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INTRODUCTION

Problem urgency

Functional disorders of a gastroenteric tract (FRZHKT) take an appreciable place in structure of a pathology of organs of digestion. According to many researches, on functional disturbances it is necessary to 90 % of all pathology GASTROINTESTINAL TRACT at early age.

Analyzing publications of last years, it is possible to notice, that this problem draws the increasing attention of researchers [5, 6, 27, 53].

According to the definition given in the Roman criteria, to FRZHKT carry those conditions at which it is not possible to find out the morphological, genetic, metabolic, biochemical and structural changes explaining observed clinical symptoms [64, 102]. In pediatric practice diagnosis FRZHKT as nosological unit, till now it is put with certain difficulties. It is bound to absence of the uniform approach to treatment and diagnostics. Therefore prevalence FRZHKT is not found out from children till today and demands the further studying [103]. According to a number of authors, on share FR 30-90 % of all pathology GASTROINTESTINAL TRACT at children of the first year of a life [45, 63] are necessary. The special attention is deserved by the life first half of the year, as the starting and most significant period for definition of health of the child in the future [66].

Pathophysiological mechanisms of development FR remain now a discussion subject. Principal causes of occurrence FR at early age can be: morphological and functional immaturity of organs GASTROINTESTINAL TRACT, imperfection of the central and vegetative regulation, late start of enzymatic activity, feature of formation of a microflora of an intestine [4, 27]. Owing to subjectivity of an estimation and the raised uneasiness of parents, and also attempts of the independent treatment, symptoms available for the child are often treated and treated incorrectly [177].

According to the modern classification recommended by group of world experts and accepted by the Roman criteria III, distinguish following variants FRZHKT at children of the first half of the year of a life: infantile regurgitations (MS), infantile intestinal gripes (MKK), functional constipations (FZ) and infantile dishezija [92, 100, 103]. Symptom-complex FR can have similarity to other diseases GASTROINTESTINAL TRACT, that demands carrying out of the differential diagnosis. On the other hand, long current FR at early age can become complicated secondary disturbances, such as a syndrome of superfluous bacteriemic growth, fermentopatii, that can cause persistence and intensifying of symptoms, and also occurrence and aggravation of inflammatory changes in a mucosa GASTROINTESTINAL TRACT [15, 16, 40, 43-45, 59, 62-64].

For finding-out of individual mechanisms of functional disorders at each child are necessary reliable, it is desirable - non-invasive methods of diagnostics. Imperfect for today are both diagnostics, and treatment FRZHKT at early age. It is bound not only to wrong statement of the diagnosis, but also with wrong understanding of a short and mechanisms FR [2, 5, 57-59, 95, 106].

Research objective

To study clinical value laktaznoj insufficiency and disturbances intestinal mikrobioty at functional disorders of a gastroenteric tract at children of early age and to develop optimum ways of their correction.

Research problems

1. To study structure of functional disorders of a gastroenteric tract at children of the first half of the year of a life.

2. To establish possible risk factors of development of functional disorders of a gastroenteric tract at children of early age.

3. To establish value transitional laktaznoj failures as the reasons of symptoms of functional disorders of a gastroenteric tract.

4. To establish interrelation of changes of an intestinal microbiocenosis and inflammation signs in an intestine at functional disorders zheludochnoyokishechnogo a tract.

5. To estimate efficiency of enzyme of a lactase (v-galaktozidazy) at children with functional disorders in a combination with laktaznoj insufficiency.

6. To estimate efficiency probioticheskogo strain L. reuteriсоставе a milk admixture and in drops, depending on a feeding kind, at functional disorders of a gastroenteric tract.

Scientific novelty of work

1. The technique of carrying out of the hydrogen respiratory test at children of the first months of a life that has allowed to diagnose laktaznuju insufficiency at symptoms of functional disorders zheludochnoyokishechnogo a tract is developed.

2. Value transitional laktaznoj failures as the reasons of symptoms of functional disorders of a gastroenteric tract at children of the first half of the year of a life is established.

3. Connection of functional disorders of a gastroenteric tract with changes intestinal mikrobioty and inflammation signs in an intestine is established.

The practical importance

1. Diagnostics laktaznoj failures at children of the first months of a life by means of the hydrogen respiratory test is improved.

2. The algorithm of diagnostics and treatment of functional disorders of a gastroenteric tract at early age is developed.

Approbation and introduction of results in practice

On dissertation materials 9 printing works, including 3 publications in the magazines recommended VAK are published. Results of research are reported at scientifically-practical conferences DGKB № 5 of St.-Petersburg in 2013, within the limits of the Slavjano-Baltic scientific forum in 2012 and 2013 and on the international congress The 27th Congress of the International PediatricAssociation (Melbourn, Australia, on August, 24-29th, 2013). The demand is submitted to Rospatent on the invention Way of non-invasive diagnostics of intolerance of lactose, registration № 2013131663, date of giving 9.07.2013 years, entering № 047329.

Volume and dissertation structure

The dissertation consists of following sections: introductions, the review of the literature, the description of a material and research methods, 4 heads of own researches, discussion of the received results, conclusions, practical references, the list of the literature including 72 domestic and 105 foreign sources, and 2 appendices. Work is stated on 162 pages of the typewritten text, illustrated by 64 tables and 53 drawings.

The personal contribution of the author

The author has developed an advanced technique of carrying out of the hydrogen respiratory test to children of the first year of a life and personally carried out research with its help of all children. The author personally participated in scheduling, working out of a computer database, the collecting and processing of the medical information, mathematical both statistical processing and the analysis of the received results. The author personally spent questionnaire of parents. All children of investigated groups are examined personally by the author.

The substantive provisions which are taken out on protection

1. Transitional laktaznaja insufficiency can cause symptoms of functional disorders more than at third of children of the first months of a life. It demands special diagnostics, the hydrogen respiratory test with lactose is optimum.

2. In structure of functional disorders of a gastroenteric tract at children of early age combinations of infantile regurgitations and infantile intestinal gripes, irrespective of presence or absence laktaznoj failures dominate. There is certain age dynamics of various functional disorders and some dependence of implications on a feeding kind.

3. High frequency of a pathology perinatalnogo the period at children with functional disorders of a gastroenteric tract: the pathology of pregnancy of mother, a delivery by cesarean sections, application of antibiotics in sorts, a prematurity, dokarmlivanie an admixture in maternity home, can be surveyed as risk factors of development of functional disorders of a gastroenteric tract.

4. The raised quantity of an is conditional-pathogenic microflora as a part of intestinal mikrobioty children of early age with functional disorders of a gastroenteric tract can cause more expressed inflammation in an intestine which strengthens semiology.

5. Functional disorders of a gastroenteric tract demand the differentiated approach to therapy. At established by means of the hydrogen respiratory test laktaznoj failures appointment of enzyme of a lactase (v-galaktozidazy) is effective, at its absence - probiotika L. reuteri: at artificial feeding - as a part of an admixture, at thoracal - in drops. Such approach promotes depression of expression of symptoms of functional disorders of a gastroenteric tract, correction of disturbances of a microbiocenosis and elimination of signs of an inflammation in an intestine.

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Scientific source KUBALOVA Saida Sultanovna. CLINICAL VALUE LAKTAZNOJ of INSUFFICIENCY And MICROBIC DISTURBANCES AT FUNCTIONAL DISORDERS of the GASTROENTERIC TRACT At CHILDREN of EARLY AGE. The dissertation on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg - 2014. 2014

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