Chapter 4 Discussion of the received results

It is known, that disturbances of a motility of organs of digestion are one of most often met symptoms of a pathology zheludochnoyokishechnogotrakta (GASTROINTESTINAL TRACT), especially in pediatric practice.

As is known, so-called recurrent abdominal pains have functional character at 90-95 % of children and only at 5-10 % are bound to the organic reason [110]. FNOP are bound in larger degree to disturbance of nervous, humoral, metabolic and local regulation [110].

The purpose of the given work was on the basis of complex research of character of disturbances of a motility of organs of digestion of functional character at children to study their possible consequences, to define prognostic markers and to optimise spent therapy for the purpose of rising of its efficiency

Inspection of 91st child (44 boys and 47 girls) at the age from 3 till 18 years, with GER and functional diseases of a colon, 35 and 56 children accordingly, and also the retrospective analysis of case histories of patients with GER and FZTK has been spent. For a motility estimation it was gastrointestinal tract spent peripheric elektrogastroenterografija (PEGEG), concerning a simple non-invasive method of an indirect estimation of impellent function GASTROINTESTINAL TRACT, based on registration, a filtration and a spectral analysis of the biological potentials registered from a surface of a body of the person (Shede H., Clifton J., 1961; Christensen J., 1971) [45]. For an estimation of a condition of a microflora the spectrum of flying fat acids in a chair was estimated, and also the respiratory test with which help it is possible to tap a syndrome of superfluous bacteriemic growth in a thin intestine was carried out. Studying KZHK in
Feces possesses high sensitivity and specificity (on the average 81 % and 87 % accordingly) in comparison with traditional bacteriological research of a feces (66 % and 41 % accordingly), and allows to survey from new positions questions eubioza and a dysbacteriosis of an intestine [4].

Despite the general representation fixed documentary in the Roman consensus, about FNOP as diseases with a favorable current, practically experience prompts, that their long current can become complicated development of serious structural disturbances [75].

In the scientific literature also there are separate, but not numerous data specifying in possibility of transformation of functional disturbances, and also on possibility of a combination of various variants FNOP. According to H.Piessevaux and co-workers. At 33,8 % of patients with a functional dyspepsia (FD) symptoms GER, and according to J.Keohane and E.M.Quigley - at 70 % of patients [56, 67, 87, 103] are observed also. Frequency of signs SRK at patients FD according to M.Corsetti and co-workers. Makes 46 % [67].

It is interesting, that according to S.L.Halder and co-workers. Approximately in 40 % of cases patients with FD or SRK within 12 years have "switching" of symptoms from one disease on another [65,83].

At last, in A.I.Havkna's research and co-workers. It has been shown, that serious infantile gripes at children of the first months of risk is a risk factor of development of functional abdominal pains at the age of 3-6 years and further formation SRK aged is more senior 10 years [50, 51].

At the first stage of the present research the retrospective analysis of current GER of a functional parentage of 120 children hospitalised in gastroenterologicheskoe unit RDKB has been carried out.

By results of the retrospective analysis of case histories of patients with GER, from 120 patients with diagnosis GER, at 50 children chair disturbance (42 %) is observed, from them at 40 patients diagnosis SRK further has been established with
Diarrhoeia and at 10 patients constipations of a functional parentage become perceptible. The obtained data specifies in system character of functional disturbances of a motility of organs of digestion.

To a consequence at 24 children with functional GER (20 %) at the age from 12 till 14 years GER it was transformed in GERB. Thus the cardia polyp has been diagnosed for 15 children, and an enteric metaplasia of a mucosa of an esophagus - at 2 children. The given transformation in all cases has occurred against long existence functional GER and it is possible to assume, that timely diagnostics and adequate therapy allow to avoid development of serious complications. Also it would be desirable to note, the important role as in development GER, and its transformation in GERB dysplasias of a connecting tissue. According to J.S.Apenchenko, I.I.Ivanovoj, S.F.Gnusaeva (2006) [2], the alimentary system lesion often enough meets at hereditary diseases of a connecting tissue (ST), thus the brightest implications are symptoms from an esophagus. At system dysplasia ST at 80 % of teenagers the digestive tube pathology was the leader in clinic. It is besides, shown, that involving gastrointestinalnogo a tract at diseases ST is taped much more often, than clinical semiology. According to Belmera S.V. and Privorotsky Century F, the important contributing factors of development GERB are the undifferentiated dysplasia of a connecting tissue, and also adiposity and a slipping hernia of an esophageal aperture of a diaphragm (SGPOD) [2, 9,18, 26, 41].

So, among 24 children with GERB, included in the present retrospective analysis at a two serious hereditary disturbances of a connecting tissue in the form of syndromes Tel-Hashomera and a syndrome Elersa - Danlosa 1 type (classical) have been taped.

Proceeding from the spent analysis, it is possible to consider, that risk factors
Transformations GER in GERB are also the early beginning and, as consequence, a long current of the disease, inadequate and late begun therapy, presence of a connective tissue dysplasia, a male (among 24 patients with GERB - 17 boys and 7 girls). Adiposity or superfluous mass of a body at the given group of patients it is not taped.

The idea of widespread character of TNFS of a motility GASTROINTESTINAL TRACT has found the acknowledgement at the analysis of results PEGEG. It has been established, that at GER electric activity of the bottom departments zheludochnoyokishechnogo a tract is broken, and at constipations of a functional parentage - top. However character of these changes differs in two surveyed groups of patients.

The received results are resulted in earlier presented tables and generalised in charts more low.

Though indicators of absolute power (Pi) are difficult enough for interpreting owing to absence of the fulfilled standard value (that is bound to a wide range disorder in norm) nevertheless it is obvious various postprandialnaja an orientation of value at GER and constipations. In the first case the tendency to rising of value in a stomach, DPK and a jejunum, while in the second - the tendency at depression is observed. At the same time in a colon postprandialnaja reakija sonapravlena both in at GER, and at constipations.

Average value of relative power (Pi/Ps) in various departments GASTROINTESTINAL TRACT were basically similar as at GER and FZTK, and authentic by differences between groups has not been taped. Authentically in comparison with norm the stomach motility (30,26±1,30 has been strengthened at GER and 30,28±1,07 at constipations, in comparison with norm 22,41±1,2, p

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Scientific source AKOPJAN AJARPI NORIKOVNA. Diagnostics and treatment of functional disturbances of a motility of organs of digestion at children (electromyographic and metabolic aspects). The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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