On the issue of irritable bowel syndrome in children

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ON THE ISSUE OF IRRITABLE BOWEL SYNDROME IN CHILDREN

Koshimbetova G.K.

In the last decade, not only the absence of a tendency to reduce the prevalence of the pathology of the digestive tract in children, but also its steady growth. Most authors believe that in 90% of cases of abdominal pain in children are due to functional disorders and only 10% - organic.

Irritable bowel syndrome (IBS) occurs in all age groups of the population, including children and the elderly, the median age of patients is 35 years, women suffer from this disease 2-3 times more often than men. IBS accounts for about half of all referrals to a gastroenterologist.

The relevance of the study of irritable bowel syndrome in children is determined by its fairly frequent detection in childhood.

The authors found that if the prevalence of IBS in the general population is from 8-14% to 14-22%, then according to American authors, it reaches 16% among children of school age and adolescents. The authors indicate that the real prevalence of IBS is much higher, since More than one-third of patients experience IBS from an early age, when diagnosis is difficult due to the child's inaccurate detail of the signs of the disease. Such frequent detection of IBS in children may be associated with the processes of gradual formation of the functions of all organs and systems of the child in postnatal ontogenesis, including the digestive apparatus, the slow formation of optimum functions from the regulatory systems of the body.

The growing interest of practitioners and researchers in the problem of functional pathology is associated with the publication in 2004 of the “Russian draft classification of functional diseases of the gastrointestinal tract in children”. This document focuses on the international classification of functional diseases in children, developed by the International Committee for the Study of Functional Diseases and the working group on the study of criteria for functional diseases in children (“Rome Criteria II”). However, to date, the main issues of etiology, pathogenesis, diagnosis of irritable bowel syndrome (IBS) remain debatable.

Most researchers emphasize the leading role of impaired autonomic regulation in the development of colon dyskinesia in IBS. At the same time, the main factor leading to the disruption of the vegetative support of the body's activity is psycho-emotional stress. However, the nature of the disturbance of autonomic homeostasis in children with IBS has not yet been studied. So, E.A. Flegontova (1999) revealed a predominance of vagotonic type of autonomic tone disorders in patients with IBS with a predominance of constipation. Data on the state of the autonomic nervous system in the remaining clinical forms of IBS are not found in the available literature. Identification of regular changes in vegetative homeostasis in various clinical forms of IBS will allow to clarify the pathogenetic mechanisms of the development of clinical forms of IBS and carry out differentiated vegetotropic therapy.

An important aspect of the study of IBS is the question of a combined lesion of the upper and lower digestive tract. This issue is devoted to a number of works performed on the therapeutic contingent of patients. In children, these issues are not well understood. cholecystitis chronic intestinal dysbacteriosis

According to the literature, IBS is associated with lesions of the upper digestive tract - from 25% to 87% of cases. The most frequent are combinations of IBS with dyskinesia of the esophagus, stomach, spasm of the sphincter of Oddi.

The pathogenetic mechanisms of these combinations currently remain undisclosed. So, Kennedy TM, Jonas R.N., Hungin P.S. (1998) emphasize the fact of independent association between IBS and gastroesophageal reflux disease. V.A. Dashiev (2004) associates a combined lesion of the upper and lower GI tracts with impaired function of the bauhinia valve in patients of this group. Most Russian researchers associate the presence of combined lesions of various parts of the gastrointestinal tract with the general mechanisms of their formation in the form of autonomic dysfunctions.

Recently, results have been obtained confirming the presence of common pathogenetic mechanisms in the development of IBS and functional dyspepsia. Thus, in patients with functional dyspepsia on the part of the upper digestive tract, a number of changes are observed, observed in IBS. Patients with functional dyspepsia (in 50% of patients) are characterized by various types of gastric motor disorders, such as disturbed gastric accommodation. In addition, in studies with balloon ballooning in the stomach and duodenum, it was shown that patients with functional dyspepsia show increased sensitivity to gastric distension.

This phenomenon of visceral hyperalgesia is highly specific for functional dyspepsia and for IBS. At the same time, less importance is attached to the variety of morphological changes in the mucous membrane of the gastroduodenal zone, the level of acid production in the genesis of clinical symptoms.

Considering the leading role of vegetative dysfunctions in the pathogenesis of IBS, it can be assumed that abnormalities in the vegetative system of the body are responsible for the formation of some combined lesions of the upper and lower parts of the gastrointestinal tract.

In the last decade, not only the absence of a tendency to reduce the prevalence of pathology of the digestive tract in children, but also its steady growth. It is emphasized that in 90% of cases of abdominal pain in children are due to functional disorders and only 10% are organic. One of the functional diseases of the gastrointestinal tract in children is irritable bowel syndrome (IBS). However, to date, the main issues of etiology, pathogenesis, diagnosis of irritable bowel syndrome in children remain debatable.

Objective: To study the risk factors for the development of irritable bowel syndrome in children, depending on the clinical variant of the disease, age, sex. Materials and research methods: the main group consisted of 56 children suffering from irritable bowel syndrome at the age of 7-14 years (mean age 10.0 ± 0.69 years), of whom 30 are girls and 26 are boys. The comparison group consisted of 100 patients with diseases of the upper digestive tract without IBS. The diagnosis of irritable bowel syndrome was established on the basis of the criteria for IBS, defined by the “III Rome Consensus”. Inclusion criteria: children aged 7-14 years with confirmed at the time of the survey and / or history of IBS; the absence of chronic diseases of other organs and systems, the absence of episodes of acute infectious diseases during the 1st month; the presence of the informed consent of the child and his parents to participate in the survey.

Exclusion criteria: the presence of "anxiety symptoms", weight loss, night pain, presence of blood in the stool, increased ESR, fever, lymphadenopathy; the presence of confirmed organic diseases of the lower digestive tract (ulcerative colitis, Crohn's disease, other specific forms of colitis, parasitic invasions, fermentopathies, damage to other organs and systems) that occur with symptoms of dyspepsia; refusal to participate in the study. All children underwent the following examinations: a clinical examination, a common set of studies for patients with gastropathology. Results of the study: The included children were in the youngest (24 children - 42.9 ± 4.6%) and older (32 children - 57.1 ± 4.6%) age groups. It was established that in the younger age group, the disease is more often detected in boys (58.3 ± 7.2% (14 children) versus 41.7 ± 7.2% (10 children), p0.05). Factors contributing to the formation of the disease in most children were the presence of allergic diseases (28.6 ± 4.2% versus 10 ± 3.0% in the comparison group (16 and 10 children, p0.05). An important factor is obesity, detected in 19.6 ± 3.6% of children in the main group (11) and 9.0 ± 2.9% of patients (9) in the comparison group (p0.05). The association of pain with changes in stool frequency as diarrhea was noted in 31, 3 ± 6.6% (10) and 29.2 ± 5.7% (7) patients, respectively, groups (p> 0.05). The relationship of pain with impaired stool frequency by constipation was found in 43.8 ± 7, 1% (14) and 25.0 ± 5.4% (6) patients, respectively, groups (p> 0.05). You pain features are revealed in patients with IBS. Pain is associated with an act of defecation in 91.1 ± 2.6% (51) patients and episodes of psycho-emotional stress in 26.8 ± 4.1% (15) of the number of patients, they more often have spasticity - in 25.0 ± 4.0% of children (14), localization of pain in the lower abdomen, detected in 41.1 ± 4.6% (23) of the examined, is characteristic. The history of the pain syndrome can also be attributed to the characteristic pain syndrome. in patients with IBS, hospitalizations with “suspected acute appendicitis” - 17.9 ± 3.5% (10) patients versus 10.0 ± 3.0% (10) children in the comparison group (p> 0.05). It was established that additional symptoms of the disease, allocated according to the “Rome III criteria”, are more often detected in patients of the older age group. At the same time, more often in children a “feeling of incomplete emptying” after defecation is detected: 37.5 ± 5.9% (12) in older children and 12.5 ± 5.0% (3) in children of the younger age group (p0.05). In addition, additional symptoms and, consequently, a more pronounced clinical course of the disease are observed in patients with clinical variants of the syndrome with a predominance of diarrhea, pain and flatulence (17 children). Thus, the feeling of incomplete emptying after defecation is detected in 52.9 ± 8.8% of patients with IBS with diarrhea (9 children) and in 17.9 ± 6.1% (6) children in the group of patients with IBS with constipation (p0, 05).

Thus, summing up our research, it can be noted that the factors contributing to the formation of the disease in most children were the presence of allergic diseases, food allergies, and past intestinal infections.

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