1 modern representations about a chronic gastritis at juvenilnom a chronic arthritis

Chronic gastritis — a chronic inflammation of a mucosa of the stomach, accompanied by disturbance of physiological neogenesis of an epithelium and thereof an atrophy, disorder motor and it is frequent inkretornoj functions of a stomach [91].

Prevalence of a chronic gastritis makes from 30 to 50 % of the population of the Earth. In Russia at children the chronic gastritis (HG) is today one of the most widespread and socially significant diseases (from 153%о to 235%о in children's population) [36, 80].

Standard classification HG is the Sydney classification of a chronic gastritis which has been accepted in 1990 [122]. According to this classification allocate three principal views of gastritises: acute, chronic and special (special) forms.

The Sydney classification of a chronic gastritis

Gastritis type

• Acute

• Chronic

• "Special" (special) forms:

• the reactive;

• the lymphocytic;

• the eosinophilic;

• the hypertrophic;

• granulematoznyj;

• others.

Lesion localisation

• Antral department

• a stomach Body

Morphological changes

• inflammation Degree

• Activity of an inflammation

• the Atrophy of gastric glands

• the Metaplasia

• Dissemination mucous N pylori

Etiological factors

• Infectious (N pylori), etc.

• not Infectious:

_ the autoimmune

_ the alcoholic

_ postgastrorezektsionnyj

_ caused by reception NPVS

_ caused by chemical agents

The description of morphological changes is supplemented with the description of endoscopic categories of gastritises:

Erimatoznyj/ekssudativnyj a gastritis (a superficial gastritis); flat erosions; the raised erosions; a hemorrhagic gastritis; a hyperplastic gastritis; a gastritis accompanied DGR.

The estimation of all signs is necessary for diagnosis statement a chronic gastritis: localisations of pathological process, histological, macroscopical changes in SOZH, etiological factors.

In 1996 the Houston classification HG which is updating of the Sydney system [122] has been published. However at Sidnejskoyohjustonsky classification exist a number of disadvantages: absence
Descriptions of a stage of a current of disease (an exacerbation, remission) and a functional estimation of secretory function of a stomach (the normal, raised or lowered secretion of a hydrochloric acid) [89]. The modified Sydney system is presented in table 1.

Table 1. The modified Sydney system

Type of a chronic gastritis Synonyms Etiological factors
The Neatrofichesky Superficial, diffusive antral, chronic antral, hypersecretory, type In H. pylori, other factors
The atrophic
The autoimmune Type And, diffusive stomach bodies, assotsiirovannyj with a pernicious anaemia The autoimmune
The multifocal H.pylori, features of a food, factors of medium
Special forms
The chemical Reactive reflux - a gastritis, type With Chemical stimuluses, bile,


The radiative Radiation injuries
The lymphocytic Varilomorfnyj, assotsiirovannyj with a Gee's disease Idiopathic, immune mechanisms, gljuten, H.pylori
Not infectious granulematoznyj The isolated granulomatosis Illness the Crone, a sarcoidosis, illness Vegenera, alien

Bodies, idiopathic
The eosinophilic Food allergy, other allergens The allergic
Other infectious Bacteria (except

H.pylori), viruses, mushrooms, parasites

Within the limits of the Sydney system it was offered to allocate two phenotypes helikobakternogo a gastritis classical antral and fundal (multifocal) [62].

It is established, that forecast HG is twisted from localisation of inflammatory changes. So patients with antral astritom in 1 % of cases have duodenal ulcers ("ulcerative" phenotype HG). At fundal and multifocal gastritises at 1 % of patients the carcinoma of the stomach, thus low frequency of development of duodenal ulcers ("cancer" phenotype HG) annually develops. [89].

In 2008 the commission of experts has offered new system of an estimation of a gastritis — system OLGA (Operative Link for Gastritis Assessment) [131, 161, 165]. In this system the estimation of histological signs of expression of an inflammation and an atrophy in antral department (3 bioptata) and a stomach body (2 biostalemates) with the subsequent definition of degree and a stage of a chronic gastritis is applied.

Under gastritis degree in SOZH (nejtrofilnymi leucocytes and mononuclear cells), expression of an inflammation is meant a stage — expression of an atrophy. Such system urged to give full enough characteristic of a gastritis and to reflect its dynamics. For an estimation of a stage of a gastritis the visually-analogue scale [108, 129, 131, 165] is used. System OLGA has advantages: definition of a stage of an atrophy allows to tap risk of development of a carcinoma of the stomach at the patient, there is a possibility of an estimation of retrogress of degree of an inflammation and a stage of an atrophy against
Treatments. Considering necessity of a plural biopsy and a rarity of atrophic changes SOZH at children, this system is seldom used in pediatric practice.

Last years the method of "not morphological biopsy of a stomach» - «Biohit Gastropanel» (Finland), based on a microtablet immunoenzymatic technique [145] has been developed. By means of definition of level of a pepsinogen I (PG I), a pepsinogen II (PG II), gastrina - 17 (G-17) and antibodies to NR in blood serum it is possible to diagnose a gastritis, including an estimation of its gravity and localisation of the centre of a lesion [120,183].

At an atrophic fundal gastritis concentration of level PG I in blood serum owing to partial loss of glands SOZH [106] decreases. In the absence of changes in a mucosa antruma, level PG IIв of blood remains within norm or raises. At patients in the presence of atrophy SOZH of both departments falling of levels PG Iи PG IIв to blood serum is observed, but degree of depression of the last, as a rule, is less. At an atrophic gastritis in antral department SOZH appreciable depression of level PG II [128] takes place. Low level PG I in blood is an immunologic marker of an intestinal metaplasia [101, 128, 183] and a carcinoma of the stomach [184].

G-17v «Biohit Gastropanel» it is regarded, as a biomarker of a condition of a mucosa in antral department SOZH. It is known, that Gastrinums represent the peptides consisting of various quantity of amino acids: gastrin-71,-52,-34,-17,-14,-6. In blood circulate basically G-17 («small Gastrinum») and G-34 («big Gastrinum). In G-cages of a mucosa of antral department of a stomach of 90 % of Gastrinum it is presented gastrinom-17 whereas gastrin-34 is present at a small bowel. It is established, that basal level G-17v to blood serum depends basically on hydrochloric acid secretion in a stomach, while level postprandialnogo G-17svidetelstvuet about morphological condition SOZH in antral department [140]. High level of serumal Gastrinum
At low level PG IIможет to testify to an atrophy of fundal department. If serumal level G-17ne raises, it is a sign of loss of G-cells at the expense of an atrophy mucous antral department SOZH. [138, 184]. At the same time high level of Gastrinum-17 is a peptic ulcer biomarker. As a rule, level of a pepsinogen II at a superficial gastritis in 2-3 times above in comparison with not changed SOZH, thus occurs depression of parity PG I / PG II [179].

According to some authors, rising of level of Gastrinum-17 occurs for the account kislotoproduktsii in an initial stage helikobakternoj infections [110]. Rising of levels PG I and PG IIотмечено at children at Nr - assotsiirovannyh chronic gastritises, thus an atrophy in SOZH is taped seldom. [183].

Raised level PG IIи rising value of parity PG I / PG IIмогут to testify to high acid emission and risk of development of complications gastroezofagelnoj refljuksnoj illnesses (GERB). Raised level PG IIможет to specify in inflammatory process in SOZH, caused by application NPVS. High informativnost a method «Biohit Gastropanel» it is proved in numerous researches at adult patients, however, works devoted to application of the given method for children are individual [35]. It objasnjaet absence of official references of firm-manufacturer on treatment of results «Biohit Gastropanel» at children.

Feature modern HG is current weighting, high frequency of relapses and appreciable number komorbidnyh the diseases bound with HG by uniform pathogenetic mechanisms [25, 45]. Only at 10-15 % of children HG is the isolated disease. Interrelation HG and thyroid gland diseases [55, 58], HG and atopicheskogo a dermatitis [22], HG and a bronchial asthma [160], HG and a diabetes [10, 27], HG and pathologies of an osteal tissue [39, 199], HG and obesities [61] at children is described. Last years have appeared not numerous
Reports on interrelation HG and juvenilnogo an arthritis (JUA) at children [20, 29, 40, 60].

JUvenilnyj an arthritis (JUA) - the arthritis of the unstated reason, lasting more than 6 weeks, developing at children aged is not more senior 16 years. According to E.I.Alekseevoj (2011), prevalence JUA in the different countries fluctuates from 0,05 to 0,6 % in territory of the Russian Federation reaches 62,3, the primary case rate — 16,2 on 100 thousand, thus a mortality is in limits of 0,5-1 %. [7]

For a long time for designation JUA the various spectrum of terms was used: illness Stilla, juvenilnyj an arthritis, juvenilnyj a pseudorheumatism (JURA), an infectious nonspecific arthritis, juvenilnyj a chronic arthritis (JUHA), a deforming arthritis. In 1997 pediatric subcommittee ILAR (the International league of rheumatological associations) in Durban (Southern Africa) under this name unites all arthritises of children's age having a chronic current [11, 95]. Development and advance JUHA is defined by a combination of genetically determined and got defects immunoreguljatornyh the mechanisms starting pathological activation of immune system in reply to potentially pathogenic, and is frequent also physiological stimulus. It leads to fast transformation of physiological acute inflammatory reaction in a chronic progressing inflammation which is integral line JUHA [44, 76].

The pathogenesis of rheumatic illnesses is surveyed from a position of a system inflammation [30, 52, 53, 70, 78]. The Pseudorheumatism results not only in an early invalidism, but also to depression of quality of a life of patients.

The is cellular-mediated and humoral autoimmune answer [51, 199], system disturbances of microcirculation and gemoreologii [1, 46], change of media even balance in an organism [59, 77] are surveyed

Today as the general mechanisms of formation JUHA in a combination to a chronic gastritis [1, 73, 74]. Autoimmune mechanisms

Occurrence JUHA and RA are closely bound to other autoimmune disease - an autoimmune gastritis [105, 181, 196], however

Features of an autoimmune gastritis at children with JUHA are not described.

For JUHA activation of cells both Th1, and Th2 the type, accompanied by a hyperproduction of proinflammatory cytokines, such as interlejkin-1 (IL-1), interlejkin-6 (IL-6), interlejkin-17 (IL - 17), the factor of a necrosis of tumours an alpha (TNF), etc. [37, 162, 177, 180, 194] is characteristic. Thus tsitokinovyj the profile can vary in various phases of disease. At a pseudorheumatism in a chronic stage the augmentation of number of the cells synthesising IL-6, Il-10i TNF becomes perceptible. Levels IL-6 and IL-8, IL-10 IL-1e, TNF are markers of a degree of activity of an arthritis [16, 23]. Thus rising Il-8assotsiirovano with low degree of activity RA. Great value give IL-8 which is surveyed as makrofagalnyj an angiogenesis mediator [26, 37, 82].

At the same time at chronic gastroduodenite changes tsitokinovogo the status in the form of augmentation of level TNF [42, 199], IL-8 [44], IL - 1, Il-6i IL-10 [42, 83] are described. An estimation tsitokinovogo the status at children with HG it was spent not only in blood serum, but also in a gastric juice [83].

Frequency helikobakterioza at JUHA at children makes 85,7 % [29].

As is known, according to a submicroscopy early reaction to becoming infected H. Pyloriявляется a hyperplasia of microvillis that interferes with adhesion of bacteria to a protoplasmatic membrane. Further H. Pyloriосуществляет a destruction of a cellular membrane at the expense of production of proinflammatory cytokines [9]. In turn, cytokines reach a cellular membrane of a gastric epithelium, having blasted a barrier mucous a stomach. Bacteriemic fosfolipazy blast layers fosfolipidov a cellular cover of epitheliocytes, translating a membrane in
Hydrophylic condition. All it reduces fastness of epithelium SOZH to aggressive action of a hydrochloric acid [103, 136, 182].

Persistirovanie HP leads to change of a profile of cytokines at children with HG. Various maintenances IL-6, Il-10v blood and homogenates bioptatov a stomach depending on presence of infection Helicobacter pylori [3] are taped. Pathogenetic interrelations helikobakterioza and an osteoarthritis are found out: HP stimulates production of cytokines TNF, IL-1 and IL-6, promoting aggravation of an osteoarthritis [199]. It is supposed, that at the heart of interrelation of becoming infected H. Pyloriи lesions of joints autoimunnoj the nature lay the two-dimensional reactions bound to a molecular (antigenic) mimicry at H. Pylori [81]; probably H. Pyloriспособствует to development or deterioration of a current of a pseudorheumatism, co-operating with mast cells, initiating liberation of mediators, causing allergic reactions in an organism of the owner as reactions of hypersensitivity of the immediate or slowed down type and reducing barrier function of an intestine that leads to entering of allergens in blood [135].

According to the literature, at Nr-positive sick by a pseudorheumatism are more often taped gastroduodenalnye damages mucous a stomach, than at not infected patients [98]. At the same time there are data, that infitsirovannost NR does not influence frequency of development of erosive and ulcerative changes, but associates with morphological signs of an inflammation [20, 29, 40]. There are reports on regress of clinical symptoms and improvement of laboratory indicators throughout the long period of observations at 40 - 73 % of patients with a pseudorheumatism after eradikatsii H. pylori. [59, 96].

Thus a number of researchers was taped by interrelations between a current of a pseudorheumatism and helikobakteriozom [3, 20, 29, 81, 96, 98, 123,135, 137, 182, 196]. There are data, that eradikatsija NR does not influence level With -
Reactive fiber, marker of an inflammation typical for a chronic arthritis [189].

However large-scale randomizirovannyh researches for an estimation of interrelation of infection H. pyloriи juvenilnogo a chronic arthritis by present time it was not spent also a true role helikobakterioza in genesis JUHA at the moment it is not clear.

Besides H. pylori, there is not studied a role of virus agents which also can promote occurrence of a chronic gastritis. Last years there were reports on a possible trigger role gerpesvirusov, enteroviruses, chlamydias and other originators in formation of inflammation SOZH [14, 72, 75, 97, 200]. Also last years the question on value veb is activly discussed at formation HG at persons of different age [19, 55, 85, 86, 93, 166].

It is known, that the infection of a virus of Epstein - Barr (veb) concerns the most widespread diseases of children's age. 50 % of children catch till 5 years, at the majority of them illness proceeds subklinicheski. Epstein's virus - Barr concerns family gerpesvirusov, to subfamily Gamma Herpesviridae of sort Gymphocryptovirus. The international agency on cancer studying (IARC) carries Epstein's virus - Barr to 1st group of carcinogens with the proved carcinogenicity for the person. Its role in occurrence of such diseases, as limfoma Berkitta, nazofarengialnaja a carcinoma, V-cellular limfoma at immunodefitsitnyh persons [200] is established.

Possibility long persistentsii veb in a stomach and duodenum mucosa that is accompanied by disturbance of local and general mechanisms of nonspecific protection and immunity [9, 43, 103, 119, 170, 176, 186, 197, 203] is established. Becoming infected veb at children is accompanied by more frequent revealing pangastrita and erosive lesions SOZH [65, 86]. Infitsirovannost veb correlates with frequency of revealing and level of autoantibodies to N +/К +-АТФазе parietal cells
Stomach and to factor Kasla [85, 86], that proves to be true in G.V.Volynets's (2006) research in which frequency of an autoimmune gastritis at children having DNA-VEB in a mucosa of a stomach has made 85 % [15].

Morphological changes SOZH in the absence of NR at children with an active phase chronic veb - infections are more expressed, than at children with a latent phase or absence veb - infections [65, 90]. Now the publications describing a role of virus veb in formation of a gastritis at children with JUHA by us it is not taped, however researches in this direction are conducted.

Also the ambiguous role of virus agents, such as viruses of a hepatitis, a rubella, Koksaki, Epstein - Barr (veb) in development of chronic arthritises [17] is shown. Recently the big attention is given veb: at 80 % of patients RA the raised level of antibodies to veb is taped. It is Besides, proved, that veb promotes formation of the rhematoid factor [146, 149, 192]. V-limfotsity patients RA in a larger measure are infected veb, than V-limfotsity healthy people [192, 193]. Antigenic similarity between components of a virus and a site of the V-chain of molecules HLA DW4, DW14, DR, bound to development of a pseudorheumatism and juvenilnogo an arthritis [147, 171] is taped.

Now diskutabelnym there is a question on a role sochetannoj to a virus and bacteriemic infection in formation HG.

According to Junko Minoura-Etoh and co-workers. (2006 [139], at H.pylori - the infected patients antigens of a virus of Epstein - Barr in a stomach mucosa meet authentically more often, than at patients presence Nr-assotsiirovannogo of a gastritis.

Ashish Saxena from co-workers. (2008 [144] have shown, that authentically more often DNA of a virus of Epstein - Barr it is defined at patients with a carcinoma of a stomach and a stomach and duodenum peptic ulcer. Presence simultaneously H. pyloriи Epstein's virus - Barr authentically it is is more often noted at patients with a carcinoma of the stomach (46,8 %) and a peptic ulcer (62,2 %).

At children at revealing of antigens of a virus of Epstein - Barr in SOZH the active gastritis [47] was taped. According to V.N.Neljubina (2011), the damage rate of a mucosa of a stomach depends on level of dissemination and a spectrum of the microorganisms which are present in SOZH [54]. It is shown, that at patients with chronic gastroduodenalnoj a pathology in a mucosa along with H. pyloriобнаружено presence of viruses of group of herpes. Various representatives Herpesviridae (a cytomegalovirus, Epstein's virus - Barr, varitsella zoster, herpes of cheloveka6 th, 7th, 8th types) sochetannaja a virus and bacteriemic infection met from 17 to 44 % of cases, domination of destructive processes in SOZH is thus noted.

In Chuprynovoj M. JU's research (2014) it is established, that one of risk factors of becoming infected SOZH Epstein-Barr virus at teenagers is the carriage of a polymorphic gene-1237TS TLR9. At H. pylori - assotsiirovannom a gastritis the inefficiency eradikatsionnoj therapies can be caused presence veb of an infection, thus within a year after eradikatsii production of antiapoptotic fiber bcl-2 [90] remains.

Persistirovanie is bacteriemic-virus agents in SOZH it is accompanied by features of an immune inflammation. At a becoming infected only H. pyloriместная reaction is accompanied by production IL-2, IL-6, IFN - Yи TNF-a.При persistirovanii viruses - there is a hyperproduction IL - 1в, IL-2, IL-10, IFN-y and TNF-a.При the admixed becoming infected the immune inflammation has raznonapravlennyj character, thus develops on «a dispersing spiral», as causes expressed destructive damages SOZH [54]. Considering feature of an immune inflammation at JUHA, the role of virusno-bacteriemic agents at a rhematoid inflammation remains opened.

The autoimmune gastritis has been described for the first time McIntyre et al. In 1965 at patients with a pernicious anaemia. At these patients the achlorhydria, an atrophy of a mucosa of a stomach and an antibody were observed to
To internal factor Kastla [41]. The Considerable quantity of publications is devoted an atrophic gastritis of a body of a stomach at adult patients [102, 130, 148, 185].

At children, according to various authors, frequency of revealing of an autoimmune gastritis makes from 1-3 % to 14 % [13, 91]. The autoimmune gastritis at children is insufficiently studied till now [14]. As is known the autoimmune gastritis is often combined with other autoimmune diseases: a diabetes of 1st type, autoimmune diseases of a thyroid gland [57, 107].

At the heart of development of an autoimmune gastritis the inflammation of a mucosa FROM) fundal department of the stomach, caused by influence of autoantibodies to parietal cells SOZH that leads to their atrophy [9, 104, 111, 121, 125, 143] lays. At 30 % sick the autoimmune gastritis taps antibodies against N +/К +-АТФазы, blocking function of the proton pump [117,164]. Frequency of revealing of antibodies to Н+К +/АТФ-aze parietal cells of a stomach at a gastritis of type And reaches 90 % and in 25-30 % of cases at a type gastritis In [190]. Correlation between quantity of antibodies and gravity of disease is noted. Thus developing destruction of a mucosa of a stomach is caused an antibody - and komplementzavisimymi by reactions. It leads to death of specific glands which are replaced psevdopiloricheskimi with glands and the intestinal epithelium, leading to atrophy SOZH [150,163,169].

In 36 % of cases the atrophic fundal gastritis is combined with antral which can be caused long persistirovaniem N pylori [116]. In some cases, antibodies to N pyloriмогут to be inductors of development of antibodies to parietal cells of a stomach, promoting development of an atrophic autoimmune gastritis [156, 158].

In the literature there are the individual publications describing role N of a ru_og_-infection at an autoimmune gastritis at children [125, 190]. However there are data, on that that for 27,7 % of children with N to/og / '-assotsiirovannym
The gastritis defines antibodies to N +/К +-АТФазе [133].

The autoimmune gastritis, not assotsiirovannyj with NR is studied insufficiently, especially at children's age. Thus in publications the role of a virus of Epstein - Barr as trigger factor of development of an autoimmune gastritis [14, 15, 31] is described. It is shown, that effective antiviral therapy leads to improvement of morphological picture SOZH and disappearance veb from SOZH, and also to depression of production of antiparietal autoantibodies in blood serum at children [66].

Considering, that at children's age the becoming infected and NR and veb meets often enough [5, 18, 34, 79], an aetiology problem

Autoimmune gastritis is rather actual in pediatrics.

Internal factor Kastla represents one-chained glikoprotein, consisting of 340 amino-acid rests, with molecular weight nearby 44 kda. It is the enzyme produced obkladochnymi by cells of the main (fundal) glands of a mucosa of a bottom and a body of a stomach [121]. Allocate 2 types of antibodies:

I type (blocking antibodies) — block a site of linkage of cobalamine in a molecule of the internal factor, interfere with capture of vitamin B12.

II type (binding antibodies) — is blocked by other sites of a molecule of the internal factor, participating in a complex attachment to receptors of cells. Its role in an organism consists in ability to contact vitamin В12 and to carry out its absorption in a small bowel [121].

Definition of specific antibodies to parietal cells of a stomach and internal factor Kastla method IFA carry to not morphological diagnostic criteria of an autoimmune gastritis [41, 109, 188]. According to some information, revealing of antiparietal autoantibodies is a unique diagnostic marker of a chronic gastritis at children [33]. Frequency of revealing of antiparietal autoantibodies at children with JUHA is unknown.

Pathological changes of organs of digestion at patients with JUHA are caused not only a system inflammation, but also damaging influence of medicinal preparations which is necessary for accepting for a long time to patients.

In treatment JUHA 2 basic groups of preparations [114, 153, 157, 198] are used:

- Symptomatic preparations (nonsteroid antiinflammatory preparations (NPVP) and steroid (hormonal) antiinflammatory preparations)

- Basic preparations influence activity of cells sinovialnoj covers (Methotrexatum, Cyclophosphanum (cyclophosphamide), Azathioprinum, Sulfasalazinum, etc.) or is immediate on proinflammatory agents in sinovialnoj to a cover («biological agents»).

The considerable quantity of publications is devoted a role of nonsteroid antiinflammatory preparations (NPVP) in development of a chronic gastritis at JUHA [67]. As is known, NPVP constantly accept not less than 68,5 % sick of a pseudorheumatism (RA) and 12,1 % sick of an osteoarthrosis [51]. Thus the risk of development of erozivno-ulcerative damages of a mucosa of a stomach and a duodenum (DPK) at reception NPVP raises in 3,9 times, and risk of bleedings in 8 times [28, 177]. Danger of the NPVP-INDUCED lesions of organs of a digestive tube is concealed available erased clinical picture and detection only in acute clinical situations at occurrence gastroenteric bleedings or perforations [67]. All applied in clinical practice NPVP render gastrotoksicheskoe action at the expense of influence on synthesis of Prostaglandinums [28, 100, 178]. The pathogenesis of gastropathies is closely bound to the mechanism of action NPVP: Suppression of production of Prostaglandinums as a result of blockade of enzyme of cyclooxygenase (TSOG), participating in their synthesis [100,178, 201]. Frequency of development NpVp-gastropaty, gastric and
Duodenal bleedings depends not only on an applied preparation, but also its dose, duration of reception [1, 12, 187].

The researches devoted to the NPVP-INDUCED pathology gastroduodenalnoj of a zone at children few, the studied groups are rather small. In the individual works spent on the given problem high frequency of a lesion of a mucosa of a stomach and duodenum has been shown at JURA. At application NPVP, frequency of gastropathies in the form of erozivno-cankers SOZH at children at system form JUA are taped more often [99]. As a rule, NpVp-gastropatii at the minimum clinical picture are characterised by endoscopic implications of lesions of a mucosa of a stomach (complaints from the party GASTROINTESTINAL TRACT showed 44 % of children while the phenomena gastroduodenita it is taped in 91 % cases) [20, 29].

Role NR in a genesis gastroduodenalnoj pathologies is high enough at the patients accepting NPVP [12, 28, 99, 100, 178]. However in a number of works possible protective role NR in development NPVP - gastropathies [27] is discussed. The opinion, that NR is expressed, causing a local inflammation, stimulates development of the endogenous Prostaglandinums possessing the cytoprotective properties, negative influence NPVP on SOZH [20,29] thereby decreases.

Data about influence of other groups of the medicinal preparations used in therapy JUA on condition SOZH — gljukokortikosteroidov, antitsitokinovyh preparations, Methotrexatum and basic agents [20, 29, 83] are inconsistent.

Individual researches are devoted results of complex therapy HG and JUHA. So, observations of domestic researchers show, that meloksikam (resolved in the Russian Federation for application for children from 12-year-old age) in a complex with eradikatsionnoj therapy or IPP
Authentically enlarged frequency of a cuticularization of erozivno-ulcerative damages FROM the top departments GASTROINTESTINAL TRACT from 57,6 % to 92,8 % [29].

Also individual researches are devoted the description klinikoyomorfologicheskih features HG at children sick JUA. So, it is shown, that for HG at JUA disharmony between a clinical picture (complaints from the party GASTROINTESTINAL TRACT show 44-58 %) and endoscopic data (HG it is endoscopically taped at 91-93 % surveyed) [20, 29, 60] is characteristic. Against treatment NPVP at 18,1 %-29, 9 % of children with JUA were taped erozivno-ulcer lesions SOZH, and they authentically were more often taped at system form JURA (51,7 %) [21, 67].

At morphological research bioptatov SOZH at JUA it is taped, that more often at combination HGD and JUA the antral department of a stomach is amazed, and in 55, 77 % of cases the atrophic gastritis [20, 83] takes place. According to some information, frequency of atrophy SOZH in the field of a body reaches 42 %, in antral department - 82 %, thus frequency intestinal

Metaplasias in antral department of a stomach are made by 14,5 % [20, 29]. Histological and immunohistochemical researches bioptatov SOZH, antral department at patients JUA have shown high percent of vasculites, depression of the maintenance of V-cages, high frequency of adjournment of immune complexes. Especially often these changes met at system form JUA [20].

Kislotoobrazujushchaja function of a stomach at children with JUHA is extremely important, as normal secretory activity SOZH provides a normal absorption of calcium from nutrition. At an atrophic gastritis and long reception NPVS, calcium is not soaked up in an intestine and at the patient the risk of an osteoporosis [155, 163, 182] is enlarged. Thus the hypochlorhydria at an atrophic gastritis can be one of the reasons of development of an iron deficiency anaemia. Meanwhile kislotoobrazovanie at JUHA at children it is not studied.

The further studying of not morphological biomarkers of a hypochlorhydria and atrophy, hyperacidity and giperpepsinogenemii, erosive lesions SOZH at children for primary non-invasive diagnostics of condition SOZH for the purpose of revealing of groups of risk on atrophy development in SOZH, erosive lesions SOZH at children, the control and a dispensary observation is necessary. For children sick JUHA, use neivazivnyh methods has the big importance in view of presence of the "erased" clinical picture of a chronic gastritis and application of a considerable quantity of the invasive diagnostic and therapeutic methods reducing quality of a life of the patient.

Thus, summing up to the aforesaid, it is necessary to notice, that discussion about a true role of infection H. pyloriи veb in development and a current juvenilnogo and rhematoid arthritises proceeds. For today it is not clear, whether they act to triggers autoimunnogo process or are simply "witnesses" of various pathological changes in SOZH and joints. There are certificates of mutual weighting HG and JUHA at their combination and inconsistent data about influence of therapy of each of diseases on a current komorbidnoj pathologies. In this connection, carrying out large-scale randomizirovannyh researches for etiopathogenesis studying sochetannoj is necessary for pathology JUHA and HG, for definition of optimum therapeutic strategy of these diseases.

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Scientific source LISTOPADOVA ANASTASIA PAVLOVNA. Etiopathogenetic and morpho-functional features of chronic gastritis in children with juvenile chronic arthritis. Thesis for the degree of candidate of medical sciences. Moscow - 2014. 2014

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