The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy

The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy

TACTICS OF PEDITRY IN ABDOMINAL PAIN IN CHILDREN

The functional abdominal pain in children and teenagers is characterized by a wide range of manifestations, doesn’t belong to the separate nosologic form, has clinical, prognostic importance and supports interest of internists to diagnostics and therapy. Taking into account a great variety of signs of the process systemic nature in children it’s reasonable to examine patients with the abdominal pain as a complex. The accurate syndrome diagnosis that determines the necessity and strategy of treatment is of paramount importance for pediatric practice whereas the task of the doctor is the choice of the drug with the maximum therapeutic and minimum toxic potentia

Functional disorders of the pancreas in children: how to manage the cause and effect

The article reflects current views on the problem of functional disorders of the pancreas in children. The discussion is focused on the complexity of diagnosis at nosological level; the most relevant clinical manifestations of pancreatopathy, from the viewpoint of the internist, are described; current diagnostic techniques are highlighted. Major group of drugs used for the correction of functional disorders of the pancreas are considered

METABOLIC SYNDROME AND METABOLISM-ASSOCIATED DISEASES OF THE DIGESTIVE SYSTEM

The article described a typical clinical situation that is frequently observed in the pediatric practice and probably will be more prevalent as the incidence of the metabolic syndrome continues to grow. Modern data testifying that changes in the qualitative and quantitative composition of the intestinal microbiota result in dramatic changes of the metabolism in the body contributing to development and progression of obesity and various functional and chronic diseases of the digestive system. Prospects of corresponding methods of metabolic disease management are discussed, including those with use of a totally new class of multi-strain probiotics

FUNCTIONAL DISORDERS OF THE BILIARY TRACT IN CHILDREN AS A MULTIDISCIPLINARY PROBLEM

Wide prevalence, multiplicity, great variety of etiological factors, diversity of clinical manifestations, and difficulties in registration of the gallbladder and bile ducts disorders and sphincter of Oddi dysfunction – all support the interest of internists to diagnosis and treatment of functional biliary disorders. Taking into account clinically relevant anatomical interrelations between the organs of the choledochopancreatoduodenal zone, a possibility to develop a great variety of systemic diseases and conditions with long-term asymptomatic course it is advisable to conduct complex examination of pediatric patients with abdominal pain and dyspepsia signs. Exact syndromal diagnosis is of great importance in pediatric practice for it determines the necessity of treatment and its strategy. The tactic physician’s task is a choice of a drug which provide therapeutic effect with minimum risk of toxicity

Bacterial overgrowth syndrome: from problem understanding to treatment

The review summarizes recent findings on the syndrome of small intestine bacterial overgrowth (SIBO) which is not a separate disease. The triggers of SIBO and the impact on gastrointestinal physiology are considered. Treatment approaches are described taking into account the mechanism of occurrence of digestive disorders. The article highlights the therapeutic effect of probiotic medicines and refers to the research profile of L. rhamnosus strain GG

THE SIGNIFICANCE OF BREASTFEEDING FOR THE INFANT GROWTH AND DEVELOPMENT: A REVIEW

Based on the literature, the review shows the real value of breast milk as the most optimal type of postnatal feeding of infants. We describe biological mechanisms that are supposed to mediate  the influence of breastfeeding on maturation of  immune response, regulation of intestinal functions, trophic effect on small and large intestinal  mucosa, its microflora and somatic growth of an  infant. In infancy, the protective properties of  breast milk against intestinal infections are largely related to its prebiotic effect. According to the  results of the studies on the structure of the milk  fat mycella envelope, their protein not only participate in bacterial adhesion, but also exert substantial anti-microbial activity due to presence of  antimicrobial components. We discuss the role  of protective nutrients, such as zinc, iron, iodine,  selenium and vitamin A and review the results of studies performed in various countries and aimed at evaluation of an association between the type of feeding of an infant in the 1  year of life and the risk of development of somatic abnormalities. A strong influence of micronutrient deficiencies in the pregnant and breastfeeding woman on delay of in utero development has been shown, as well as its contribution to formation of congenital ab- st normalities of any organ or system, connective  tissue dysplasia, initiation and development of alimentary-related conditions in infants

IMMUNOLOGICAL FUNCTION OF INTESTINAL MICROFLORA, ITS ABNORMALITIES AND POSSIBILITIES OF CORRECTION

The review presents  current  data  indicating  that normal   microflora  plays  an  important  role  in the development of intestinal immune system. Intestinal microorganisms stimulate maturation of intestinal  lymphoid  tissue, synthesis  of secretory immunoglobulin A,  activate  phagocytosis, stimulate  the  cytokine and  interferon  system. Of interest is the discussion of tolerance  phenomenon which is highly significant for formation of a stable   micro-biocenosis. Probiotics are increasingly used for controlled  formation  or restoration  of abnormal micro-biocenosis. Confirmation of the useful properties  of every strain of a probiotic culture in controlled clinical trials is recognized as one of the key requirements to probiotics

THE ANALYSIS OF MORBIDITY, HOSPITALIZATIONS, LETHALITY AND MORTALITY AMONG PEDIATRIC POPULATION OF THE MOSCOW REGION IN 2014 AND UPGRADING OF THE SYSTEM OF MEDICAL CARE FOR CHILDREN

Aim: To assess the rates and changes  in morbidity, hospitalizations, lethality and mortality of pediatric population in the Moscow Region in 2014, compared to 2013, and similar data for the Russian Federation  (RF). Materials and methods: We calculated  and  analyzed  morbidity  (based  on referrals),  hospitalizations, lethality  and  mortality  of the pediatric population aged  from 0 to 17 years in the  Moscow Region. The information  was taken from the Federal Statistical Surveillance report forms No 12 and No 14, as well as the Rosstat data for the Moscow Region. Results: In 2014, total pediatric morbidity (age 0–14) in the Moscow Region was 2290.2 per 1000 pediatric  population, being 10% higher, than that in 2013, but lower than the Russian Federation  average  for 2014  (2332.9‰) and lower than that in the Central Federal District (2333.5‰).  Total  morbidity  among   adolescents of 15 to 17 years of age in 2014 increased non-significantly by 1.6% and achieved  2104.7‰. This is lower than Russian Federation and Central Federal District  average   values   (2267.8  and   2188.5‰,   respectively). In 2014, pediatric lethality (age 0–17) in in-patient  department of the  Moscow Region was 0.1% (in infants, 0.13%) and was mainly related to neoplasms  (0.32%), blood and lymphatic disorders  (0.33%), congenital  abnormalities  and  birth defects  (2.61%). In 2014, infant  mortality  in the Moscow Region was 6.8‰ (in 2013, 7.0‰) versus 7.4‰ in Russian Federation  in general. In the first 6 months  of the  year 2015, this parameter in the Moscow Region continues  to  be  lower than  the average  values in Russian Federation  and Central Federal District (5.1, 6.6 and 6.2‰). With this infant mortality, the  Moscow Region ranks 13th   among Russian  Federation   administrative   subjects  and 5th  in Central Federal District. Conclusion: Despite positive trends in many parameters in the Moscow Region, it is necessary to further improve the system of pediatric medical care at all its levels