favor of IBS are also the variability and variety of complaints, lack of progression, normal weight and general appearance of the child, increased complaints during stress, no symptoms at night, association with other functional disorders. Often, pain occurs before a bowel movement and disappears after it. To a certain extent, the indicated lack of progression is controversial, because. over time, against the background of IBS, chronic colitis can form.

There are three main clinical variants of IBS:

• IBS with pain and flatulence;
• IBS with constipation;
• IBS with diarrhea.

The treatment of IBS is discussed below in a separate section.

Functional abdominal pain(ICD-10, XVIII, R10). In the clinical picture, there are complaints of pain, which is more often localized in the umbilical region, but can also be observed in other areas of the abdomen. Intensity, nature of pain, frequency of attacks varied. Pain is observed for more than 3 months, with partial or complete absence of a connection between pain and physiological events (i.e., eating, defecation, etc.), accompanied by a slight loss of daily activity, the absence of organic causes of pain and diagnostic signs of other functional gastroenterological disorders .

In children of the first year of life, the diagnosis of functional abdominal pain is not made, and a condition with similar symptoms is called infantile colic. Clinically, children's colic is expressed by prolonged crying, anxiety, twisting of the legs (signs of discomfort, bursting or squeezing in the abdominal cavity). Children's colic is a consequence of the immaturity of the nervous regulation of the intestine, enzymatic immaturity, a manifestation of emotional discomfort or deprivation.

Abdominal migraine(ICD-10, XVIII, R10) - paroxysmal pain of an intense, diffuse nature, accompanied by nausea, vomiting, anorexia in combination with blanching and coldness of the extremities, other vegetative manifestations, lasting from several hours to several days, alternating with "light" intervals from several days to several months. It is important to combine abdominal pain with headache, photophobia, as well as the presence of migraine in relatives and the different nature of the sensory or motor aura before the onset of an attack. Abdominal migraine is observed in children older than 1 year with pain localized in the navel, concomitant dyspeptic manifestations and autonomic disorders (blanching and cold extremities, autonomic crises). The duration of pain ranges from half an hour to several hours or even several days.

The appearance of symptoms of abdominal migraine is a very alarming fact and requires the exclusion of epilepsy, neurological and mental illness. Similar symptoms can be observed with ischemic lesions of the abdominal organs, obstructive uropathy, acute pancreatitis and many other diseases. In differential diagnosis with pain of an organic nature, it is necessary to take into account the provoking and accompanying factors characteristic of migraine, young age, family history, the therapeutic effect of anti-migraine drugs, an increase in the velocity of linear blood flow in the abdominal aorta during dopplerography (especially during paroxysm).

The relief of attacks of abdominal pain in case of functional disorders is carried out with antispasmodic drugs: myotropic antispasmodics - mebeverine (Duspatalin) is used in capsules of prolonged action from the age of 12 at a dose of 200 mg x 2 times. Papaverine (children, depending on age, 0.005-0.06 2 times a day), drotaverine - children under 6 years of age inside 0.01-0.02 g 1-2 times a day, children 6-12 years old 0.02 1-2 times a day.

Functional disorders accompanied by impaired defecation

The diseases of this group are quite closely related to IBS, but the cardinal difference is the absence of pain.

functional diarrhea(ICD-10, XI, K59) - diarrhea that is not associated with any organic lesion of the digestive organs and is not accompanied by pain syndrome. In young children, diarrhea is considered to be more than 15 g of stool per kg of body weight per day. By the age of three years, stool volume approaches that of adults, and diarrhea is considered to be a stool volume exceeding 200 g per day. At an older age, the functional nature of diarrhea can also be confirmed not by an increase in stool volume, but by a change in its nature - liquid or mushy with a frequency of more than 2 times a day, which may be accompanied by increased gas formation, and the urge to defecate is often imperative. Chronic diarrhea is defined as diarrhea that lasts at least 3 weeks. Functional diarrhea is not accompanied by pain syndrome.

functional constipation(ICD-10, XI, K59) (constipatio, synonym: obstipacia, literal translation - accumulation) is a violation of bowel function in the form of a chronic delay in bowel emptying for more than 36 hours, an increase in the intervals between defecation acts, compared with the individual physiological "norm ", difficulty in the act of defecation, a feeling of incomplete emptying of the intestine, discharge of a small amount of feces of increased density.

Functional stool retention is an irregular defecation, accompanied by the passage of fecal masses of significant diameter in the absence of the above criteria for constipation. Functional stool retention is often associated with a conscious delay in defecation, which leads to impaired motility of the distal intestines and expansion of the rectum, followed by retention of feces in it. Often this condition is accompanied by a subsequent dysfunction of the muscles of the pelvic floor, which is manifested by a more significant than usual participation in the act of defecation of the abdominal muscles, and in some cases, in other ways that ensure the evacuation of feces.

Functional encopresis(ICD-10, XI, K59) - functional fecal incontinence resulting from mental stress (fear, fear, the influence of constantly depressing mental impressions), systematic suppression of the urge to defecate, acute intestinal infections suffered at an early age or perinatal damage to the central nervous system.

Principles of treatment of IBS and functional disorders of defecation

The diet for IBS is selected individually depending on the leading clinical manifestations of the disease. Poorly tolerated (causing pain, dyspepsia) and gas-producing foods are excluded: fatty foods, chocolate, legumes (peas, beans, lentils), cabbage, milk, black bread, potatoes, carbonated drinks, kvass, grapes, raisins. Fresh vegetables and fruits are limited. Other foods and dishes are prescribed depending on the prevalence of diarrhea or constipation in the clinical picture.

For constipation, the appointment of laxatives and / or prokinetics is indicated, however, in the last group of drugs there are no effective drugs approved for use in pediatric practice, and of the laxatives, the only effective and safe agent in all age groups is lactulose (Duphalac).

The main feature of lactulose is its prebiotic effect. Prebiotics are partially or completely indigestible food components that selectively stimulate the growth and / or metabolism of one or more groups of microorganisms living in the large intestine, ensuring the normal composition of the intestinal microbiocenosis. From a biochemical point of view, this group of nutrients includes polysaccharides and some oligo- and disaccharides. For microorganisms, they are vital components of their nutrition, sources of energy and plastic material. As prebiotics, dietary fiber, oligosaccharides, lactose and lactulose are the most well studied.

As a result of microbial metabolism of prebiotics in the colon, lactic acid, short-chain fatty acids, carbon dioxide, hydrogen, and water are formed. Carbon dioxide is converted to acetate to a large extent, hydrogen is absorbed and excreted through the lungs, and organic acids are utilized by the macroorganism, and their importance for humans can hardly be overestimated.

In 1957, the Austrian pediatrician F. Petuely first described the bifidogenic properties of lactulose. F. Petuely showed that when children are artificially fed with a milk formula containing 1.2 g / 100 kcal of lactulose at a ratio of lactose to protein of 2.5: 1, an almost pure culture of bifidobacteria is formed in the intestine, and the pH of the intestinal contents decreases. Based on his research, F.Petuely named lactulose "Bifidusfactor" (Der Bifidusfactor). In 1959, F. Mayerhofer and F. Petuely called lactulose "an ideal laxative", especially for children. The term "Bifidus factor" has become widely used to refer to nutrients that promote the growth of bifidobacteria and normalize the composition of the intestinal microflora.

Lactulose is a disaccharide composed of galactose and fructose (4-0-a-D-galactopyranosyl-D-fructose). Under natural conditions, lactulose in small quantities can be formed from lactose when milk is heated to temperatures above 100 ° C. Lactulose is highly soluble in water and is about 1.5-2 times sweeter than lactose. For the industrial production of lactulose, special methods for its synthesis have been developed.

The prebiotic effect of lactulose has been proven in numerous studies. So, in a randomized, double-blind, controlled study on 16 healthy volunteers (10 g / day of lactulose for 6 weeks), a significant increase in the number of bifidobacteria in the colon was shown.

Normalization of microflora / prebiotic action
Duphalac has a bifidogenic effect and stimulates the growth of beneficial microflora in the large intestine.
As a prebiotic*:
Age	Dose
adults	5-10 ml per day for 1 month
Children	3-5 ml per day for 1 month
In a prebiotic dose, Duphalac does not affect the frequency of stools and can be used for dysbacteriosis accompanied by diarrhea.
* Tuohy et al., Microbial Ecology in Health and Disease, 2002. Venema K. et al. Microbial Ecology in Health and Disease, 2003. Bouhnik et al., Eur J Nutr, 2004.

The laxative effect of lactulose is directly related to its prebiotic effect and is due to a significant increase in the volume of the contents of the colon (by about 30%) due to the growth of the bacterial population. An increase in the production of short-chain fatty acids by intestinal bacteria normalizes the trophism of the colon epithelium, improves its microcirculation, providing effective motility, absorption of water, magnesium and calcium. As part of drugs (for example, Duphalac), lactulose can be effectively used for functional constipation in both adults and children. The frequency of side effects of lactulose is significantly lower compared to other laxatives and does not exceed 5%, and in most cases they can be considered insignificant. The safety of lactulose determines the possibility of its use even in premature babies, proven in clinical trials. For the same purpose, lactulose can be introduced into formulas for the nutrition of children of the first year with a tendency to constipation.

The prebiotic effect of lactulose has significant metabolic implications. Lowering the pH in the lumen of the colon increases the colonization resistance of the entire microbial community, but also promotes the ionization of ammonia and its excretion in the form of ammonium ions. The latter effect of lactulose is used in clinical practice for the purpose of detoxification in liver failure. The potentially anticarcinogenic properties of lactulose are also associated with a decrease in the activity of microbial enzymes azoreductase, beta-glucuronidase, 7-dehydrogenase, nitroreductase and urease. In a placebo-controlled study, a significant decrease in fecal concentrations of phenol, cresol, indole and skatol was shown with lactulose.

Anti-infective protection is provided both by the own forces of intestinal bacteria and by stimulation of the immune system. The antagonism of representatives of normal microflora in relation to other microbes is manifested in competition for substrates for growth, competition for fixation sites, stimulation of peristalsis, creation of an unfavorable environment(including modification / deconjugation of bile acids), synthesis of antibiotic-like substances. Lactulose, by stimulating the growth of normal intestinal microflora, helps to maintain the anti-infective protection of the macroorganism, in particular against shigella, salmonella, yersinia and rotaviruses.

Thus, among laxatives, lactulose in pediatric practice is the drug of choice, providing an effective and safe effect in all age groups, while having a unique prebiotic effect for laxatives.

The dose of lactulose (Duphalac) is selected individually, starting with 5 ml 1 time per day. In the absence of effect, the dose is gradually increased (by 5 ml every 3-4 days) until the desired effect is obtained. Conventionally, the maximum dose can be considered in children under 5 years old 30 ml per day, in children 6-12 years old - 40-50 ml per day, in children over 12 years old and adults - 60 ml per day. The multiplicity of reception can be 1-2 (less often - 3) times a day. The course of lactulose is prescribed for 1-2 months, and if necessary - for a longer period. Cancel the drug gradually under the control of the frequency and consistency of the stool.

Antispasmodic drugs are indicated for spastic conditions. As noted above, mebeverine is an effective antispasmodic drug.

A feature of mebeverine (Duspatalin) is its double action. On the one hand, it blocks fast Na + channels, preventing the depolarization of the muscle cell membrane and the development of spasm, while disrupting the transmission of impulses from cholinergic receptors. On the other hand, mebeverine blocks the filling of the Ca ++ depot, depleting them and thereby limiting the release of K + from the cell, which prevents the development of hypotension. Thus, mebeverine has a modulating effect on the sphincters of the digestive organs, in which it is possible not only to relieve spasm, but also to prevent excessive relaxation. A feature of Duspatalin is its new form of release: 200 mg of mebeverine are enclosed in microgranules coated with a pH-sensitive shell, and the microgranules themselves are enclosed in a capsule. Thus, not only the greatest effectiveness of the drug is achieved, but also the prolongation of its action over time and throughout the entire gastrointestinal tract. Gradually released from the granules, the drug provides a uniform effect for 12-13 hours. Duspatalin is administered orally for 20 minutes. before meals, 1 capsule 2 times a day (morning and evening) in children from 12 years of age.

The high efficiency and safety of Duspatalin has been confirmed by numerous works. Berthelot J. et al. in an 8-week double-blind, placebo-controlled study showed that in patients with IBS, the use of Duspatalin significantly reduces the intensity of abdominal pain (p = 0.03) and stool disorders (p<0,03). В меньшей степени Дюспаталин уменьшал вздутие живота. При этом "отличные" результаты лечения наблюдались у 72% пациентов, получавших мебеверин, и только у 18%, получавших плацебо . По результатам исследования Tasman-Jones C. et al. эффективность лечения пациентов с СРК составляет 83%, по сравнению с 33% при приеме плацебо . Положительный опыт применения Дюспаталина при СРК получен не только зарубежными, но и отечественными специалистами .

When comparing the tablet form of mebeverine and Duspatalin capsules in a study by Guilbody J. et al. it was shown that the positive effect in the treatment of patients with IBS with capsules and tablets according to doctors was 70% and 64%, respectively, and according to patients - 81% and 75%.

An important feature of the drug is the absence of anticholinergic effects, which greatly expands the scope of its application. In Europe, Duspatalin is used in the form of a suspension, 1 ml of which contains 10 mg of mebeverine hydrochloride, in children from 3 years old in age dosages:

With flatulence, drugs are prescribed that reduce gas formation in the intestine by weakening the surface tension of gas bubbles, leading to their rupture and thereby preventing stretching of the intestinal wall (and, accordingly, the development of pain). Simethicone and combined preparations can be used: pancreoflat (enzyme + dimethicone), from the age of 14 - meteospasmyl (m-cholinolytic + simethicone). Pancreoflat for older children is prescribed 1-4 tablets with each meal. At a younger age, the dose is selected individually.

Deceleration of intestinal motility can be achieved by the appointment of adsorbents (smecta), while the use of loperamide (imodium) is justified only in severe intractable diarrhea and should be well controlled.

A new direction in the treatment of IBS is the use of drugs that reduce visceral hypersensitivity.

Normalization of the intestinal microflora is an important component of the treatment of functional diseases. The set of measures includes nutritional correction using functional foods, preparations based on pre- and probiotics.

In addition, due to a secondary violation of the processes of digestion and absorption, it may be necessary to include pancreatic enzyme preparations (Creon 10000) in the therapy.

The use of microspherical preparations of pancreatic enzymes in children with functional disorders of the digestive system, which includes Creon, is justified both from a medical and economic point of view. The high activity of these drugs is determined by several factors. The first of them is a high degree of activity of the initial substrate (pancreatin) used for the production of these drugs, the second is a special form (microspheres 1.0-1.2 mm in size), which ensures uniform mixing with gastric contents and synchronous passage into the duodenum, the third – pH-sensitive shell of microspheres, which protects the enzyme from destruction in the stomach and releases it in the duodenum. In addition, the microspheres themselves are placed in pH-sensitive capsules, which protect them from premature activation in the oral cavity and in the esophagus, where, as well as in the duodenum, there is an alkaline environment, and facilitate the administration of the drug. Thus, the drug in capsules reaches the stomach, where the capsules dissolve and the microspheres are released and mixed with the gastric contents. In the duodenum, at a pH value of about 5.5, the pH-sensitive shell of the microspheres dissolves and highly active enzymes begin their action.

1 capsule of Creon 10000 contains highly purified pancreatin obtained from the pancreas of a pig and containing 10,000 U of lipase, 8,000 U of amylase and 600 U of proteases (E = units according to Ph. Eur.), and 1 capsule of Creon 25,000 contains, respectively, 25,000 U , 18000 E, 1000 E. A serious advantage of the drug is the absence of bile acids in its composition. The dose of the drug is determined empirically under the control of the clinical picture and laboratory data. With functional disorders, in most cases, the daily dose of the drug is 3-6 capsules per day of Creon 10000. In pediatric practice, to facilitate the administration of the drug by young children, the capsule can be carefully opened and the microspheres can be taken without chewing, with a small amount of water or juice. If the microcapsules are mixed with food, they should be taken immediately after mixing: otherwise damage to the enteric coating may occur.

Even long-term use of highly active preparations of pancreatic enzymes does not inhibit the exocrine function of the pancreas, which remains at least at the same level, and in some cases even increases. The safety of long-term use of Creon 10000 was also shown in our studies. In 34 children with secondary digestive insufficiency aged from 1 g to 12 years, who for a long period (4-6 months) received a microspherical preparation of pancreatic enzymes Creon 10000, after 6 months of observation of a decrease in the exocrine function of the pancreas (according to the activity of elastase-1 in feces) relative to baseline did not occur in any case. In most cases (23 children), the level of elastase-1 in the stool remained approximately at the same level (± 10% of the initial level), while in the rest it increased by 10-20%. The presented data indicate the possibility of safe use of microspherical preparations of pancreatic enzymes in children, not only for a short course, but, if necessary, for a long period of time.

The use of enzyme preparations for functional disorders helps to restore the internal environment in the intestinal lumen, breaks pathogenetic "vicious circles", thereby favoring the normalization of intestinal motility.

Functional disorders of the biliary tract

Only two diseases are included in this category of diseases: motility disorders (dyskinesia) of the gallbladder (ICD-10, XI, K82) and tone disorders (dystonia) of the sphincter of Oddi (ICD-10, XI, K83). This limitation is caused by objective reasons: modern examination methods available in everyday practice do not allow assessing the motility of other parts of the biliary tract and the tone of other sphincters. Moreover, in pediatric practice, manometry of the sphincter of Oddi is used extremely rarely. Thus, based on the results of routine research methods (ultrasonography, less often - cholecystography), one can reliably speak only about the state of motility of the gallbladder.

Dyskinesia of the gallbladder is most often a manifestation of vegetative dysfunctions, however, it can occur against the background of gallbladder damage (with inflammation, changes in the composition of bile, cholelithiasis), as well as damage to other digestive organs, primarily the duodenum, due to violations of humoral regulation its functions.

Typical symptoms of gallbladder dyskinesia are discomfort or pain in the right hypochondrium of varying intensity (dull or sharp, after eating or after physical or emotional stress), nausea, and a feeling of bitterness in the mouth. On palpation, pain in the projection of the gallbladder and positive "vesical symptoms" are determined.

To confirm the diagnosis, ultrasonographic examination, radiography (cholecystography), as well as currently little used duodenal sounding, can be used. According to the nature of the disorders, hypomotor (hypokinetic) and hypermotor (hyperkinetic) dyskinesia of the gallbladder is distinguished.

Correction of motility of the gallbladder and sphincter tone may include diet, the use of cholagogues and antispasmodics. Treatment can be supplemented with hepatoprotectors.

It is not recommended to consume cold foods that can cause spasm of the sphincters of the biliary tract. In case of hypokinesia, it is recommended to include bread with bran or black rye bread in the diet, fruits and vegetables in large quantities, vegetable and butter, cream, sour cream, soft-boiled eggs. With both variants of violations, fried foods, chocolate, cocoa, coffee, strong broths, smoked meats, carbonated drinks, beer should be excluded.

Choleretic drugs are divided into choleretics and cholekinetics.

Choleretics primarily stimulate bile production and are divided into two groups. Preparations of the first group increase the concentration of bile acids in bile (preparations containing components of bovine bile - allochol, cholenzyme, lyobil, etc.), and the second - increase the concentration of organic anions (plant sterols that are part of choleretic herbs).

Cholekinetics stimulate the function of the gallbladder and reduce pressure in the biliary tract (magnesium sulphate, polyhydric alcohols, holosas, to a certain extent, domperidone).

An important component of the treatment are cholespasmolytics, which include mebeverine (Duspatalin), which is 20-40 times more effective than papaverine in its ability to relax the sphincter of Oddi.

Mebeverine (Duspatalina) proved to be an effective drug for violations of the function of the biliary tract. In particular, the effectiveness of the drug in biliary tract dysfunctions after cholecystectomy, often accompanied by hypertension of the sphincter of Oddi, is shown, expressed in pain relief, normalization of laboratory and ultrasonographic parameters. According to Ilchenko A.A. et al. in patients with cholelithiasis, pain symptoms are effectively stopped (in 70% of patients after 7 days and in 85% after 14 days), the feeling of bitterness in the mouth decreases (in 35% and 45%, respectively), in 70% duodenogastric reflux is stopped.

Hepatoprotectors can also be prescribed in the treatment of functional disorders of the biliary tract. All preparations of this group are divided into preparations of chemical, animal, plant origin, as well as homeopathic. The most widely used for functional disorders in pediatric practice are herbal remedies (hepabene, LIV.52, hepatofalk planta, etc.), many of which include silymarin as an active principle, contained in the berries of milk thistle (Silybum marianum). Silymarin has a wide spectrum of action, provides inhibition of excessive lipid peroxidation (LPO) and binding of LPO products (hydrogen peroxides, free ions O ++ and H +, etc.), restoration of cell membrane structures, has an antifibrotic effect due to the suppression of the activity of stellate cells that stimulate the growth of connective tissue, increases the detoxifying function of hepatocytes by increasing the reserves of glutathione, taurine, sulfates and increasing the activity of enzymes involved in the oxidation of xenobiotics. In addition, silymarin has anti-inflammatory and immunomodulatory effects, reduces the activity of macrophage cells involved in the presentation of antigens, reduces the number and activity of T-killers (CD8+). The introduction of hepatoprotectors in the treatment of functional disorders of the biliary tract in children helps prevent damage to hepatocytes and duct epithelium against the background of prolonged cholestasis and altered bile composition.

Conclusion

Functional disorders of the digestive system are a large group of diseases that are widespread in childhood and have an ambiguous prognosis. Diagnosis of these diseases presents certain difficulties. requires the involvement of a large number of modern methods of examination to exclude organic pathology. At the same time, in recent years, significant progress has been made in the treatment of functional disorders associated with the emergence of new effective drugs that regulate the motility of the gastrointestinal tract. However, these remedies cannot provide a final solution to the problem: due to the significant role of the nervous system in the development of these diseases, their treatment should be comprehensive and carried out in collaboration with neuropathologists, psychologists, psychoneurologists.

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Dyspepsia in children is a fairly common disease characterized by functional or organic indigestion. The disease can develop gradually without pronounced symptoms. For this reason, parents of babies in most cases do not attach much importance to the first signs of the disease. Untimely treatment can lead to health-threatening consequences and the transition of dyspepsia to the chronic stage.

The problem of dyspepsia in children requires mandatory consultation with a doctor and competent complex treatment.

Classification of dyspepsia

Depending on the factors provoking disruption of the digestive system, dyspepsia in children is divided into organic and functional. The first form develops against the background of gastritis, pancreatitis, biliary tract dysfunction, inflammation in the gallbladder and liver.

Functional dyspepsia in children is associated with malnutrition, enzyme deficiency and diseases that cause temporary disturbances in the proper absorption of food. Functional indigestion in a child is divided into the following types:

1. Simple (alimentary). It develops in infants under 1 year of age due to the inconsistency of nutrition with the functional characteristics of their digestive system. Simple dyspepsia appears due to overeating, improperly selected infant formula, or foods that are not perceived by the baby's intestines.
2. Enzymatic. It is the result of an enzyme deficiency.
3. Dyspepsia due to malabsorption in the small intestine.
4. Toxic. This type of functional indigestion may be the result of an untreated alimentary form of indigestion.
5. Dyspepsia caused by intestinal infections.
6. Parenteral (intoxication). It develops against the background of influenza, pneumonia, otitis or acute intoxication with toxic agents.

Functional dyspepsia is characterized by difficult painful digestion with regular malnutrition of the child.

Alimentary indigestion has such subspecies as fermentative, putrefactive and fatty. Fermentative dyspepsia develops against the background of the intake of foods high in carbohydrates, putrefactive - proteins, and fatty (steatorrhea) - fats.

Simple dyspepsia, depending on the symptoms, is divided into ulcer-like, reflux-like, dyskinetic and nonspecific. To successfully cure the disease, it is necessary to identify the factors that provoke its occurrence.

Causes of pathology in children

Often, violations of the digestive system in children are caused by causes of alimentary - food-related - nature. These include:

• irregular meals;
• diet change;
• abuse of dry foods, fatty, pickled and spicy foods;
• malnutrition or overeating.

Dyspepsia can develop as a result of malnutrition of the baby

Indigestion of the stomach can be caused by the psycho-emotional state of the child. Among these factors are:

• severe fatigue during study;
• frequent change of residence and transfer to a new school;
• parental abuse;
• heavy emotional atmosphere in the family;
• fears of a different nature.

The stomach of infants is adapted to a certain type of food. Often, a change in diet provokes a malfunction in the digestive system.

In most cases, indigestion in an infant is caused by a sudden introduction of complementary foods or the transfer of an infant to artificial nutrition.

Much more often, dyspepsia affects weak, prematurely born children and babies who have had diseases such as:

• rickets;
• allergic manifestations;
• vitamin deficiency;
• diathesis;
• anemia;
• hypotrophy.

The symptoms of the disease are extensive. Some types of digestive disorders, such as toxic dyspepsia, are extremely dangerous for a child's life. For this reason, parents need to be able to identify the signs of the disease in time.

Symptoms

Dyspepsia is characterized by increased bowel movements

A simple type of dyspepsia usually occurs in babies during the first year of life. Its symptoms are:

• increased bowel movements, in which the feces become heterogeneous, liquid, with inclusions of mucus;
• frequent regurgitation;
• bouts of vomiting;
• refusal to eat;
• bloating;
• excessive accumulation of gases in the intestines;
• colic;
• restlessness of the child.

In most cases, simple dyspepsia lasts up to 7 days. In weakened children, it can transform into a toxic form, the symptoms of which will manifest as:

• frequent vomiting;
• high fever and feverish condition;
• bowel movements up to 20 times a day.

The baby's stool takes on a watery appearance with inclusions of the epithelium. Due to constant diarrhea and vomiting, the child's body becomes dehydrated, he loses weight, and a large fontanel may recede. The face in this condition becomes frozen, convulsions appear.

Toxic dyspepsia is an extremely dangerous disease, often leading to coma. In older children, functional indigestion manifests itself in the form of pain after eating, rapid satiety, heartburn and burning, sweating, dizziness, alternating frequent stools and constipation.

Diagnostics

When diagnosing, the doctor takes into account the absence of pain of a growing nature and malaise at night, improper diet, the presence of fatigue and drowsiness. To make a diagnosis, the following is indicated:

• endoscopic examination of the gastrointestinal tract;
• fluoroscopy;
• analysis of urine pH level;
• coprograms (we recommend reading:).

Pediatricians advise parents to monitor the quantity and quality of food consumed by their child, the frequency of bowel movements, and the consistency of feces for 2 weeks. Such information will help the doctor to make the correct diagnosis and prescribe the best methods of therapy.

Treatment of different types of dyspepsia in children

Treatment of indigestion is based on the use of medications. These include:

• hydrochloric acid secretion inhibitors;
• neutralizers;
• histamine receptor blockers;
• psychotropic drugs;
• prokinetics or neurohormones.

In a severe form of the disease, antibiotics, glucocorticoid preparations, gamma globulin are prescribed. Alma-gel, Smecta, Mezim, Linex are used to relieve pain. Enzymes and vitamin complexes are included in the treatment without fail. To eliminate the risk of recurrence, preventive measures should be taken.

Forecasts and prevention

The prognosis for a successful cure for dyspepsia is favorable. The main thing is to start timely therapy, and already on the 5-7th day the condition of the little patient will improve significantly.

Disease prevention should be based on proper and balanced nutrition. For example, when fermentative dyspepsia is detected, it is necessary to normalize the amount of carbohydrates in the diet, and when putrefactive - proteins. From the menu of the child should be excluded products that are unusual for his age. Breastfeeding should be carried out strictly according to the schedule. Babies should not be overfed or underfed - this can provoke the development of functional dyspepsia.

Children should be protected from emotional overstrain. They need to provide a long and restful sleep. Infectious and general somatic diseases must be treated in a timely manner. It is forbidden to deal with the symptoms of diseases in children on their own. Only a doctor can prescribe the best treatment methods.

Indigestion in a child is a fairly common phenomenon caused by a violation of the intestines. But if in infants the symptoms of indigestion repeat again and again, this is a direct signal of the need to take measures aimed at normalizing and restoring the digestive process.

The manifestation of signs of indigestion has its own clinical designation - dyspepsia. At the same time, dyspepsia in newborns and children of a later age can be different, have characteristic manifestations and methods of treatment.

With dyspepsia in infants, there is severe discomfort in the abdomen and digestive system. Acute indigestion is recurrent.

Approximately 20% of cases of dyspepsia occur in children 7-12 years old. It is noteworthy that girls are the most susceptible category of children.

It is not always possible to determine the root cause of the development of digestive disorders in children. In about 40% of all cases of dyspepsia in an infant or older child, it disappears on its own over time. But still, you should not rely on chance. Parents need to stop such a disease in the bud by providing appropriate treatment and care.

Varieties of the disorder in children

If we take into account the causes of development, then the disease is divided into the following types:

• Fermentation. With fermentative dyspepsia in children, the main reason is the child's abuse of drinks based on such a process as fermentation, as well as carbohydrate-containing foods. The highest concentration of carbohydrates dangerous for the baby is found in potatoes and flour products.
• Rotten. This form is due to excess protein in the child's diet, which provokes the development of putrefactive dyspepsia. Products simply do not have time to be completely digested, as a result of which the process of decay begins inside the body.
• Fatty. The syndrome of dyspepsia in children of the fatty type is caused by the abuse of refractory and indigestible fats.

There is also a certain classification that distinguishes three types of ailment:

• Represents acute digestive disorders in young children. Most often, the disease affects children who are breastfed. A variety of the disease is characterized by a disease of the digestive system.
• Toxic dyspepsia in children. In the toxic type of the disease, the symptoms are due to metabolic disorders. The toxic form is more dangerous because it can quickly spread throughout the body and cause damage to other organs.
• parenteral dyspepsia. It is a violation of the digestive system that accompanies various infectious diseases. In most cases, the disease manifests itself when the baby suffers from otitis media, pneumonia, measles or influenza.
• Physiological dyspepsia. Signs of physiological dyspepsia can be observed in children over the age of 1 year. It is accompanied by discomfort in the abdomen and the substrate, but no diseases are observed. Not infrequently, the physiological variety of the disease develops due to stress, malnutrition, increased acidity of gastric juice, or the use of foods that do not correspond to the age of the baby.

Types of functional dyspepsia

It is not uncommon to encounter digestive and nutritional disorders in infants. Like any other disease, functional dyspepsia in children (FD) entails negative consequences and a threat to the health of the baby.

If relapses of functional dyspepsia in young children are repeated again and again, this will become an impetus for the development of gastrointestinal diseases - gastritis, ulcers, etc. Plus, the immune system will be at risk, the restoration of which will require a lot of strength, patience and time.

To determine how to treat FD, it is necessary to determine the specific type of disease your baby is experiencing. Each of them has a certain sign and method of identification:

• Ulcerative. Such FD is accompanied by pain in the area of ​​the substrate after eating. Symptoms are most pronounced in case of overeating or after taking certain medications. In particular, we are talking about drugs for acid-dependent diseases of the digestive system.
• Dyskinetic. The main symptom is rapid saturation. Having eaten quite a bit of food, the baby feels that he is full. This happens almost after the first spoons of food. In the substrate, satiety and a sour taste are felt. In addition, the symptoms are often accompanied by vomiting and nausea.
• Nonspecific. Difficult to diagnose because it is characterized manifestation symptoms of two varieties of functional dyspepsia at once.

Causes of indigestion in a child

With functional dyspepsia in children, treatment is prescribed based on what provoked the onset of symptoms of the disease. In most cases, the reason lies in malnutrition. But this concept can mean many different things.

Therefore, we will acquaint you with the main factors that can provoke the development of functional dyspepsia in a child:

• abrupt transition to another diet;
• quick change of breast milk to artificial mixtures;
• changes in the child's lifestyle;
• lack of regular and systematic meals;
• frequent skipping of breakfast, dinner or lunch;
• abuse of food from fast foods;
• regular overeating;
• copious amounts of carbohydrates and proteins in the diet;
• frequent snacks;
• the inclusion in the daily diet of a large amount of dry food;
• stressful situations and strong emotional upheavals.

Symptoms

Functional disorders of the digestive system in children entail changes in the gastrointestinal tract. In doing so, the following happens:

• the motor function of the stomach is disturbed;
• there is a disorder of the digestive processes;
• organs related to the digestive system weaken;
• food in a practically undigested form from the duodenum moves to the stomach;
• the stomach is not active enough to digest food.

Functional frequent dyspepsia in young children is largely similar in its symptoms to other diseases of the gastrointestinal tract. Therefore, self-diagnosis of FD is extremely difficult.

There are several symptoms that are not characteristic of FD. That is, when they appear, another ailment should be suspected. These symptoms include:

• frequent diarrhea;
• development of anorexia (excessive thinness);
• pain at night that interferes with sleep;
• insomnia due to pain;
• pain in the joints;
• irradiation of painful sensations;
• signs of fever;
• changes in the behavior of the baby during seizures, he may behave non-standard or inadequate.

Faced with the above uncharacteristic signs, it can be concluded that another disease is taking place, and not functional dyspepsia. Or FD is accompanied by other diseases, connecting with each other and showing appropriate signs. In any case, you need to contact a specialist who will prescribe treatment and give recommendations.

Acute dyspepsia

Separately, acute dyspepsia should be considered. It is not as rare as we would like dyspepsia to go into an acute course. Its appearance is due to the inconsistency of nutrition in its composition and volume when feeding the baby. The body simply does not have the physiological capacity for the digestive system to cope with the load.

For acute dyspepsia, certain signs are characteristic:

• regurgitation;
• slow growth process;
• frequent diarrhea, that is, diarrhea;
• stool of heterogeneous consistency;
• sometimes there are impurities of mucus in the feces.

For the treatment of dyspepsia in children of an acute nature, it is necessary to unload in the diet. Just for a while skip no more than 2 feedings a day, changing them to nutrient fluid.

Features of treatment

Various methods and means can be used to treat indigestion in children. But in no case should you buy medicines or prepare them on the basis of folk recipes without first consulting with specialists.

The first priority is to visit a doctor. He will conduct an examination and diagnosis in order to confirm the disease and determine the nature of its course. Having received the necessary information, the specialist will be able to appoint the optimal solution.

The basis of treatment are two points:

• Changes in the child's diet. Since the problem is most directly related to the digestive system, treatment should begin with dietary adjustments. Violations are caused by an inactive and wrong way of life. The less the child moves, the less he wants to eat. Because of this, damage is done to the entire body. It is best to treat the ailment by breaking the daily food into several small portions throughout the day. We are talking about the so-called separate nutrition. Also, be sure to exclude allergenic foods that can trigger allergic reactions after consumption. The ideal alignment is to completely remove fried and fatty foods, soda, smoked meats and sweets from the child's diet. But this is often difficult to do, so just try to minimize the use of these products. Not infrequently, a simple change in nutrition can save the baby from all the symptoms of functional dyspepsia.
• Medications. To supplement proper nutrition, doctors prescribe certain medications. This allows you to speed up the healing process. The types of drugs depend directly on what type of dyspepsia the child has encountered. In the ulcer form, inhibitors or histamine blockers are usually prescribed. In the case of the treatment of a dyskinetic type of disease, prokinetics are used. If you are faced with non-specific dyspepsia, then you will not need medication. This form of indigestion is not amenable to drug treatment.

Folk remedies against FD

Since we are talking about a child's weak body, many doctors are leaning towards the safest, most natural and effective remedies. These include folk recipes. But in no case should traditional medicine be used without first consulting a doctor.

There are several ways to relieve the child of the symptoms of dyspepsia by alternative treatment:

• Blackberry. You need about 10 gr. the roots of the bush of this berry, which are poured with 500 ml of water and put on fire. Boil the root until 2/3 of the water remains in the container. Strain and add high-quality red wine to the mixture in proportions of 1 to 1. Once every 4 hours, you need to give the child 2 large spoons of the product.
• Fennel. He's a pharmacy dill. It costs a penny, but it helps a lot. Pour 10 fruits with 500 ml of boiling water, put on fire and cook for about 10-15 minutes. Let the mixture cool, then strain. It is important that 200 ml of decoction remain. It should be drunk throughout the day in small portions.
• Sagebrush. Although it is bitter, the benefits are amazing. Take a large spoonful of wormwood, pour 200-250 ml of boiling water over it. Strain after half an hour. Regarding the dose, be sure to ask your doctor for advice, since a certain portion of the decoction is required for each individual case.

Dyspepsia can not be called a terrible disease. Especially if you consult a doctor in a timely manner and begin a comprehensive treatment of the problem. Provide your child with proper nutrition, an active lifestyle and minimize the number of stressful situations. This guarantees him reliable protection against indigestion.

- functional or organic malnutrition and indigestion. Dyspepsia in children is manifested by a characteristic symptom complex: discomfort or pain in the epigastrium, a feeling of fullness in the stomach after eating, early satiety, nausea, vomiting, belching, heartburn, constipation or diarrhea. Diagnosis of dyspepsia in children is aimed at identifying the cause of indigestion and may include ultrasound of the abdominal organs, endoscopy, examination of blood biochemistry, feces for scatology, helminth eggs, lablia, etc. Etiotropic treatment of dyspepsia in children is carried out on the basis of laboratory and instrumental data .

General information

Dyspepsia in children is a symptom complex of digestive disorders that develops as a result of disruption of the upper gastrointestinal tract. In pediatrics, dyspepsia syndrome occurs in 13-40% of children and adolescents, which indicates its high prevalence. The frequency of dyspepsia in children is explained by the anatomical and physiological characteristics of the gastrointestinal tract, the nervous system, and the state of metabolism in childhood. Dyspepsia in children is a polyetiological and heterogeneous syndrome that can accompany a wide range of pathological conditions. The issues of studying the syndrome of dyspepsia in children are beyond the scope of pediatric gastroenterology and require the participation of various pediatric specialists.

Causes

The syndrome of functional dyspepsia in children is based on a violation of the neurohumoral regulation of the motor function of the upper gastrointestinal tract and visceral hypersensitivity. At the same time, a disorder of the regulatory system can occur at any level: central (at the level of the central nervous system), peripheral (at the level of pathways), local (at the level of the receptor apparatus of the stomach and intestines, enteroendocrine cells, etc.) and entails dyskinesia of subordinate organs.

Simple dyspepsia in most cases is associated with alimentary factors - errors in feeding a child: overfeeding, monotonous nutrition, violation of the diet of a nursing mother, rapid transfer to artificial feeding, introduction of complementary foods. A feature of the digestion of young children is the adaptability of the gastrointestinal tract to food of a certain composition and quantity, so a sharp change in the nature of nutrition can lead to dyspepsia. One of the factors of dyspepsia in young children is overheating, which leads to an increase in electrolyte losses with sweat and a decrease in the acidity of gastric juice.

In older children, simple dyspepsia can develop with the abuse of fast food, soda, non-compliance with the diet, increased training loads, and stressful situations.

Toxic dyspepsia or intestinal toxicosis in children may be the outcome of simple dyspepsia. An uncorrected diet and lack of treatment contribute to the absorption of toxic products of bacterial metabolism, general intoxication, disruption of the liver, cardiovascular and nervous systems. In addition, toxic dyspepsia in children can develop against the background of acute intestinal infections: salmonellosis, dysentery, etc.

The development of parenteral dyspepsia in children is associated with the overall impact of a microbial or viral infection on the body. Indigestion is secondary and is caused by the presence of other diseases in the child.

Dyspepsia syndrome in children is a preliminary diagnosis that requires clarification of the etiology. In this regard, with an in-depth examination of the child, organic or functional dyspepsia can be detected. Organic dyspepsia can be caused by gastritis, gastric ulcer, cholecystitis, pancreatitis, biliary dyskinesia in children. Functional dyspepsia in children includes those cases when, with a thorough gastroenterological examination, organic pathology is not detected. However, with a long course and inadequate treatment of functional disorders, the development of organic pathology (GERD, gastritis, colitis, etc.) is possible.

Functional dyspepsia in children can occur in several forms. Simple functional dyspepsia is characterized by an isolated dysfunction of the gastrointestinal tract. With toxic dyspepsia, in addition to digestive disorders, pronounced toxicosis and exsicosis are observed. Parenteral dyspepsia in children can occur against the background of some other disease - otitis media, pneumonia, influenza, etc.

In addition, depending on the clinical manifestations, functional dyspepsia in children is divided into 4 variants of the course:

• ulcerative- characterized by localized pain in the epigastrium, passing after eating, antacid or antisecretory drugs
• reflux-like- occurs with belching, heartburn, nausea, vomiting, bloating, regurgitation
• dyskinetic- characterized by discomfort in the epigastrium, aggravated after eating, flatulence, intolerance to certain types of food (fatty, dairy, etc.)
• nonspecific- not related to the above options for the course of dyspepsia in children.

In the structure of the dyspepsia syndrome in children, the organic form is no more than 5-10%, so in the future we will mainly talk about the functional variant of dyspepsia.

Symptoms of dyspepsia in children

Simple dyspepsia is more common in children of the first years of life. It can develop acutely or against the background of precursors: anxiety, loss of appetite, regurgitation, frequent stools. After 3-4 days, the stool frequency reaches 5-7 times a day, it becomes liquid, heterogeneous in color, resembling the appearance of a chopped egg with lumps of white, yellow and greenish color, an admixture of mucus. With dyspepsia in children, there is bloating, frequent discharge of gases, regurgitation, vomiting. The child is disturbed by intestinal colic: before the act of defecation, he twists his legs, cries. Appetite is reduced until the refusal of food, which leads to a suspension of body weight gain (flattening of the weight gain curve). Simple dyspepsia in children lasts 2-7 days. Against the background of dyspepsia, children may develop thrush, stomatitis, diaper rash.

In debilitated children, simple dyspepsia can transform into a toxic form. At the same time, fever, indomitable vomiting, frequent (up to 15-20 times a day) stools appear, which quickly acquires a watery character with lumps of desquamated epithelium. A significant loss of fluid during vomiting and diarrhea is accompanied by dehydration, a decrease in tissue turgor, retraction of a large fontanel, and a sharp decrease in body weight. The child's face acquires mask-like features with a fixed gaze; skin and mucous membranes become dry; reflexes are reduced and seizures may occur. Toxic dyspepsia in children can lead to impaired consciousness, development of coma and death of the child.

Functional dyspepsia in older children presents with intermittent abdominal pain (usually shortly after eating), early satiety, nausea, feelings of fullness, belching, heartburn, and alternating constipation or diarrhea. Digestive disorders in dyspepsia in children are often exacerbated due to stressful situations, combined with dizziness and sweating.

Physiological dyspepsia of newborns refers to transient phenomena and will be discussed in the article " Borderline conditions of newborns".

Diagnostics

Examination of children with dyspepsia by a pediatrician or pediatric gastroenterologist should include the collection of anamnesis and complaints, clinical examination, complex laboratory and instrumental diagnostics.

First of all, in the presence of dyspepsia syndrome in children, it is necessary to differentiate the organic or functional nature of indigestion. For this purpose, the child undergoes an ultrasound of the abdominal organs (liver, gallbladder, pancreas), esophagogastroduodenoscopy, radiography of the stomach. From laboratory tests, a study of feces for H. Pylori, biochemical liver tests, and the determination of pancreatic enzymes in the blood and urine are used. With the help of bacteriological culture of feces, AII is excluded, by examining feces for helminth eggs - helminthic invasion.

A study of the coprogram in dyspepsia in children reveals single leukocytes, a little mucus with a large amount of neutral fats and free fatty acids. To assess the motility of the upper GI tract, electrogastrography is performed; for the purpose of studying the environment, intraesophageal or intragastric pH-metry may be required,

To improve digestion in dyspepsia in children, enzymes (pancreatin) are prescribed; to remove toxins - sorbents; to relieve pain - antispasmodics. Since 75% of cases of dyspepsia syndrome in children are based on impaired gastric motility, it is advisable to prescribe prokinetics. With increased gas formation, a gas outlet tube is introduced, dry heat is used on the stomach. To restore the intestinal flora after suffering dyspepsia, children can be given preparations with live cultures of bifidobacteria and lactobacilli.

Moderate and severe forms of dyspepsia in children must be treated in a hospital setting. The treatment includes parenteral hydration therapy (transfusion of plasma, plasma-substituting and saline solutions), symptomatic therapy (administration of anticonvulsants, antipyretics, cardiovascular agents, etc.). Toxic dyspepsia in children requires the appointment of antibacterial drugs.

A child suffering from dyspepsia needs careful care: maintaining an appropriate temperature regime, a calm environment, and maintaining hygiene. It is necessary to carefully monitor the dynamics of the child's condition, examine the nature of vomit and feces, and prevent aspiration of vomit into the respiratory tract.

Forecast and prevention

Simple dyspepsia usually ends with the recovery of children in a few days and does not entail complications. In children with an unfavorable premorbid background, simple dyspepsia can turn into toxic - in this case, the outcome is determined by the timing and completeness of the necessary medical care. The prognosis of organic and parenteral functional dyspepsia in children largely depends on the course of the underlying disease.

Prevention of dyspepsia in children is reduced to compliance with the age-specific diet, the timing and sequence of the introduction of complementary foods, feeding hygiene, timely and adequate treatment of infectious and general somatic childhood diseases.