RU2572161C1 - Method for detecting gastroduodenal erosions and ulcers in children suffering dyspeptic syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves determining an animal protein (AP) daily intake by 24-hour nutrition simulation. Erosions and ulcers are detected if the AP daily intake makes 0.4 g/kg of body weight or less. If the AP daily intake is more than 0.4 g/kg of body weight, the blood serum is additionally examined to measure free oxyproline (CO) that is a collagen metabolite. If the measured CO level is more than 29.9 mmol/l, gastroduodenal mucosal erosions and ulcers are diagnosed.

EFFECT: characterised by high informative value and a possibility to narrow the range of complaint children in need of invasive, stressful endoscopic examination, the method allows the more effective detection of gastroduodenal mucosal erosions in the children with dyspeptic syndrome.

2 ex, 3 tbl

Description

The invention relates to medicine, namely to pediatrics and gastroenterology, and can be used to predict destructive changes in the mucous membrane of the gastroduodenal zone in children with dyspepsia syndrome.

Digestive diseases in children, due to their widespread prevalence, clinical features, high risk of early manifestation and disability, pose a serious medical and social problem. Among the chronic diseases of the digestive system, the leading place is occupied by lesions of the organs of the gastroduodenal zone.

The main clinical manifestation of gastroduodenal diseases is dyspepsia syndrome (DM), diagnosed if the patient has pain or discomfort in the epigastric region [1]. The prevalence of dyspepsia among children reaches 30%, in most cases it is functional in nature and only in 10-15% it is associated with erosive-ulcerative lesions of the gastric mucosa (coolant) and duodenum (duodenum) [2]. In recent years, in children with erosive diseases of the gastroduodenal zone, the incidence of complications, transformation into peptic ulcer and progression to atrophy of the coolant and mucous membrane of the DIC has increased [3], which is prognostically extremely unfavorable at an older age [4].

The urgency of the problem of timely diagnosis, timely treatment and rehabilitation of children with erosive and ulcerative lesions of the mucous membrane of the gastroduodenal zone necessitates the development of a timely forecast for the presence of this pathology.

Closest to the proposed method is a generally accepted in clinical practice method for determining erosive-ulcerative lesions of the gastroduodenal zone in diabetes, which consists in collecting an anamnesis when patients present complaints typical of erosive lesions of the gastroduodenal zone (heartburn, belching, bloating, stool, epigastric pain or pyloroduodenal region, both constant and periodic, associated with food intake) and subsequent fibroesophagogastroduodenoscopy (FGS) to confirm n alicia of erosive and ulcerative lesions of the gastroduodenal zone.

The disadvantage of this method is that it is not accurate and informative, since according to available scientific information, erosive-ulcerative lesions of the gastroduodenal zone do not have strictly specific clinical symptoms, as a result of which an excessive number of children undergo an invasive examination method (FGS), which is associated with severe psychoemotional stress for the child, as well as with the risk of complications and infection.

The objective of the invention is to develop a minimally invasive informative method for determining erosive and ulcerative lesions of the mucous membrane of the gastroduodenal zone in children with dyspepsia syndrome.

The problem is solved by the fact that in children with dyspepsia syndrome, the daily level of consumption of animal protein (GB) is estimated by 24-hour nutrition. In this case, erosive-ulcerative lesions are determined with a daily level of consumption of reinforced concrete, equal to or less than 0.4 g / kg of body weight. If the daily level of consumption of reinforced concrete is more than 0.4 g / kg body weight, then the content of free oxyproline (CO), which is a metabolite of collagen, is additionally determined in blood serum, and when it is above 29.9 mmol / l, erosive ulcerative lesions of the mucous membrane of the gastroduodenal zone.

The threshold values of the level of consumption of reinforced concrete (0.4 g / kg of body weight) and concentration of CO (29.9 mmol / l) were obtained empirically based on a comparison of the values of the consumption of reinforced concrete and collagen metabolism by its metabolite (CO) with the results of FGS examination patients with dyspepsia for the presence or absence of erosive-ulcerative lesions of the mucous membrane of the gastroduodenal zone.

The pathogenetic basis of the risk of developing erosive-ulcerative lesions of the mucous membrane of the gastroduodenal zone is an imbalance of aggressive and protective factors of the stomach towards a decrease in protective and intensification of aggressive factors. This, first of all, concerns the state of the mucous barrier in the stomach and the state of regenerative plastic processes in epithelial cells [5]. The optimal course of these processes largely depends on the availability of protein in the body and, first of all, to animals. The child’s body reacts more sharply to protein deficiency, since in addition to its maintenance costs, protein is intensively spent on the growth of the body and organs. Protein deficiency in food affects protein metabolism in the body, in particular, collagen metabolism, which makes up more than 30% of the total protein mass of the human body and is actively involved in the regeneration and maintenance of the mucous barrier of the coolant [5]. This allows you to use the level of consumption of animal protein and the level of free oxyproline (CO) - collagen metabolite as prognostic factors of erosive-ulcerative lesions of the mucous membrane of the gastroduodenal zone.

The method is as follows.

In children with dyspepsia syndrome, verified according to the Rome criteria (1999) [1] in the presence of complaints of pain or discomfort in the epigastric region, the daily level of animal protein intake is determined by 24-hour (daily) nutritional reproduction using a special questionnaire, album color photographs of products and dishes or their models, standardized in volume and weight [6]. When interviewing a patient, a one-day menu of the subject is found out and analyzed, the volume of animal products in its composition, the frequency of consumption of animal products during the previous month. The daily level of consumption of animal protein is determined using coding notebooks developed at the Institute of Preventive Cardiology of the All-Russian Scientific Center for Medical Sciences of the USSR [7, 8].

If the daily level of consumption of animal protein (GB) is equal to or less than 0.4 g / kg body weight, then the subject is predicted to have erosive-ulcerative lesions of the mucous membrane of the gastroduodenal zone. In this case, it is not necessary to determine the content of the collagen metabolite, free oxyproline (CO), in the patient's blood serum.

If the daily level of consumption of animal protein is more than 0.4 g / kg of body weight, then the content of free hydroxyproline (CO) - a collagen metabolite [9], and at a CO level of more than 29.9 mmol / l also predict erosive and ulcerative lesions of the mucous membrane of the gastroduodenal zone.

When predicting the presence of erosive and ulcerative lesions of the mucous membrane of the gastroduodenal zone, the patient is recommended to conduct FGS to clarify the diagnosis.

We examined 32 children 7-17 years old with dyspepsia syndrome. Fibroesophagogastroscopy was performed for all children to assess the presence of destructive changes in the gastric mucosa and to clarify the diagnosis. According to the results of FGS, patients were divided into 2 groups: the first group consisted of children with erosive-ulcerative lesions of the mucosa of the gastroduodenal zone (8 children); the second group (24 children) consisted of patients without destructive changes in the gastric mucosa and DNA. In all examined patients, the amount of consumption of reinforced concrete per day was estimated (using the 24-hour (daily) nutritional replenishment method [6]) and the level of CO, the metabolite of collagen metabolism (biochemical method [9]).

In accordance with Art. 24 of the Constitution of the Russian Federation on scientific research, the examined children and their parents were acquainted with the goals, methods and possible complications during the study, and informed consent was signed by parents to participate in the surveys.

It was noted that the level of consumption of animal protein in children with erosive and ulcerative lesions was lower than in children without these changes (Table 1). This is obviously due to the fact that in conditions of deficiency of protein supply (primarily with a deficiency in the nutrition of animal protein), the process of physiological regeneration in the mucous membranes of the stomach and DHA is disrupted.

In addition to reducing the consumption of animal protein in children with erosive and ulcerative lesions, an increase in the CO indicator was established (Table 2), indicating the degradation (decomposition) of collagen, which is necessary for participation in the regeneration and maintenance of the gastric mucosa and DNA.

A simultaneous comparison of two parameters (values of indicators of consumption of gastrointestinal tract and free oxyproline) with the presence of erosive-ulcerative lesions of the mucous membrane of the gastroduodenal zone in children with diabetes showed that erosive-ulcerative pathology is present in 2 cases: when the level of consumption of gastrointestinal tract is equal to or less than 0 , 4 g / kg body weight (regardless of the level of CO), and with an animal protein intake of more than 0.4 g / kg body weight and a free hydroxyproline of more than 29.9 mmol / l (Table 3). An increase in collagen catabolism (CO> 29.9 mmol / L) with a consumption of GB> 0.4 g / kg of body weight in children may indicate a decrease in the absorption of GB in the intestine and (or) increased consumption associated with other pathological processes . With an indicator of CO equal to or less than 29.9 mmol / l, and the level of consumption of reinforced concrete more than 0.4 g / kg of body weight in children with diabetes, zero indicators of the frequency of erosive and ulcerative lesions of the mucous membrane of the gastroduodenal zone were established.

Note: the significance of differences in the indicators was calculated using the χ2 criterion.

Example 1:

Patient K., 11 years old, was examined at the clinic of the village. Baykit of the Krasnoyarsk Territory. Diagnosis: dyspepsia syndrome, ulcer-like variant.

Anamnesis: Complaints of complaints of epigastric pain 2-3 times a week, disappear after taking medication or food; belching with air, discomfort above the navel. Complaints are noted within 3 months. The patient was examined according to the proposed method. When collecting anamnestic data, the child noted the consumption of animal products 1-2 times a week. The daily intake of animal protein was 0.15 g / kg body weight (less than 0.4 g / kg body weight), which allows us to determine the presence of erosive-ulcerative lesions of the mucous membrane of the gastroduodenal zone.

Conducted FGS. Conclusion: Cardia deficiency, nodular gastritis, erosive duodenitis.

Example 2:

Patient Ch., 11 years old, was examined at the clinic of the village. Baykit of the Krasnoyarsk Territory. Diagnosis: dyspepsia syndrome, mixed variant.

Anamnesis: Complaints of pain, a feeling of rapid satiety and bursting in the epigastric region are disturbing. The pains are sharp, varying in duration, more often occur on an empty stomach. Considers herself a patient for 2 years, when the first appeared inconstant epigastric pain. Over the past 2 months, deterioration has been observed: pain has increased to 1-2 times a week. During the survey, data were obtained on a sharp restriction on the consumption of products of animal origin, which she uses no more than 2 times a week.

Studies according to the proposed method:

- determination of the daily amount of consumption of reinforced concrete: 0.44 g / kg body weight (more than 0.4 g / kg body weight).

- determination of free oxyproline - an indicator of collagen metabolism: 30.2 mmol / L (more than 29.9 mmol / L).

According to the invention, the presence of erosive and ulcerative lesions of the mucous membrane of the gastroduodenal zone is determined in a child.

Conducted FGS. Conclusion: Cardia deficiency, superficial gastritis. Complete erosion of the antrum, duodenitis.

The technical result of the claimed method:

- high information content of the method due to the use of indicators reflecting the consumption of animal protein and collagen metabolism;

- the ability to narrow the circle of children with dyspeptic complaints requiring an invasive, traumatic endoscopic examination (FGS);

- expanding the arsenal of tools for determining erosive and ulcerative lesions of the mucous membrane of the gastroduodenal zone in children with dyspepsia syndrome.

Thus, the proposed method allows you to more reasonably determine the need for invasive, traumatic endoscopic examination (FGS) in order to identify erosive and ulcerative destruction of the mucous membrane of the gastroduodenal zone in children with dyspepsia syndrome.

Information sources

1. Functional gastrointestinal disorders / N.J. Talley, V. Stanghellini, R.C. Heading [et al.] // Gut. - 1999. - Vol. 45, No. 2. - P. 1137-1142.

2. Pekchurov D.V. The use of clinical tests in determining the priority of examination of children with dyspepsia syndrome / D.V. Pekchurov, P.L. Shcherbakov, T.I. Kaganova // Pediatrics. - 2004. - No. 2. - S. 4-8.

3. Low rate of emergence of claritromicin resistent Helicibacter pylori with amoxycillin co - therapy / L. Laine, L. Suchower, J. Frantz et al. // Aliment. Pharmacol Ther. - 1998. - Vol. 12, No. 9. - P.887-892.

4. Achievements of domestic children's gastroenterology: origins, current status, prospects / A.M. Zaprudnov, K.I. Grigoryev, V.A. Eagle owl [et al.] // Pediatrics. - 2008. - No. 6. - S. 8-13.

5. Cunningham, D.F. Proline specific peptidases / D.F. Cunningham, B. O′Connor // Biochim. Biophys. Acta. - 1997. - V. 1343, No. 2. - P. 160-186.

6. Methodological recommendations for estimating the amount of food consumed by the 24-hour (daily) nutritional reproduction method / А.М. Martinchik, V.M. Kadentsova, O.A. Vrzhesinskaya et al. - M., 1996 .-- 25 p.

7. The chemical composition of food products. Prince 1. Reference tables for the content of basic nutrients and the energy value of food products // Under. ed. THEM. Skurikhina, Μ.N. Volgareva. - M.: Medicine. - 1987. - 198 p.

8. The chemical composition of food. Prince 2. Reference tables for the content of amino acids, vitamins, macro- and microelements, organic acids and carbohydrates // Under. ed. THEM. Skurikhina, Μ.N. Volgareva. - M.: Medicine. - 1987. - 167 p.

9. Sharaev P.Η. Biochemical methods for the analysis of indicators of exchange of biopolymers of connective tissue / P.N. Sharaev, I.V. Volkhina, N.G. Naumova: method. recommended - Izhevsk, 1990 .-- 14 p.

Claims (1)

A method for determining erosive and ulcerative lesions of the mucous membrane of the gastroduodenal zone in children with dyspepsia syndrome, including examining children, characterized in that the daily level of consumption of animal protein (GB) is estimated by 24-hour nutritional reproduction, and erosive and ulcerative lesions are determined at a daily level consumption of reinforced concrete equal to or less than 0.4 g / kg of body weight, if the daily level of consumption of reinforced concrete is more than 0.4 g / kg of body weight, then the content in blood serum is additionally established free oxyproline (CO), which is a metabolite of collagen, and at a CO level above 29.9 mmol / L, erosive and ulcerative lesions of the mucous membrane of the gastroduodenal zone are also determined.