Dyspepsia at children – functional or organic frustration of food and violation of digestion. Dyspepsia at children is shown by characteristic simptomokompleks: discomfort or pain in an epigastriya, feeling of overflow of a stomach after food, early saturation, nausea, vomiting, an eructation, heartburn, a lock or diarrhea. Diagnosis of dyspepsia at children is directed to identification of a cause of infringement of digestion and performing ultrasonography of abdominal organs, EGDS, a blood biochemistry research, a calla on a koprologiya, eggs of helminths can include, lyabliya etc. Etiotropny treatment of dyspepsia at children is carried out on the basis of laboratory and tool data.
Dyspepsia at children
Dyspepsia at children – the simptomokompleks of disorders of digestion developing owing to violation of work of the top departments of a GIT. In pediatrics the syndrome of dyspepsia occurs at 13-40% of children and teenagers that testifies to its high prevalence. Chastoyota of dyspepsia at children is explained by anatomo-physiological features of a GIT, nervyony system, a condition of a metabolism in a children's vozyorast. Dyspepsia at children is a polietiologichny and heterogeneous syndrome which can accompany a wide range of pathological states. Questions of studying of a syndrome of dyspepsia at children are beyond children's gastroenterology and demand participation of various children's experts.
Classification of dyspepsia at children
The dyspepsia syndrome at children is the preliminary diagnosis demanding specification of an etiology. In this regard at profound inspection of the child organic or functional dyspepsia can be revealed. Organic dyspepsia can be caused by gastritis, stomach ulcer of a stomach, cholecystitis, pancreatitis, dyskinesia of biliary tract at children. Those cases when at careful gastroenterologichesky inspection organic pathology does not come to light belong to functional dyspepsia at children. However at the long course and inadequate treatment of functional violations development of organic pathology is possible (GERB, gastritis, colitis, etc.)
Functional dyspepsia at children can proceed in several forms. Simple functional dyspepsia is characterized by the isolated dysfunction of a GIT. At toxic dyspepsia, except disorders of digestion, are observed the expressed toxicosis and . Parenteral dyspepsias at children can arise against the background of any other disease – otitis, pneumonia, flu, etc.
Besides, depending on clinical manifestations functional dyspepsia at children is subdivided into 4 options of a current:
- yazvennopodobny – is characterized by the localized pains in an epigastriya passing after meal, antatsidny or antisekretorny medicines
- reflyuksopodobny – proceeds with an eructation, heartburn, nausea, vomiting, an abdominal distension, vomiting
- diskineticheskiya – it is characterized by the discomfortable feelings in an epigastriya amplifying after food, a meteorizm, intolerance of some types of food (fat, dairy and so forth)
- nonspecific – not belonging to above-mentioned options of a course of dyspepsia at children.
In structure of a syndrome of dyspepsia at children the organic form makes no more than 5-10% therefore further it will be a question mainly of functional option of dyspepsia.
The dyspepsia reasons at children
At children violation of neurohumoral regulation of motor function of the top departments of digestive tract and visceral hypersensitivity is the cornerstone of a syndrome of functional dyspepsia. At the same time frustration of regulatory system can happen at any level: central (at the level of TsNS), peripheral (at the level of the carrying-out ways), local (at the level of the receptor device of a stomach and intestines, enteroendokrinny cages etc.) also involves dyskinesia of subordinates of bodies.
Simple dyspepsia is in most cases connected with alimentary factors – errors in feeding of the child: reforage, monotonous food, violation of a diet of the nursing mother, bystry transfer to artificial feeding, introduction of a feeding up. Feature of digestion of small children is fitness of a GIT to food of a certain structure and quantity therefore sharp change of character of food can lead to developing of dyspepsia. To one of dyspepsia factors at children of early age serve the overheating leading to increase of electrolytic losses with then and to decrease in acidity of gastric juice.
At children of advanced age simple dyspepsia can develop at abuse of fast food, aerated water, non-compliance with a diet, the raised academic loads, stressful situations.
Toxic dyspepsia or intestinal toxicosis at children can be an outcome of simple dyspepsia. Not modified diet and lack of treatment promote absorption of toxic products of bacterial exchange, the general intoxication, violation of work of a liver, cardiovascular and nervous systems. Besides, toxic dyspepsia at children can develop against the background of sharp intestinal infections: salmonellosis, dysentery, etc.
Development of parenteral dyspepsia in children is connected with the general impact of a microbic or viral infection on an organism. Disorder of digestion has secondary character and is caused by presence of other diseases at the child.
Dyspepsias are subject practically all children, however more often from this violation children with perinatal damage of TsNS, a hypotrophy, rickets, allergic reactions, hypovitaminoses, anemia, ekssudativno-catarrhal diathesis suffer premature. With a dispepsichesky syndrome parasitic invasions () and helminthoses at children can proceed.
Dyspepsia symptoms at children
Simple dyspepsia meets at children of the first years of life more often. It can sharply develop or against the background of harbingers: concerns, loss of appetite, vomiting, increase of a chair. In 3-4 days the frequency of a chair reaches 5-7 times a day, it becomes liquid, non-uniform coloring, reminding a type of chopped egg with lumps of white, yellow and greenish color, slime impurity. At dyspepsia at children the abdominal distension, a frequent otkhozhdeniye of gases, vomiting, vomiting is noted. The child is disturbed by intestinal gripes: before the act of defecation he rolls out legs, cries. Appetite decreases up to refusal of food that leads to suspension of increase of body weight (flattening of a curve increase of weight). Simple dyspepsia at children proceeds 2-7 days. Against the background of dyspepsia at children the milkwoman, stomatitis, an intertrigo can develop.
At the weakened children simple dyspepsia can be transformed to a toxic form. At the same time there is fever, unrestrained vomiting, frequent (till 15-20 once a day) a chair which quickly gains watery character with lumps of a slushchenny epithelium. Considerable loss of liquid at vomiting and diarrhea is followed by dehydration, decrease in turgor of fabrics, a zapadeniye of a big fontanel, sharp reduction of body weight. The child's face gains masklike lines with the eye turned in one point; skin and mucous become dry; reflexes decrease, there can be spasms. Toxic dyspepsia at children can lead to consciousness violation, development of a coma and death of the child.
Functional dyspepsia at children of advanced age proceeds with periodically arising abdominal pains (usually soon after meal), bystry saturation, nausea, feelings of overflow of a stomach, an eructation, heartburn, alternation of locks or diarrheas. Disorders of digestion at dyspepsia at children often escalate in connection with stressful situations, are combined with dizzinesses and perspiration.
Physiological dyspepsia of newborns belongs to the tranzitorny phenomena and will be considered in the article "Borderlines of Newborns".
Diagnosis of dyspepsia at children
Inspection of children with dyspepsia by the pediatrician or the children's gastroenterologist has to include collecting the anamnesis and complaints, clinical examination, complex laboratory and tool diagnostics.
First of all, in the presence of a dyspepsia syndrome at children it is necessary to differentiate the organic or functional nature of disorder of digestion. For this purpose to the child ultrasonography of abdominal organs (a liver, a gall bladder, a pancreas), an ezofagogastroduodenoskopiya, a stomach X-ray analysis is carried out. From laboratory tests the research a calla on H. Pylori, biochemical tests of a liver, definition of enzymes of a pancreas in blood and urine is used. By means of bacteriological crops of excrements are excluded OKA, by a research a calla on eggs of helminths – a helminthic invasion.
The koprogramma research at dyspepsia at children reveals single leukocytes, it is a little slime at a large amount of neutral fats and free fatty acids. For assessment of motility of the top departments of a GIT the elektrogastrografiya is carried out; with a research objective of the environment the intra esophageal or intragastric rn-metriya, gastric or duodenal sounding can be required.
As functional disorders of digestion are practically always connected with violations from nervous system, children with dyspepsia have to be consulted by the children's neurologist and the psychologist.
Treatment of dyspepsia at children
Easy forms of alimentary dyspepsia at children are treated on an outpatient basis. The main component of therapy of simple dyspepsia at children is cancellation of the product which led to digestion violation, observance of a diet and diet according to age of the child. Babies are recommended to replace 1-2 feedings a day with a water and tea pause and to reduce the volume of other feedings. To the child allow to drink glyukozo-salt solutions, carrot and rice broth, rather weak tea.
For improvement of digestion at dyspepsia at children enzymes (Pancreatinum) are appointed; for removal of toxins – sorbents; for removal of pains – spazmolitik. As 75% of cases of a syndrome of dyspepsia at children are the cornerstone violation of motility of a stomach, purpose of prokinetik is expedient. At the increased gas generation introduction of an exhaust tube is carried out, are used dry heat on a stomach. For recovering of intestinal flora from the postponed dyspepsia children can give medicines with live cultures bifido-and lactobacilli.
Medium-weight and severe forms of dyspepsia at children it is necessary to treat in the conditions of a hospital. Include parenteral hydration therapy (transfusion of plasma, plazmozamenyayushchy and salt solutions), symptomatic therapy in treatment (introduction of anticonvulsive, febrifugal, cardiovascular means etc.). Toxic dyspepsia demands purpose of antibacterial medicines from children.
The child having dyspepsia needs careful leaving: maintenance of the corresponding temperature condition, quiet situation, respect for hygiene. Attentive observation of dynamics of a condition of the child, survey of character of emetic masses and excrements, the prevention of aspiration of emetic masses in airways is necessary.
The forecast and prevention of dyspepsia at children
Simple dyspepsia usually comes to an end with recovery of children in several days and does not involve complications. At children with an adverse premorbidny background simple dyspepsia can pass into toxic – in this case the outcome is defined by terms and completeness of rendering necessary medical care. The forecast of organic and parenteral functional dyspepsia at children in many respects depends on the course of the main disease.
Prevention of dyspepsia at children comes down to observance of an age diet, terms and the sequence of introduction of feedings up, hygiene of feeding, timely and adequate treatment of infectious and all-somatic children's diseases.