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Introduction

Problem urgency

Disturbances of a motility of organs of digestion are one of most often met symptoms of a pathology of a gastroenteric tract (GASTROINTESTINAL TRACT). With some share of convention they can be parted on primary, bound to an organic pathology (anomalies of the development, the got diseases, etc.) And secondary (functional), bound to disturbance of nervous, humoral, metabolic and local regulation.

Functional disturbances of a motility can be unique implication of illness, but are more often accompanied by disturbance of other functions GASTROINTESTINAL TRACT: disturbances of secretion, digestion, an absorption, a condition of a microflora, activity of immune system. Advance of one functional disorder inevitably leads to disturbance of all other functions GASTROINTESTINAL TRACT [15,16,77]. In particular, 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]. For statement of the diagnosis of functional disturbances of the alimentary system it is necessary to exclude morphological and-or biochemical substrate of disease. For this purpose the all-round complex inspection which key elements are endoscopic research with a biopsy for an exception inflammatory, erosive, ulcerative, etc. lesions, and also radiological inspection - for an exception of anomalies GASTROINTESTINAL TRACT [96,97] is required.

Research objective: 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

Research problems:

1. To study the nearest and remote consequences of functional disturbances of a motility of organs of digestion at children on the basis of the retrospective analysis of case histories.

2. To study features of a motility of organs of digestion at children with

Functional disturbances with use peripheric elektrogastroenteromiografii.

3. To study metabolic activity of an intestinal microflora at children with

Functional disturbances of organs of digestion on the basis of a spectrum estimation korotkotsepochechnyh fat acids in a chair.

4. To define possibility and efficiency of application prokinetikov in therapy of functional disturbances of a motility of organs of digestion at children.

5. To develop on the basis of the received data of a way of optimisation of diagnostics and treatment of functional disturbances of a motility of organs of digestion at children.

Scientific novelty

For the first time on the basis of complex studying of a motility zheludochnoyokishechnogo a tract at children with FNOP the concept of unity of a lesion of various departments GASTROINTESTINAL TRACT is developed.

For the first time on the basis of results PEGEG character of disturbances of a motility of the bottom departments of a digestive tube at children with GER a functional parentage, and also the top departments at children with functional constipations is defined

For the first time it is studied metabolic activity of a microflora of a colon at functional disturbances of a motility of the top departments GASTROINTESTINAL TRACT.

For the first time application prokinetikov, influencing is proved on
Motility of all departments GASTROINTESTINAL TRACT (including, the bottom departments) at children with GER.

Possibility of transformation of one variants FNOP in others, and also possibility of transformation FNOP in an organic pathology is shown.

For the first time with use of method PEGEG and studying of spectrum KZHK influence prokinetikov both on a microflora of an intestine and on a motility is shown GASTROINTESTINAL TRACT at sochetannom disturbance of its various departments.

The practical importance

Possibility and value of application PEGEG as simple and non-invasive method of diagnostics of a condition of a motility of organs of digestion at children with funktsonalnymi disturbances GASTROINTESTINAL TRACT are shown.

It is shown, that method PEGEG can be applied to revealing of clinically latent disturbances of a motility of organs of digestion at children, an estimation of their character, differential diagnostics of functional diseases of organs of digestion, and also for an estimation of efficiency of spent therapy.

During research the most informative indicators PEGEG which can be used in practical pediatrics have been allocated.

For diagnostics FNOP of the top and bottom departments the complex approach with use PEGEG and definition of level KZHK in a chair the GZHH-ANALYSIS method is proved.

At revealing FNOP in therapy can be to use a preparation trimebutin which renders modulating effect on a motility of all departments of the alimentary system through peripheric opiatnye the receptors, located on gladkomyshechnyh cells on all extent GASTROINTESTINAL TRACT.

The positions which are taken out on protection

1. Functional disturbances of organs of digestion have widespread character, covering all departments GASTROINTESTINAL TRACT, irrespective of prevailing clinical semiology.

2. Functional disturbances GASTROINTESTINAL TRACT can be transformed in time: at children with functional GER can develop gastroezofagealnaja refljuksnaja illnesses, including a metaplasia of a mucosa of an esophagus.

3. PEGEG is vysokoinformativnym a method of research of a motility GASTROINTESTINAL TRACT which allows to tap the latent disturbances framing a basis for further transformation FNOP.

4. As at GER, and ZFP essential shifts in metabolic activity of the intestinal microflora, the reflecting changes of its structure having similar character, the motilities substantially caused by disturbances are observed.

5. Use in therapy FNOP at children prokinetikov allows to normalise a motility GASTROINTESTINAL TRACT and to liquidate disturbances of an intestinal microbiocenosis.

Introduction in practice

Results of the spent researches are used in work of II therapeutic unit of hospital № 13 of N.F.Filatova and unit of gastroenterology of the Russian Children's Hospital.

Work approbation

Dissertation substantive provisions are reported and discussed at the All-Russia scientifically-practical conference with the international participation the Functional pathology in children's gastroenterology,
Samara. On September, 25-26th, 2013, 6th European Pediatric GI Motility Meeting. Brussels, Belgium. 3-5, XI Russian Congress Innovative technologies in pediatrics and children's surgery. Moscow. On October, 22-24nd, 2012, XXI International Congress of children's gastroenterologists of Russia and the CIS countries, Moscow. On March, 18-20th, 2014, 16th International Slavjano-Baltic scientific forum St.-Petersburg - Гастро-2014. St.-Petersburg on May, 19-21th, 2014

Dissertation approbation is spent on faculty meeting of hospital pediatrics № 2 RNIMU of N.I.Pirogova.

Personal participation of the author of dissertation

The author immediately participated in the organisation and work carrying out: at a formulation of the purpose and research problems, working out of methodical approaches, a set of a clinical material, carrying out of functional methods of researches, statistical processing, the analysis and interpreting of the received data.

Publications

On a dissertation theme 7 printing works, including 5 articles in the magazines reviewed VAK the Russian Federation are published.

Volume and dissertation structure

The dissertation consists of introduction, 4 heads, the conclusion, conclusions, practical references, the literature list. Work is illustrated by 38 tables and 10 drawings. The bibliographic index contains 117 sources, from them 55 domestic and 62 foreign authors.

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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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