Gastroduodenitis in children

In children, unlike adults, isolated lesions of the stomach and duodenum are rare. According to statistics, they account for only 10 to 15%.Significantly more common is the inflammation of these parts of the digestive tract.

Gastroduodenitis in children is a persistent inflammation of the mucous membrane, accompanied by nonspecific disturbances in its structure, changes in the secretory and motor function of the organs. Gastritis and duodenitis most affect the activity of the pyloric part of the stomach, the bulb of the duodenum and, between them, the sphincter( channel for food passage).

Over the past 20 years, the prevalence of gastroduodenitis among toddlers up to 6 years has almost doubled, among schoolchildren - by 50%.In the clinical course, the disease of children has the feature of rapidly changing into a chronic process, manifesting with erased symptoms, taking the masks of another pathology.

What pathological changes causes gastroduodenitis in children?

Both the stomach and the duodenum are organs that produce hormone-active substances. It is they who regulate under the influence of the signals of the nervous and endocrine system all the functions that "include" the digestive enzymes of the pancreas and the contents of the biliary tract.

Stimulants for the synthesis of hydrochloric acid( pepsin, gastrin, histamine, acetylcholine) are produced in the stomach, and their antagonists( enterogastron, cholecystokinin, secretin, pancreosimin, enterocrinin, vallikinin) produce duodenal mucosa.

For the normal operation of the pyloric department and for providing the throughput, it is important to neutralize the hydrochloric acid in the area of ​​the bulb - the border zone, with an alkaline reaction the sphincter opens, while the acidic one is closed.

. Under the influence of damaging factors, changes in the structure of epithelial cells appear in both organs, glandular species lose the opportunityto develop a secret, slime. Violation of the ratio of acid and alkalizing substances. As a result, the food lump is not removed from the stomach at the required rate.

Increases toxic and allergic effects. First, on the mucosa of both organs there is irritation, then the cells are subjected to dystrophy( eating disorder), then die off with complete atrophy.

Local protective reaction is no less important. At first, it was believed that local immunity simply falls, as a result, the aggressiveness of the damaging factors increases. Now it is proved that the immunity changes: it provides the formation of antibodies to own cells and supports attack on the regulatory system, destruction of the mucous membrane.

The ability to recover is greatly suppressed. In children, great importance is attached to the violation of the regulation of secretion and secretion of pancreatic juice and bile. The inflammatory process spreads to the pancreas and bile ducts.

A vicious circle appears that supports the disturbed alkalization of the contents of the duodenum, which contributes to the progression of atrophic changes in the cells of the epithelium.

Why does gastroduodenitis occur?

The list of causes of gastroduodenitis in children is led by the Helicobacter pylori bacterium - causes 60-70% of cases of the disease. Usually the inflammation passes from the pyloric part of the stomach, where the "pathogen" lives. In childhood, patients often have combinations with other pathogens( enterovirus, herpes, Epstein-Barr virus).

Inflammation in the stomach causes the epithelium to pass into the intestine( metaplasia).In the duodenum, there are islands of "non-native" gastric cells. Helicobacter pylori settles in these foci. They are exposed to the factors of the intestine, because they do not have resistance to them. The process is accompanied by erosion.

For external( exogenous) reasons, more often:

• transferred foodborne toxic infections;
• irresponsible attitude of parents to the baby's nutrition, disruption of the feeding regime, violation of the quality of the products;
• uncontrolled consumption by preschoolers and school children of fast food products that irritate the gastric mucosa;
• eating teenagers in a dry place, hurriedly without proper chewing;
• forced long-term treatment with antibiotics, nonspecific anti-inflammatory drugs, hormones.

Since the maximum incidence of children with gastroduodenitis falls on the first school years, doctors consider an important reason for the increase in nervous and mental stress, agitation and stress caused by schooling.

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Among endogenous causes:

• pathological course of pregnancy and childbirth in the mother;
• early conversion from breastfeeding to artificial feeding;
• pathology of the digestive organs( cholecystitis, advanced viral hepatitis, pancreatitis, enterocolitis, intestinal flora dysbiosis);
• endocrine diseases( early diabetes, adrenal insufficiency, thyrotoxicosis);
• the presence of foci of chronic infection in caries of the teeth, tonsillitis, parasite infection( helminthiases, giardiasis).

The role of risk factors is attached to: the child's propensity to allergic reactions to food, expressed as facial edema, dermatitis, urticaria, hereditary predisposition, decreased immunity and adaptive abilities of the organism after the diseases.

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Classification of

There is no generally accepted classification. Forms and species are subdivided according to the course and visual picture of inflammation obtained during gastroduodenoscopy. Depending on the mechanism of formation gastroduodenitis can be: primary, secondary( against the background of other lesions of the digestive tract).

It is customary to select acute gastroduodenitis: acute gastroduodenitis - occurs rarely in food poisoning, lasts up to three months, in 30% of children it passes asymptomatically and goes to chronic stage, chronic - is accompanied by previously described signs of morphological restructuring of the stomach and duodenal mucosa, each aggravation aggravatesviolations.

In chronic course there are:

• phases - exacerbations, complete and incomplete remission;
• , depending on the changes revealed in endoscopy - superficial, hyperplastic, atrophic and erosive;
• on histological signs - reveal the degree of inflammation( mild, moderate, severe), atrophic changes in cells, gastric metaplasia of the epithelium.

What clinical signs indicate gastroduodenitis?

Symptoms of gastroduodenitis in children with acute form consist in sudden pain in the upper abdomen. The child complains of a swelling. Possible eructations, regurgitation in infants, vomiting in elders. At the same time there is a violation of the stool( diarrhea or constipation).If treatment is started in a timely manner, then the prognosis of full recovery is favorable.

In chronic gastroduodenitis, the symptomatology is diverse, it is often difficult to distinguish it from the signs of the pathology of other digestive organs. It is difficult to understand which of the diseases is primary.

In the acute phase, children complain of short-term cramping or aching pain in the epigastric region. Occur 1.5-2 hours after ingestion. Can spread to the umbilical region or the right hypochondrium. Feeding reduces pain.

The pain syndrome in a child is caused by dyskinesia of the duodenum. Enhanced reductions contribute to the reverse( reflux) casting of the contents into the stomach. Since there are bile acids in it, the patient feels a belch of bitterness.

When examined, the doctor pays attention to the child's pallor, insufficient body weight, white or yellowish coating on the tongue, prints of teeth. Palpation reveals soreness in the epigastrium on the right, in the right hypochondrium at the point of the gallbladder, around the navel.

Positive Kare symptom( hypersensitivity in inspiration in the area of ​​the gall bladder projection)

Children with chronic duodenitis must have signs of vegetative-vascular dystonia, psychoemotional disorders. They are expressed:

• in frequent headaches;
• sleep disturbance( insomnia or drowsiness);
• dizziness;
• weakness;
• increased sweating;
• strengthened intestinal peristalsis with a rumbling in the abdomen.

In the case of a long break between meals, symptoms of hypoglycemia caused by a drop in blood glucose( muscle weakness, tremor, sudden increase in appetite) may occur. Exacerbations with gastroduodenitis are associated with periods of the off-season( spring, autumn).

Are provoked by overloads in school, violation of diet and diet, infectious diseases. Pain usually passes a week later, but pain remains in the characteristic zone during palpation. The period of exacerbation lasts up to two months.

The stage of incomplete remission is not manifested by patients' complaints, but the examination establishes moderate endoscopic changes. With complete remission, there are no complaints, no signs of inflammation during examination.

Chronic course variants

The ability of the disease to "mask" for another pathology necessitated the isolation of flow variants with characteristic symptoms.

Yazvenvennopodobnoe current - the most common type, combined with pronounced antral gastritis, "real" ulcer disease of the bulb of the duodenum or stomach. In a phase of exacerbation, hungry and nocturnal pains occur in the epigastric zone. They clearly depend on the season of the year.

Gastric-like gastroduodenitis is characterized by a simultaneous course of atrophic funda- mental gastritis and enteritis. The process of atrophy of the epithelium captures the duodenum. With enteritis, absorption in the small intestine is impaired, the child has frequent diarrhea, weight loss.

A cholecystitis-like variant is caused by congestion of bile in the bladder and in the outflow ducts. Pain more often radiates to the right hypochondrium and right side of the abdomen. They can be of a permanent nature or manifest as bouts of colic. The child feels a belching bitterness, nausea, with vomiting bile is released. The stomach is constantly swollen.

Pancreatitis-like flow is caused by inflammation of the parotid zone in the lower part of the duodenum, where holedoh and pancreatic duct enter it. Locally, the formation of the diverticulum of the bowel wall is possible.

Due to local changes, the supply of pancreatic juice and bile to the intestine is disrupted. The pains are characterized by a clear localization in the right hypochondrium, in connection with the consumption of fatty foods. Children have a moderate yellowing of the sclera and skin.

Symptoms of pancreatitis are rare( shingles, bloating, diarrhea, temporary milk intolerance)

Diagnosis

Diagnosis of gastroduodenitis is given to children with sufficient clinical observation data, characteristic changes in the function of the stomach and duodenum, according to endoscopy and histology.

To study the function, duodenal probing is performed with a solution of magnesium sulfate through the probe. The patient has pain and nausea, the solution flows back due to a spasmodic contraction of the duodenum.

In the evaluation, it is important to determine the activity of enzymes of enterokinase and alkaline phosphatase in the content. They are increased in the early stages of the disease and decrease as the cells become atrophic. Microscopic analysis of the contents from the probe shows the intestinal epithelium, it is possible to identify the vegetative forms of lamblia.

The study of the type of secretion of gastric juice is important for proper treatment and dietary recommendations. Hyper secretion is detected in bulbite. In cases of a combination of duodenitis and atrophic gastritis, acidity is reduced.

Maximum information about the stage, the prevalence of the disease is obtained with fibrogastroduodenoscopy. For young children, it can not be done without anesthesia. The elders manage to persuade, explain the importance.

Treatment of

Treatment of gastroduodenitis in children does not differ from gastritis therapy. In the acute stage, a bed rest is required on average for a week. Diet is important. The food is assigned according to table No. 1 with gradual expansion. Then they go to table № 5.

The feeding of the child should be carried out on a clear schedule. All dishes are cooked only boiled or steamed. Avoid fatty foods, rich broths. Fruits are given only in the garbled form, from berries cook compote.

Ice cream is forbidden, the cold irritates the mucous

To get rid of Helicobacter pylori, a course of bismuth preparations is prescribed, with antibiotics and Metronidazole for 10 days. If the acidity is increased, the use of H2-blockers of histamine, omeprazole is recommended.

If necessary, use the means regulating the motor activity of the stomach and duodenum( Metoclopramide, Domperidone, Drotaverin).In the recovery phase, a good action is exercised by physical therapy, methods of physiotherapy, sanatorium treatment with mineral waters.

Methods of prevention

To protect the child from gastroduodenitis, it is important to monitor and monitor the diet according to the regimen, quality. Do not allow the baby to feed "adult" food. The child should be protected from overload, observe time for rest, arrange walks.

If the pediatrician directs the children to the gastroenterologist, you need to get the most information and follow them in the organization of treatment. How healthy the generation of children will grow depends on the attention of adults. Untreated gastroduodenitis leads already at a young age to the appearance of a peptic ulcer with subsequent complications.