Патологія стравоходу у дітей: основні причини формування і складність діагностики

This article presents literature review on the problem of gastroesophageal reflux disease (GRD). Clinical data, risk factors, diagnostic methods, prediction of the GRD course in children of different age (regarding the main causative and pathogenic factors, clinical evidence including esophageal and extra-esophageal) and modern approaches to GRD treatment are considered in the article.В статье приведен обзор литературных данных, посвящённых проблеме гастроэзофагеальной рефлюксной болезни. Рассмотрены вопросы факторов риска, методов диагностики, прогнозирования течения данного заболевания у детей разного возраста и современные подходы к лечению.У статті наведено огляд літературних даних, присвячених проблемі гастроезофагеальної рефлюксної хвороби. Розглянуто питання факторів ризику, методів діагностики, прогнозування перебігу даного захворювання у дітей різного віку та сучасні підходи до лікування

Gastroesophageal reflux disease in pediatric practice: current topical issues

In recent years, much attention has been paid to the upper digestive tract diseases in children, particularly gastroesophageal reflux disease, as a cause that has an impact on the quality of life, even in children of school age, and thereafter in young adults. Consequently, there are searches for optimization of early detection, new me-thods of non-invasive diagnosis, screening of this pathology in children’s population in order to determine persons with risk factors and to control disease development and complicated course, as well as searches for the formation of preventive activities algorithm. Scientists came to a consensus that all examinations, which are used in pediatric practice, must be maximally available, simple and non-invasive to the extent of child’s condition. The question about advisability of performing esophagogastroduodenoscopy for all patients with complaints of heartburn and with other symptoms of gastroesophageal reflux disease, the question relative to performing ultrasonography of the esophagus in children as an additional method of examination, usage of questionnaire in pediatric practice, formation of disease course prediction algorithm, and identification of preventive measures specific to every patient remain open. In order to explain their application, the developmental mechanisms of this pathology must be well-understood, and individual risk factors that may influence disease severity and disease course prediction, which occur in children in different periods of life, must be taken into account. Therefore, the goal of this research is to provide an overview of modern literature with reference to topical issues of clinical evidence, risk factors, diagnosis, prediction of gastroesophageal reflux disease course in children of different ages (regarding main causative and pathogenic factors, clinical evidence (esophageal and extra-esophageal), diagnostic methods and modern approaches to gastroesophageal reflux disease treatment)

Diagnostic algorithm and management of children with liver pathology

The paper deals with the diagnostic algorithm including a comprehensive study, substantiates the necessity to evaluate the results obtained taking into account the age and sex of the child. The article considers the features of management of children with liver pathology and the mechanisms of action of ursodeoxycholic acid on the human body as well as the results of clinical research and observations on the use of the ursodeoxycholic acid for the treatment of children with liver diseases

Using GerdQ as a screening diagnostic method in children with gastroduodenal diseases

Background. Problem of screening for esophageal diseases in primary stages of diagnosis in children with gastroduodenal pathology is widespread. As non-invasive and economically available method, a modified Gastroesophageal Reflux Disease Questionnaire (GerdQ) is proposed for children aged 12–18 years. The purpose of the study is comparative analysis of the state of esophageal, gastric and duodenal mucosa and endoscopic pH values of the esophagus with the results of GerdQ use in children with gastroduodenal patho­logy. Materials and methods. Sixty seven children aged 12–18 years were examined. All patients underwent endoscopic study of the esophagus, stomach and duodenum with endoscopic pH measuring. The GerdQ was filled out by the children surveyed. Results. The data obtained indicate a significantly higher incidence of catarrhal and erosive esophagitis in children with destructive and catarrhal changes in the gastric mucosa and duodenum. The degree of gastroesophageal reflux and a decrease in pH values in the esophagus and stomach progressed in the presence of significant changes in the gastric mucosa. GerdQ results indicated GERD in patients with score ≥ 8. Endoscopy findings in this group were mostly catarrhal and destructive changes of esophageal mucosa with high acidity. Patients with score < 8 had mostly motility disorders (gastroesophageal reflux) and moderate increase of acidity. The results of GerdQ comparison with the data of the endoscopic study and the pH-measuring shows a significant (95 %; p < 0.05) coincidence of positive GerdQ results with pronounced endoscopic changes in the esophageal mucosa and a decrease in pH < 4 in the esophagus and < 1.2 in the stomach. Conclusions. The study shows that the sensitivity of the questionnaire is quite high and allows its use at the primary stage of diagnosis in children of middle and senior school age

Experience of using ursodeoxycholic acid in the therapy of biliary sludge in children

Background. The article presents the causes, diagnostic criteria and peculiarities of pathogenetic therapy of biliary sludge (BS). The results of the study on the effectiveness of Ukrliv (ursodeoxycholic acid) are described in the correction of sludge syndrome in children. Materials and methods. Open comparative study included 60 patients with BS (42 girls, 18 boys) aged 4 months to 8 years. BS diagnosis in each child was established during ultrasound examination of the abdominal cavity. After this, two groups of 30 persons were formed by means of random sampling: study group — Ukrliv was used at a dose of 10 mg/kg body weight once a day in the evening for a month on the background of standard therapy; comparison group — children received only standard therapy. Before treatment and after it, we have evaluated clinical manifestations of the disease, the data of ultrasound examination of the abdominal cavity, the results of the biochemical study of the liver function. Results. In the study group, on the background of Ukrliv administration, BS was resolved or decreased in all children, while only 8 of the 30 children in the comparison group had spontaneous disappearance of BS. In the comparison group, the results of the biochemical study of the liver function were a little different from baseline and significantly different from indicators of the study group, where normalization of the biochemical liver functions occurred. Conclusions. Ukrliv administration contributed to the rapid resolution of BS according to ultrasound research. On the background of drug intake, there was a rapid normalization of liver function. Ukrliv did not cause side effects that would require drug withdrawal, and was well tolerated by sick children. Inclusion of Ukrliv (ursodeoxycholic acid) in the comprehensive therapy of children with BS is pathogenetically grounded