How does indigestion manifest in children? The symptoms of this pathological condition will be listed below. You will also learn about why this disease develops and how it should be treated.

Basic information

Stomach upset in children is quite common. As you know, the mentioned organ is one of the main elements that make up the human digestive system. Interruptions in its work negatively affect not only the patient’s well-being, but also his health in general.

In children, it is a special condition in which one of the functions of the organ in question (for example, motor or secretory) is disrupted. In this case, the small patient feels noticeable pain in the epigastrium and experiences a significant feeling of discomfort.

A characteristic feature of this condition is the absence of any structural changes in the gastric mucosa. Thus, the diagnosis is made based on a survey of the patient, existing symptoms, test results and other studies.

Types of disease, their causes

Indigestion in children, or rather its type, is determined by several factors that cause an imbalance in its functioning. Primary disorders are independent diseases. The main reasons for their development are the following:

Why does indigestion occur in children? Secondary causes of this pathology are accompanying factors or consequences of other diseases. internal organs. These include the following:

• vascular and heart diseases;
• disruptions in the functioning of the gastrointestinal tract;
• irregularities in work endocrine system;
• chronic infections;
• organic or functional diseases of the central nervous system.

Most often, stomach upset in children occurs not because of one, but because of several factors that were mentioned above.

Symptoms of the disease

Now you know what constitutes such a pathological condition as indigestion. Symptoms in children, however, as in adults, can be different. IN modern medicine There are several clinical pictures of this disease:

• dyspeptic;
• painful;
• mixed.

Usually, functional indigestion in children is accompanied by such unpleasant symptoms as painful sensations At the same time, both children and adults talk about paroxysmal pains, which usually concentrate in the navel and are intermittent.

Babies with this pathology may develop mild soreness, especially when pressing on the stomach.

Signs of illness

If the temperature and indigestion in a child, you should definitely contact the pediatrician. It is also necessary to visit a doctor if a small patient has poor appetite, a feeling of heaviness in the abdomen, as well as belching with the smell of rotten or sour food and nausea, turning into vomiting.

According to experts, a strong one in a child may indicate the presence of pylorospasm. It should also be noted that difficulties with swallowing food in a baby may indicate the development of cardiospasm.

Other symptoms of the disease

How does indigestion manifest itself in children (treatment of such a disease should be carried out only by a gastroenterologist)? The disease in question in children is often accompanied by excessive sweating, emotional instability, instability of the heart and blood vessels, as well as other internal organs.

It should also be noted that such a disorder of the main digestive organ has special forms in which symptoms such as aerophagia (that is, strong belching of air), acute dilatation of the stomach and habitual vomiting (including sudden attacks of vomiting) are observed.

All of the above symptoms require special attention from doctors. But in order to make a correct diagnosis, one should rely not only on the identified signs of the disorder, but also on test results. Only in this case will the specialist be able to prescribe the necessary treatment, as well as adjust the diet of his patient.

According to statistics, children and adolescents suffer from gastric disorders much more often than adults. This fact is explained by the fact that it is young people, who are inextricably linked with computers and other electronic equipment, who regularly experience psycho-emotional overload. By the way, against the background of this, many children and adolescents forget about regular and nutritious meals, snacking on hamburgers and washing them down with carbonated drinks. Usually the results of such behavior are not long in coming.

A child has an upset stomach: what to do?

Modern food products do not always meet all quality and safety requirements. Therefore, diseases of the gastrointestinal tract took first place among all others.

Very often this problem occurs in young children and adolescents, especially if their parents do not particularly monitor their diet. So how to treat an upset stomach in a child? To eliminate the cause of this disease, doctors recommend using non-drug methods. Experts suggest the following:

• Normalization of diet. This includes the choice of high-quality and safe products, the presence of various hot dishes on the menu, regularity of meals, the absence of coffee, hot chocolate and sparkling water among the drinks consumed, as well as the complete exclusion of fried, spicy, fatty and salty foods.
• If an upset stomach in an adult is associated with harmful working conditions, then they must be eliminated. To do this, you should refuse to work at night, and also cancel frequent business trips.
• Healthy lifestyle. This method of eliminating the causes of gastric upset involves regular exercise and physical exercise, alternating work and rest, and giving up bad habits (for example, smoking or drinking alcohol).

In most cases of indigestion, such measures can not only significantly improve the patient’s condition, but also eliminate malfunctions in other internal organs.

Fever and stomach upset in a child can be observed not only in early childhood, but also in adolescence. By the way, in such children the signs of the pathology in question are very similar to gastritis. To make a more accurate diagnosis, morphological confirmation is required.

Medicines for stomach upset in children are used for more serious disorders, as well as for the presence of a huge number of symptoms of this disease. In addition, in this condition the patient is prescribed a special diet.

Drug treatment

What remedy for indigestion for children should be used? Experts say that to eliminate motor disorders, babies can be prescribed medications from the following groups: antispasmodics, anticholinergics, selective cholinomimetics and prokinetics. If it is necessary to correct secretory disorders, then doctors recommend the use of antacids or anticholinergics.

In case of vegetative disorders, it is allowed to use drugs and various herbs that have a sedative effect. Also, with such a pathology, acupuncture, antidepressants, electrosleep, massage, gymnastics, and water procedures are often used. If gastric disorders have arisen due to psycho-emotional overload, then a psychiatrist's consultation is indicated.

Treatment of young children

If teenagers and adults with indigestion can be prescribed various drugs and other procedures, then for young children such treatments are not suitable. So what to do if a similar disease occurs in a baby?

The main condition for successful treatment of indigestion in small child is to drink enough fluids to help prevent dehydration.

If, with gastric pathologies, a child willingly and more often takes a breast, as well as a bottle with a mixture, then he should not be limited in this. Also, in addition, the baby is required to give an electrolytic solution. The drug "Regidron" can act as it. This tool will help restore in the children's body.

According to experts, in case of gastric disorders, fruit juices with glucose should not be given to the child. Children are also prohibited from drinking carbonated drinks. If you ignore this advice, the listed products will increase diarrhea and significantly worsen the child’s condition. By the way, it is not recommended to give strengthening drugs to children, since they are contraindicated for children under 12 years of age.

If the sick child is already 6 months old, then if severe diarrhea develops, he can be given ripe banana puree, or for older children, starchy foods and chicken are ideal.

If liquid stool If a child has an upset stomach for two days or more, and dietary restrictions do not affect his condition in any way, you should definitely consult a doctor. Purchase independently medicines, intended for the treatment of this condition, are not recommended in pharmacies.

Sequencing

The feasibility of using certain medicines, their doses, as well as the duration of therapy for gastric disorders are determined only by the doctor.

If the disease in question has secondary causes of development, then treatment should be aimed at eliminating the main symptoms and those pathologies that caused the disorder itself. For this purpose, a sick child or adult with complaints of severe pain in the stomach must be registered with a therapist or gastroenterologist for a period of 12 months. In this case, examinations of the patient should be carried out every six months.

Diet for a child with an upset stomach is very important for the healing process. Correct mode nutrition for a baby or adult is prescribed by a doctor. In this case, the doctor must give the patient a brochure indicating prohibited and permitted products.

In particularly severe cases, the patient is prescribed sedatives, as well as moderate exercise.

If after some time the main symptoms of gastric disorders no longer recur, then no more is required. In this case, the patient is removed from the register.

If you do not consult a doctor in time for an upset stomach, the child may experience serious disorders in the gastrointestinal tract, which can develop into peptic ulcers or chronic gastritis. In this case, the symptoms and treatment will differ significantly.

Proper nutrition for a child with an upset stomach is very important. Usually a special diet is used during an exacerbation of the disease. At the same time, the child’s diet includes nicotinic acid and additional vitamins C and B.

All dishes intended for a sick baby should be cooked exclusively by steaming. The products can also be consumed boiled.

If you have an upset stomach, you should eat in small portions, that is, up to 6 times a day. As the main symptoms of the disease are eliminated, the patient is transferred to a balanced diet. A gentle diet is also recommended for him.

What preventive measures can you take to prevent stomach upset for both you and your child? Primary prevention of the disease in question consists of introducing healthy image life. This will not only entail the elimination of many causes that cause disturbances in the functioning of the digestive tract, but will simply improve the patient's condition.

According to experts, proper adherence to the daily routine, lack of physical overload, a balanced diet, as well as the elimination of nervous tension will help to significantly reduce the number of patients, including children, with the mentioned diagnosis.

If a child has or is experiencing helminthic infestations that contribute to the development of a gastric disorder, then preventive measures must be carried out in conjunction with the treatment that is being carried out at a given time. In order to rehabilitate the little patient, he is recommended to undergo sanatorium-resort therapy.

Functional disorders gastrointestinal tract(Gastrointestinal tract) represent one of the most widespread problems among children in the first months of life. A distinctive feature of these conditions is the appearance clinical symptoms in the absence of any organic changes in the gastrointestinal tract (structural abnormalities, inflammatory changes, infections or tumors) and metabolic abnormalities. With functional disorders of the gastrointestinal tract, motor function, digestion and absorption of nutrients, as well as the composition of the intestinal microbiota and activity may change immune system. The causes of functional disorders often lie outside the affected organ and are caused by a violation of the nervous and humoral regulation of the digestive tract.

In accordance with the Rome III criteria, proposed by the Committee on the Study of Functional Disorders in Children and the International Working Group on the Development of Criteria for Functional Disorders in 2006, functional gastrointestinal disorders in infants and children of the second year of life include:

• G1. Regurgitation in babies.
• G2. Rumination syndrome in infants.
• G3. Cyclic vomiting syndrome.
• G4. Newborn colic.
• G5. Functional diarrhea.
• G6. Painful and difficult bowel movements (dyschezia) in infants.
• G7. Functional constipation.

In infants, especially in the first 6 months of life, conditions such as regurgitation, intestinal colic and functional constipation are most common. In more than half of the children, they are observed in various combinations, less often - as one isolated symptom. Since the causes leading to functional disorders affect various processes in the gastrointestinal tract, the combination of symptoms in one child seems to be quite natural. So, after undergoing hypoxia, vegetative-visceral disorders may occur with a change in motility according to the hyper- or hypotonic type and disturbances in the activity of regulatory peptides, leading simultaneously to regurgitation (as a result of spasm or gaping of the sphincters), colic (disturbances in the motility of the gastrointestinal tract with increased gas formation) and constipation (hypotonic or due to intestinal spasm). Clinical picture aggravate the symptoms associated with a violation of the digestion of nutrients, due to a decrease in the enzymatic activity of the affected enterocyte, and leading to a change in the intestinal microbiocenosis.

The causes of functional disorders of the gastrointestinal tract can be divided into two groups: related to the mother and related to the child.

The first group of reasons include:

• complicated obstetric history;
• emotional lability of a woman and a stressful situation in the family;
• errors in nutrition in a nursing mother;
• violation of feeding technique and overfeeding with natural and artificial feeding;
• improper dilution of infant formula;
• woman smoking.

Child related reasons include:

• anatomical and functional immaturity of the digestive organs (short abdominal esophagus, insufficiency of sphincters, reduced enzymatic activity, uncoordinated work of the gastrointestinal tract, etc.);
• dysregulation of the gastrointestinal tract due to immaturity of the central and peripheral nervous system(intestines);
• features of the formation of intestinal microbiota;
• formation of the sleep/wake rhythm.

The most common and most serious causes leading to regurgitation, colic and stool disturbances are hypoxia (vegetative-visceral manifestations of cerebral ischemia), partial lactase deficiency and gastrointestinal form food allergies. Often, to varying degrees of severity, they are observed in one child, since the consequences of hypoxia are a decrease in enzyme activity and an increase in permeability small intestine.

Regurgitation is the spontaneous reflux of gastric contents into the esophagus and oral cavity.

The frequency of regurgitation syndrome in children of the first year of life, according to a number of researchers, ranges from 18% to 50%. Mostly regurgitation is observed in the first 4-5 months of life, much less often observed at the age of 6-7 months, after the introduction of thicker foods - complementary foods, practically disappearing by the end of the first year of life, when the child spends a significant part of the time in an upright position (sitting or standing).

The severity of regurgitation syndrome, according to the recommendations of the ESPGHAN expert group, is proposed to be assessed on a five-point scale, reflecting the overall characteristics of the frequency and volume of regurgitation (Table 1).

Infrequent and mild regurgitation is not regarded as a disease, since it does not cause changes in the health of children. Children with persistent regurgitation (score from 3 to 5 points) often experience complications, such as esophagitis, retardation in physical development, Iron-deficiency anemia, diseases of ENT organs. Clinical manifestations esophagitis are decreased appetite, dysphagia and hoarseness.

The next most common functional gastrointestinal disorder in infants is intestinal colic - these are episodes of painful crying and restlessness of the child, which take at least 3 hours a day, occurring at least 3 times a week. Usually their debut occurs at 2-3 weeks of life, culminates in the second month, gradually disappearing after 3-4 months. The most typical time for intestinal colic is the evening hours. Attacks of crying arise and end suddenly, without any external provoking reasons.

The frequency of intestinal colic, according to various sources, ranges from 20% to 70%. Despite a long period of study, the etiology of intestinal colic remains not entirely clear.

Intestinal colic is characterized by sharp painful crying, accompanied by redness of the face, the child takes a forced position, pressing his legs to his stomach, and difficulties arise with the passage of gases and stool. Noticeable relief occurs after defecation.

Episodes of intestinal colic cause serious concern for parents, even if the child’s appetite is not impaired, he has normal indicators weight curve, grows and develops well.

Intestinal colic occurs with almost the same frequency in both natural and artificial feeding. It is noted that the lower the birth weight and gestational age of the child, the higher the risk of developing this condition.

IN last years Much attention is paid to the role of intestinal microflora in the occurrence of colic. Thus, in children with these functional disorders, changes in the composition of the intestinal microbiota are detected, characterized by an increase in the number of opportunistic microorganisms and a decrease in the protective flora - bifidobacteria and especially lactobacilli. Increased growth of proteolytic anaerobic microflora is accompanied by the production of gases with potential cytotoxicity. In children with severe intestinal colic, the level of an inflammatory protein, calprotectin, often increases.

Functional constipation is one of the most common disorders of intestinal function and is detected in 20-35% of children in the first year of life.

Constipation is understood as an increase in the intervals between bowel movements compared to the individual physiological norm for more than 36 hours and/or systematically incomplete bowel movement.

The frequency of stool in children is considered normal if, from 0 to 4 months of age, there are from 7 to 1 bowel movements per day, from 4 months to 2 years, from 3 to 1 bowel movement. Defecation disorders in infants also include dyschezia - painful defecation caused by dyssynergia of the pelvic floor muscles, and functional stool retention, which is characterized by an increase in the intervals between bowel movements, combined with feces of soft consistency, large diameter and volume.

In the mechanism of development of constipation in infants, the role of colon dyskinesia is great. Most common cause The occurrence of constipation in children of the first year of life is caused by nutritional disorders.

The absence of a clearly defined boundary between functional disorders and pathological conditions, as well as the presence of long-term consequences (chronic inflammatory gastroenterological diseases, chronic constipation, allergic diseases, sleep disorders, disorders in the psycho-emotional sphere, etc.) dictate the need for a careful approach to the diagnosis and treatment of these conditions.

Treatment of infants with functional disorders of the gastrointestinal tract is complex and includes a number of successive stages, which are:

• outreach and psychological support to parents;
• diet therapy;
• drug therapy (pathogenetic and syndromic);
• non-drug treatment: therapeutic massage, exercises in water, dry immersion, music therapy, aromatherapy, aeroion therapy.

The presence of regurgitation dictates the need to use symptomatic positional (postural) therapy - changing the position of the child’s body, aimed at reducing the degree of reflux and helping to clear the esophagus of gastric contents, thereby reducing the risk of esophagitis and aspiration pneumonia. The baby should be fed in a sitting position, with the baby's body positioned at an angle of 45-60°. After feeding, it is recommended to hold the baby in an upright position for a sufficiently long time, until the air leaves, for at least 20-30 minutes. Postural treatment must be carried out not only throughout the day, but also at night, when the clearing of the lower esophagus from aspirate is impaired due to the absence of peristaltic waves (caused by the act of swallowing) and the neutralizing effect of saliva.

The leading role in the treatment of functional disorders of the gastrointestinal tract in children belongs to therapeutic nutrition. The purpose of diet therapy primarily depends on the type of feeding of the child.

When breastfeeding, first of all, it is necessary to create a calm environment for the nursing mother, aimed at maintaining lactation, to normalize the child’s feeding regimen, excluding overfeeding and aerophagia. Foods that increase gas formation in the intestines (sweets: confectionery, tea with milk, grapes, curd spreads and cheeses, soft drinks) and those rich in extractive substances (meat and fish broths, onions, garlic, canned food, marinades, pickles) are excluded from the mother’s diet. , sausages).

According to some authors, functional disorders of the gastrointestinal tract can arise as a result of food intolerance, most often an allergy to cow's milk proteins. In such cases, the mother is prescribed a hypoallergenic diet; whole cow's milk and foods with a high allergenic potential are excluded from her diet.

In the process of organizing diet therapy, it is necessary to exclude overfeeding of the child, especially with free feeding.

If there is no effect from the measures described above, for persistent regurgitation, “thickeners” (for example, Bio-rice broth) are used, which are diluted with breast milk and given from a spoon before breastfeeding.

It must be remembered that even pronounced functional disorders of the gastrointestinal tract are not an indication for transferring a child to mixed or artificial feeding. The persistence of symptoms is an indication for an additional in-depth examination of the child.

With artificial feeding, it is necessary to pay attention to the feeding regimen of the child, to the adequacy of the choice of milk formula, corresponding to the functional characteristics of his child. digestive system, as well as its volume. It is advisable to introduce into the diet adapted dairy products enriched with pre- and probiotics, as well as fermented milk mixtures: Agusha fermented milk 1 and 2, NAN Fermented milk 1 and 2, Nutrilon fermented milk, Nutrilak fermented milk. If there is no effect, products specially created for children with functional disorders of the gastrointestinal tract are used: NAN Comfort, Nutrilon Comfort 1 and 2, Frisovoy 1 and 2, Humana AR, etc.

If the disorders are caused by lactase deficiency, the child is gradually introduced to lactose-free mixtures. For food allergies, specialized products based on highly hydrolyzed milk protein may be recommended. Since one of the causes of regurgitation, colic and stool disturbances are neurological disorders due to perinatal damage to the central nervous system, dietary correction should be combined with drug treatment, which is prescribed by a pediatric neurologist.

Both with artificial and natural feeding, it is advisable to offer the child baby drinking water between feedings, especially if he is prone to constipation.

Children with regurgitation syndrome deserve special attention. If there is no effect from the use of standard milk formulas, it is advisable to prescribe anti-reflux products (AR mixtures), the viscosity of which increases due to the introduction of specialized thickeners into their composition. For this purpose, two types of polysaccharides are used:

• indigestible (gums that form the basis of locust bean gluten (CLG));
• digestible (rice or potato starches) (Table 2).

CRP is, of course, an interesting component in baby food products, and I would like to dwell on its properties in more detail. The main physiologically active component of CRD is the polysaccharide galactomannan. It belongs to the group of dietary fibers and performs two interrelated functions. In the stomach cavity, KRD provides a more viscous consistency of the mixture and prevents regurgitation. At the same time, CRF is a non-degradable but fermentable dietary fiber, which gives this compound classic prebiotic properties.

The term “non-degradable dietary fiber” refers to its resistance to the effects of pancreatic amylase and small intestinal disacchidases. The concept of “fermentable dietary fiber” reflects their active fermentation by beneficial microflora of the colon, primarily bifidobacteria. As a result of such fermentation, a number of physiological effects important for the body occur, namely:

• the content of bifidobacteria in the colon cavity increases (tens of times);
• during the fermentation process, metabolites are formed - short-chain fatty acids (acetic, butyric, propionic), which promote a shift in pH to the acidic side and improve the trophism of intestinal epithelial cells;
• Due to the growth of bifidobacteria and a change in the pH of the environment towards the acidic side, conditions are created for the suppression of opportunistic intestinal microflora and the composition of the intestinal microbiota improves.

The positive effect of CRD on the composition of the intestinal microflora in children of the first year of life has been described in a number of studies. This is one of the important aspects of the use of modern AR mixtures in pediatric practice.

Mixtures containing KRD (gum) also have a proven clinical effect for functional constipation. An increase in the volume of intestinal contents due to the development of beneficial intestinal microflora, a change in the pH of the environment towards the acidic side and moistening of the chyme contribute to increased intestinal motility. An example of such mixtures are Frisov 1 and Frisov 2. The first is intended for children from birth to 6 months, the second - from 6 to 12 months. These mixtures can be recommended either in full or partially, in an amount of 1/3-1/2 of the required volume at each feeding, in combination with a regular adapted milk formula, until a lasting therapeutic effect is achieved.

Another group of AR mixtures are products that include starches as a thickener, which act only in the upper gastrointestinal tract, and the positive effect occurs when they are used in full. These mixtures are indicated for children with less pronounced regurgitation (1-3 points), as in normal stool, and with a tendency to liquefy. Among the products in this group, the NAN Antireflux mixture stands out, which has double protection against regurgitation: due to a thickener (potato starch), which increases the viscosity of gastric contents and moderately hydrolyzed protein, which increases the rate of gastric emptying and additionally prevents constipation.

Currently, an updated anti-reflux mixture, Humana AR, has appeared on the Russian consumer market, which simultaneously contains locust bean gum (0.5 g) and starch (0.3 g), which makes it possible to enhance the functional effect of the product.

Despite the fact that AR formulas are complete in composition and are designed to meet the child’s physiological needs for nutrients and energy, according to international recommendations they belong to the group of baby food products “for special medical purposes.” Therefore, products in this group should be used strictly when clinically indicated, on the recommendation of a physician and under medical supervision. The duration of use of AR mixtures should be determined individually and can be quite long, about 2-3 months. Transfer to an adapted milk formula is carried out after achieving a stable therapeutic effect.

Literature

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2. Frolkis A.V. Functional diseases of the gastrointestinal tract. L.: Medicine, 1991, 224 p.
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5. Hyman P. E., Milla P. J., Bennig M. A. et al. Childhood functional gastrointestinal disorders: neonate/toddler // Am.J. Gastroenterol. 2006, v. 130 (5), p. 1519-1526.
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14. Sorvacheva T. N., Pashkevich V. V., Kon I. Ya. Diet therapy for constipation in children of the first year of life. In the book: Guide to baby nutrition (edited by V. A. Tutelyan, I. Ya. Kon). M.: MIA, 2009, 519-526.
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16. Functional disorders of the gastrointestinal tract in infants and their dietary correction. In the book: Therapeutic nutrition of children in the first year of life (under the general editorship of A. A. Baranov and V. A. Tutelyan). Clinical guidelines for pediatricians. M.: Union of Pediatricians of Russia, 2010, p. 51-64.
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19. Anokhin V. A., Khasanova E. E., Urmancheeva Yu. R. and others. Evaluation of the clinical effectiveness of Frisov’s mixture in the nutrition of children with intestinal dysbiosis varying degrees and minimal digestive dysfunctions // Issues of modern pediatrics. 2005, 3: 75-79.
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T. E. Borovik*,
V. A. Skvortsova*, Doctor of Medical Sciences
G. V. Yatsyk*, Doctor of Medical Sciences, Professor
N. G. Zvonkova*, Candidate of Medical Sciences
S. G. Gribakin**, Doctor of Medical Sciences, Professor

*NTsZD RAMS, **RMAPO, Moscow

> Functional gastrointestinal disorder

This information cannot be used for self-medication!
Consultation with a specialist is required!

Functional gastrointestinal disorder

Functional disorders of the gastrointestinal tract mean a whole group of conditions that manifest themselves with a variety of symptoms from the organs of the digestive system. However, the exact cause of these disorders is absent or not identified. The doctor will be able to make such a diagnosis if the functioning of the intestines and stomach is impaired, but there are no infectious, inflammatory diseases, oncopathology or anatomical defects of the intestine.

This pathology is classified based on which symptoms prevail. Disorders with a predominance of the vomiting component, pain syndrome or defecation disorder are distinguished. Irritable bowel syndrome, which is included in the international classification of diseases, is considered a separate form.

Causes of functional gastrointestinal disorders

The reasons are genetic predisposition and exposure to environmental factors. The congenital nature of functional disorders is confirmed by the fact that in some families representatives of several generations suffer from this pathology. Past infections, stressful living conditions, depression, hard physical work - all this applies to external reasons disorders.

How do functional gastrointestinal disorders manifest themselves?

The leading symptoms of these disorders are bloating, frequent constipation or, conversely, diarrhea, abdominal pain (usually in the umbilical area). Unlike other intestinal diseases, functional bloating is not accompanied by a visible enlargement of the abdomen. Sick people may complain of rumbling in the stomach, flatulence, a feeling of incomplete bowel movements after defecation, tenesmus (painful urge to defecate).

Who makes the diagnosis and what tests are prescribed?

In adults, a gastroenterologist diagnoses these conditions. In children, this pathology is much more common; pediatricians are involved in its diagnosis and treatment. Diagnosis is made based on the typical symptoms listed above. To make a diagnosis, it is necessary that the total duration of digestive disorders be at least 3 months over the past year.

To diagnose a functional disorder, the doctor must exclude another pathology that may have caused similar symptoms. For this, he can prescribe an FGDS, colonoscopy, sigmoidoscopy, survey fluoroscopy abdominal cavity, CT or MRI, ultrasound of the abdominal cavity and pelvis. Blood tests include liver enzymes, bilirubin, and sugar levels. Examination of stool for helminths and coprogram are mandatory tests.

Treatment and prevention

For functional gastrointestinal disorders, treatment and prevention are almost synonymous. The main emphasis is on diet correction. The patient is recommended to have a balanced diet, including proteins, fats and carbohydrates in full, as well as vitamins and microelements, and normalization of the diet. Eating small meals in small portions helps relieve symptoms. For constipation, laxatives and enemas are prescribed, foods that have a laxative effect are included in the diet, and drinking plenty of fluids is recommended.

For diarrhea, limit the amount of roughage and prescribe stool-fixing drugs. Pain syndrome in case of functional disorders, they are eliminated by taking antispasmodic (relieving spasms of smooth muscles) drugs.

Much attention is paid to increasing overall stress resistance through lifestyle changes. This means giving up bad habits (drinking alcohol and smoking). A positive effect is observed after completing a course of psychotherapy.

Functional gastrointestinal disorders are a combination of gastrointestinal symptoms without structural or biochemical disorders of the gastrointestinal tract.

The reason lies outside the organ whose reaction is disturbed and is associated with a disorder of nervous and humoral regulation.

Classification:

• RF manifested by vomiting
• RF manifested by abdominal pain
• FR defecation
• FR of the biliary tract
• combined FR

Causes of RF in young children:

• anatomical and functional immaturity of the digestive organs
• uncoordinated work various organs
• dysregulation due to immaturity of the intestinal nervous system
• unformed intestinal biocenosis

RF of the stomach:

• rumination
• functional vomiting
• aerophagia
• functional dyspepsia

Important signs of gastrointestinal RF in young children:

• symptoms are associated with normal development
• arise due to insufficient adaptation in response to external or internal stimuli
• observed in 50-90% of children under 3 months
• not related to the nature of feeding

Vomiting and regurgitation syndrome in young children:

Regurgitation– passive involuntary reflux of food into and out of the mouth.

Vomit- a reflex act with automatic contraction of the muscles of the stomach, esophagus, diaphragm and anterior abdominal wall, in which the contents of the stomach are thrown out.

Rumination– esophageal vomiting, characterized by the reverse flow of food from the esophagus into the mouth during feeding

Due to the structural features of the upper gastrointestinal tract: weakness of the cardiac sphincter with a well-developed pyloric sphincter, horizontal location of the stomach and a “bag” shape, high pressure in the abdominal cavity, the horizontal position of the child himself and a relatively large amount of food.

This is the norm for children of the first 3 months of life, it is a condition at a certain stage of life, and not a disease.

Functional vomiting is based on:

• impaired coordination of swallowing and esophageal peristalsis
• low salivation
• insufficient peristalsis of the stomach and intestines
• delayed gastric emptying
• increased postprandial gastric distension
• pylorospasm

In most cases, this is the result of the immaturity of the neurovegetative, intramural and hormonal systems for regulating the motor function of the stomach. At a later age, functional vomiting is a manifestation of neurotic reactions, and occurs in emotional, excitable children in response to various unwanted manipulations: punishment, force-feeding. Often combined with anorexia, selectivity in food, and stubbornness. functional vomiting is not accompanied by nausea, abdominal pain, intestinal dysfunction. Easily tolerated, feeling good.

Diagnostic criteria for regurgitation:

• 2 or more r/d
• for 3 or more weeks
• no vomiting, impurities, apnea, aspiration, dysphagia
• normal development, good appetite and general state

Treatment:

• feeding children when spitting up: sitting, the child is at an angle of 45-60 degrees, holding him in horizontal position 10-30 seconds, before feeding, taking rice water ("HIP"), diluted in expressed milk, for children over 2 months old 1 tsp. 5% rice porridge before each feeding
• special mixtures with a thickener (NaN-antireflux, Enfamil A.R., Nutrilon A.R.)

Thickeners: potato or rice starch (has nutritional value, slows down motility), locust bean gum (has no nutritional value, has a prebiotic effect, increases stool volume and intestinal motility)

Rules for taking the mixture: prescribed at the end of each feeding, a dose of 30.0 is sufficient, given in a separate bottle with an enlarged hole in the nipple, can be replaced as the main one for artificially fed children

At the same time, sedatives and antispasmodics are prescribed

If diet and sedatives are insufficiently effective, prokinetics are prescribed:

dopamine receptor blockers – cerucal 1 mg/kg, domperidone 1-2 mg/kg 3 times a day 30 minutes before meals, serotonin receptor antagonists cisapride 0.8 mg/kg.

Aerophagia- swallowing a large amount of air, accompanied by distension in the epigastric region and belching.

More often occurs during feedings in hyperexcitable greedily sucking children from 2-3 weeks of life in the absence or small amount of milk in the mammary gland or bottle, when the child does not grasp the areola, with a large hole in the nipple, horizontal position of the bottle during artificial feeding, when the nipple does not completely filled with milk, with general hypotension.

Bulging in the epigastrium and a boxy sound when percussing over it. After 10-15 minutes, regurgitation of unchanged milk with a loud sound of escaping air. May be accompanied by hiccups.

X-ray shows an excessively large gas bubble in the stomach.

Treatment: normalization of feeding techniques, sedatives for excitable children and consultation with a psychotherapist.

Functional dyspepsia

– a symptom complex including pain and discomfort in the epigastrium. Occurs in older children.

Causes:

• nutritional – irregular meals, sudden changes in diet, overeating, etc.
• psycho-emotional – fear, anxiety, dissatisfaction, etc.
• Disruption of the circadian rhythm of gastric secretion, excessive stimulation of the production of gastrointestinal hormones, leading to the secretion of hydrochloric acid
• impaired motor function of the upper gastrointestinal tract due to gastroparesis, impaired antroduodenal coordination, weakened postprandial motility of the antrum, impaired distribution of food within the stomach, impaired cyclic activity of the stomach in the interdigestive period, duodenogastric reflux.

Clinic:

• ulcer-like – pain in the epigastrium on an empty stomach, relieved by food, sometimes night pain
• dyskinetic – feeling of heaviness, fullness after eating or not related to food, rapid satiety, nausea, belching, loss of appetite
• nonspecific - complaints of pain or discomfort of a changing, indistinct nature, rarely recurring, no connection with food.

Diagnosis only by exclusion of diseases with a similar clinic (chronic gastritis, ulcer, giardiasis, chronic diseases liver and biliary tract). To do this, use FEGDS, a study on Helicobacter, abdominal ultrasound, fluoroscopy with barium, 24-hour monitoring of intragastric pH, to study motor function - electrogastrography, rarely scintigraphy. A diary is kept for 2 weeks (time of intake, type of food, nature and frequency of stools, emotional factors, pathological symptoms).

Rome criteria:

• persistent or recurrent dyspepsia for at least 12 weeks in the last 12 months
• lack of evidence organic disease, confirmed by a thorough history taking, endoscopy, ultrasound
• lack of association of symptoms with defecation, with a change in the frequency and nature of the stool

Treatment: normalization of lifestyle, nutrition and diet

In the ulcer-like variant, H2-histamine blockers are prescribed famotidine 2 mg/kg 2 times a day, PPI omeprazole 0.5-1 mg/kg/day for 10-14 days

With a dyskenitic variant of prokinetics, motillium 1 mg / kg / day or cisapride 0.5-0.8 mg / kg 3 times a day 30 minutes before meals for 2-3 weeks

For a non-specific variant, a psychotherapist.

If Helicobacter is detected - eradication

Functional disorders of the small and large intestines:

Intestinal colic.

Occurs as a result:

• excessive gas formation, gases stretch the intestinal wall, causing pain
• digestive and motility disorders - food retention in the stomach and intestines, constipation and excessive fermentation
• visceral hypersensitivity, i.e. increased pain perception due to immaturity of the enteric nervous system

Symptoms:

• appear in 1-6 months, more often in the first three
• episodes of crying more often 2 weeks after birth (rule of 3 - crying more than 3 hours a day, more than 3 days a week, at least one week)
• extremely sharp uncontrollable screaming, sudden onset, for no apparent reason, cannot be calmed by normal means
• signs of colic: red face, clenched fists, tucked legs, tense, swollen belly
• normal weight gain, good general condition
• calm between episodes of colic

Treatment:

• correction of the mother’s diet (exclude cucumbers, grapes, beans, corn, milk)
• in case of fermentopathy, exclude adapted mixtures based on hydrolyzate; in case of lactose deficiency, lactose-free mixtures (enfamil, lactofri, NAN lactase-free)
• Uses NAN-comfort mixture
• correction of intestinal microflora (pro- and prebiotics)
• adsorbents (smecta)
• enzymes (Creon)
• defoamers (espumisan, disflatil)
• myotropic antispasmodics (no-spa)
• carminative herbs – mint, fennel fruits

Functional constipation

– dysfunction of the intestine, expressed in an increase in the intervals between acts of defecation, compared with the individual physiological norm or systematic insufficiency of bowel movement.

Causes:

• disturbance of nervous and endocrine regulation – vegetative dystonia, disturbance of spinal innervation, psycho-emotional factors
• suppression of the urge to defecate
• intestinal infections suffered at an early age (development of hypogangliosis)
• nutritional factors – lack of dietary fiber (30-40 g/d), poor diet
• endocrine pathology – hypothyroidism, hyperparathyroidism, adrenal insufficiency
• weakening of the muscles of the anterior abdominal wall, diaphragm, pelvic floor due to hernias, exhaustion, physical inactivity
• anorectal pathology – hemorrhoids, anal fissures
• side effects medicines

Two mechanisms of formation: a decrease in propulsive activity and a slowdown in transit throughout the intestine (hypotonic constipation) and a violation of the movement of contents along the rectosigmoid region (hypertensive constipation). The feces thicken, causing pain and reflex retention. Extension distal sections intestines, decreased receptor sensitivity, even greater decrease in feces.

Clinic: the stool is compacted, fragmented or resembles “sheep stool”. Sometimes the first portions are dense, then normal. After the first constipation, stool periodically passes in large volumes, and may become liquefied. There may be pain in the lower abdomen or diffuse pain, which disappears after defecation. Abdominal bloating, palpation of dense stool in the lower left quadrant. It is not always possible to distinguish between hypo- and hypertensive. When hypotonic, they are more severe and persistent, with smearing and the formation of stones.

Diagnostic criteria, at least 2 criteria within 1 month in a child under 4 years of age

• 2 or fewer bowel movements per week
• at least 1 episode per week of fecal incontinence after toilet training
• history of prolonged stool retention
• history of painful or difficult bowel movements
• the presence of a large amount of feces in the colon
• history of large-diameter stool that clogged the toilet

The diagnosis is established by history and objective data. Dense stool can be objectively palpated. Rectally, the rectum is filled with dense feces, the anal sphincter may be relaxed.

Additional studies to exclude organic pathology:

• digital rectal examination – condition of the ampulla, sphincter, anatomical disorders, blood behind the finger
• endoscopy - condition of the mucosa
• colonodynamic study - assessment of motor function

Differential diagnosis with Hirschsprung's disease, hypertrophy of the internal anal sphincter

Treatment: diet - for children under one year of age, mixtures with prebiotics (NAN-comfort, Nutriln comfort), with gum (Frisov, Nutrilon A.R.), lactulose (Semper-bifidus), for older children, fermented milk products enriched with bifido- and lactobacilli. Consumption of dietary fiber (coarse fiber cereals, bread, bran).

Active lifestyle, sports, running. If ineffective, prescribe:

• hypertension – anticholinergics (spasmomen, buscolan), antispasmodics (dicetel)
• hypotension - cholinomimetics (cisapride), anticholinosterases (prozerin)
• laxatives – lactulose (Duphalac 10 ml/day). Cleansing enemas with a delay of more than 3 days.

Irritable bowel syndrome

– a complex of functional intestinal disorders lasting over 3 months, the main clinical syndrome which are abdominal pain, flatulence, constipation, diarrhea and their alternation

Etiology:

• intestinal motility disorder
• diet violation
• neurogenic disorders associated with external and internal nervous regulation
• impaired sensitivity (hyperreflexia as a result of muscle overstretching, impaired innervation, inflammation)
• disruption of the gut-brain connection - psychological disorders.

Clinic:

• pain of varying intensity, relieved after defecation
• stool frequency more than 3 times a day or less than 3 times a week
• hard or bean-shaped stool that is thin or watery
• imperative urge to defecate
• feeling of incomplete bowel movement
• feeling of fullness, distension, bloating

Characterized by variability and variety of symptoms, lack of progression, normal weight and general form, increased complaints during stress, association with other functional disorders, pain occurs before bowel movement and goes away after it.

Diagnostic criteria:

abdominal discomfort or pain for 12 weeks in the last 12 months. In combination with two of the 3 signs:

Associated with changes in stool frequency

Associated with changes in stool shape

Stopped after defecation

Research: HOW, used, stool analysis occult blood, coprogram, irrigography, sigmocolonoscopy, stool culture for intestinal pathogens, eggworm, colonodynamic and electromyographic study of the colon.

Treatment:- daily routine and diet (reducing carbohydrates, milk, smoked foods, soda). If it's not effective.

Functional stomach disorder - when parents overfed

As a result, manifestations of gastric dyspepsia arise (digestion problems, digestion of food and its absorption), while there are no morphological (structural) disorders in the area of ​​the gastric mucosa (no gastritis, ulcers, erosions, etc.). These functional disorders in the structure of the pathology of the digestive system occupy about 35-40% of all digestive disorders, and they are often man-made, that is, the parents themselves provoke these disorders - by feeding their children too much, or with foods that are inappropriate for their age.

What are the causes of indigestion?

The mechanism of development of functional disorders

The basis of these functional stomach disorders are disturbances in the normal daily rhythm of gastric juice secretion and active contractions of the stomach due to too active changes in muscle tone or the nervous system, disturbances in the functioning of the regulatory systems of the hypothalamus and pituitary gland, changes in the tone of the nerves and the formation of stomach spasms. Also, an important role is played by the increased production of special digestive gastric hormones due to external and internal factors - for example, due to passive smoking, worms, or enzyme inhibition due to illness, overheating, overwork and stress.

For reasons and mechanisms of development, functional disorders of the stomach are:

1. primary or external, caused by exogenous factors,
2. toric, internal, caused by diseases.

1. disorders of the motor type (that is, motor activity of the stomach), these include gastroesophageal reflux or duodenogastric - this is the reverse reflux of contents from the intestine into the stomach or from the stomach into the esophagus. This includes spasms of the stomach and spasms of the esophagus.
2. Secretory-type disorders are an increase or decrease in gastric secretion with disruption of food processing by enzymes.

Functional disorders stomach problems can manifest themselves with all sorts of symptoms, both localized in the area of ​​​​the projection of the stomach itself, and somewhat distant from it, and even completely remote from the stomach, but, nevertheless, caused precisely by problems with digestion. But typical for all functional disorders in the stomach are:

1. episodic manifestation of problems, short-term manifestations, their constant variability, attacks are not similar to each other.
2. The examination does not reveal any abnormalities in the structure of the mucous membrane, there are no erosions, injuries, ulcers, etc., and there are no changes in the histological structure of the stomach.
3. symptoms mainly appear under stress, off-season, weather changes and other phenomena that, one way or another, affect the functioning of the autonomic nervous system and the central nervous system,
4. There is a connection with nutritional factors, especially in the context of taking new foods, fatty, heavy, spicy, fast foods and other errors in eating.
5. Almost always a negative neurotic background, the presence of diseases of the digestive system, excretory system or endocrine system are revealed.
6. In addition to digestive disorders, children also experience irritability and excessive emotionality, sleep problems, hyperhidrosis (excessive sweating), fluctuations in blood pressure and pulse instability.

The most common and most common symptom of a functional indigestion will be the occurrence of pain in the stomach and abdominal area, there may be pain of a different nature, but most often it is a paroxysmal nature of the pain, pain of a colicky nature, the localization of which is constantly changing, and predominantly the pain is concentrated on different sides around navel At the same time, with such functional pain, antispasmodic drugs are of great help.

Less commonly, there is a feeling of heaviness in the stomach, attacks of belching, including rotten or sour ones, nausea and even vomiting. Frequent vomiting can be a sign of pylorospasm, a functional disorder of motility at the junction of the stomach with the intestines, but with cardiospasm, convulsive contractions in the area of ​​the transition of the esophagus into the stomach, there may be problems with swallowing food and regurgitation of undigested food. Sometimes vomiting while eating a fountain.

Usually, when palpating the abdomen in children, they do not show signs of severe pain in the abdomen; there may be slight pain in the epigastric region (under the lower part of the sternum), but the pain is not constant and quickly goes away on its own.

How is the diagnosis made?

Typically, the diagnosis of “functional stomach disorder” is made by excluding all organic pathologies of the intestine and lesions of a morphological nature. First of all, a detailed questioning and examination of the child is important for the doctor to rule out gastritis, peptic ulcer stomach and intestines, erosions, organic pathology. But often the data from the parents’ stories and their complaints is not enough to establish an accurate diagnosis - the manifestations of many digestive diseases of a functional and organic nature are very similar to each other.

It is also important to assess the secretory ability of the stomach - to examine the quantity and quality of gastric juice by probing and pH-metry. Normal or slightly increased secretion of juice is usually noted. It is also worth noting the presence or absence of motor disorders - sphincter spasm, increased peristalsis, problems with the esophagus and duodenum - reflux.

Sometimes it is necessary to carry out samples of gastric juice with a load of special drugs that both stimulate and suppress peristalsis and secretion - these can be gastrin, secretin, histamine, physical activity.

How is this treated?

First of all, the basis of treatment and preventive measures to eliminate functional indigestion is to eliminate the root causes of its occurrence. First of all, therapy includes the normalization of children's nutrition with the quantity and quality of food appropriate for their age. Their menu must exclude spicy and fatty foods, fried, smoked and highly salted foods, coffee and soda, chips, crackers, sausage, chewing gum and lollipops.

The child should eat regularly, it should be hot food, definitely soups, and meals should be strictly at the same time. In the vast majority of children, normalization of diet and nutrition leads to a significant improvement in their condition.

It is also necessary to correct all underlying diseases, autonomic disorders - vagotonic drugs with a sedative effect, sedative herbs and infusions, psychotherapeutic measures and minor tranquilizers. Preparations like phenibut - vegetative correctors - are excellent for treating symptoms of vegetative dystonia; adaptogen drugs - golden root, eleuthorococcus, ginseng - help. Treatment methods such as acupuncture and acupuncture, electrophoresis with calcium, bromine, vitamins, the use of massage and electrosleep, water procedures and physical therapy are excellent in eliminating autonomic disorders. Usually, correction of the digestive disorders themselves when the causes are eliminated is no longer required, since after the causes are eliminated, the symptoms of the disorders disappear.

In case of gastric motility disorders, drugs and correction agents may be indicated - for colicky and cramping pain, antispasmodics and antispasmodic herbs, nitrates, and calcium channel blockers are used. If vomiting and nausea occur, prokinetics such as cerucal or imotilium may be needed.

If disturbances in gastric secretion occur, it is necessary to use antacids (in case of increased secretion and acidity), and in case of very high acidity - anticholinergics. Usually treatment is quick and prevention measures and a healthy lifestyle are more important.

Prevention measures are simpler than ever - leading a healthy lifestyle from birth and proper nutrition, which does not violate the motility and secretion of digestion. It is important to strictly adhere to the daily routine and nutrition, compliance of products with age limits, and adequate physical and emotional stress on the child. A baby with a functional stomach disorder will be registered with a pediatrician or gastroenterologist for one year, his complaints will be assessed, all vegetative and digestive disorders will be corrected, and measures will be taken for physical and psychological rehabilitation. Usually, only preventive doses of sedatives or herbs, normalization of exercise and proper nutrition are sufficient; after a year, the dispensary observation is removed and the child is considered healthy.

Under unfavorable conditions and in the absence of adequate observation and treatment, functional indigestion can develop into more serious pathologies - gastritis and gastroduodenitis, ulcerative processes in the stomach and intestines. And these processes are already chronic and may require almost lifelong treatment.