Diagnosis of functional dyspepsia in children

Differential-diagnostic measures for functional dyspepsia are carried out in 3 stages.

• I - definition of patients with a high risk of organic dyspepsia according to anamnestic, clinical and available laboratory data. Direction for urgent gastroenterological examination.
• II - elimination or correction of etiological factors and pathogenetic mechanisms of functional dyspepsia in a group of children with a low risk of organic dyspepsia.
• III - determination of the form of functional disorders of the digestive tract in accordance with the classification.

Among the diseases that make up the group of organic dyspepsia in children, the most important is peptic ulcer of the stomach and duodenum; the prevalence of this disease is 1 per 1000 population aged 0 to 14 years. Among young children, cases of peptic ulcer are rare, in the age group 4-9 years, the prevalence does not exceed 0.4%, and among adolescents, the incidence of peptic ulcer disease reaches 3 per 1000. The more rare causes of organic dyspepsia in childhood are chronic cholecystitis and pancreatitis, gallstone disease (SCI), diverticulitis of the gastrointestinal tract.

Clinical diagnosis of these diseases is not an easy task even for an experienced gastroenterologist, but exacerbations, and even more complications, are accompanied by very vivid symptoms, in the literature referred to as anxiety symptoms.

Symptoms of anxiety with organic dyspepsia

Symptoms	Diseases	Complications
Intensive and non-curative pain	Ulcer disease, cholecystitis, pancreatitis, LAD, diverticulum	Penetration, perforation, obturation, diverticulitis
Increased temperature, intoxication, inflammatory changes in the blood	Cholecystitis, pancreatitis, liver cancer, diverticulum	Abscess, empyema, obturation, diverticulitis
Admixture of blood in vomit masses or stools, pallor, weakness, fainting, drop in blood pressure, anemia	Peptic ulcer, diverticulum	Bleeding
Weight loss	Severe common diseases with abdominal syndrome, tumors

Since the structure of dyspepsia syndrome in children predominates peptic ulcer, early diagnosis of this disease is recognized as a priority task. Epidemiological criteria that increase the risk of peptic ulcer disease: age over 10 years (= 10 times), belonging to the male sex (3-4 times), weighed down by a factor of 6-8. Clinically, the presence of peptic ulcer is indicated by night and "hungry" pains, severe rare pains, heartburn and acidic eructations. If the child has at least one of the listed symptoms of anxiety, the EGDS is indicated as a matter of priority. Contraindications to EGDS - acute circulatory disorders, pulmonary and cardiac insufficiency, marked anatomical and topographic changes in the esophagus, mental illnesses, a serious condition of the patient, threat of bleeding.

Ultrasound is a non-invasive and accessible method for screening pathological conditions. If the child has not had ultrasound of the liver, pancreas and gallbladder for a long time, the study is shown to exclude anomalies in the development of these organs, tumors and cysts, GAD, portal hypertension and cirrhosis. The prevalence of these conditions in childhood is low and there is no evidence of that. That in the population of patients with dyspepsia syndrome the indicator is higher. Nevertheless, the screening of these diseases is necessary for the purpose of possibly early diagnosis, so a single ultrasound of the abdominal cavity to a child with dyspepsia is mandatory. The definition of the contractile function of the gallbladder during primary treatment should be considered unnecessary and unreasonably increasing the time and cost of the examination.

The most likely etiological factors of functional dyspepsia include psychosocial. Finding an unfavorable situation in the family, problems with peers, at school, increased stress requires trust and patience from both the patient and the doctor. These are the situations most often lead to the development of neurotic reactions, asthenic and anxiety syndrome.

Asthenic syndrome is characterized by fatigue, decline in physical and mental strength, weakness, weakness, hyperesthesia, sleep disorders, intolerance to normal loads. Anxiety is a low mood with a feeling of inner tension, anxiety for oneself or loved ones, restlessness, excessive motor chaotic activity, intensifying in the evenings. Numerous tests allow pediatricians to diagnose neurotic syndromes that require specialist advice.

Dyspepsia can play the role of one of the visceral symptoms of autonomic dysfunction. To facilitate the diagnosis and refinement of the form of the vegetative disorder of the digestive tract, it is convenient to use the AMWayne table in the modification.

The signs underlying the study of the vegetative tone of the gastrointestinal tract (no AM Wein in the modification, 2000)

Symptom	Sympathetic reaction	Parasympathetic reaction
Salivation	Reduced, thick saliva	Reinforced, liquid saliva
Acidity	Normal	Increased, belching sour, heartburn
Intestinal motility	Reduced, atonic constipation	Increased, diarrhea, spastic constipation
Nausea	Uncharacteristic	Typical
Type of pain	Constant	Paroxysmal

By prevailing in the patient of certain symptoms, one can judge the type of vegetative dystonia, assign appropriate vegetative preparations. In most cases, children with functional dyspepsia have a predominance of parasympathetic regulation of the gastrointestinal tract.

The role of H. Pylori in the development of dyspepsia syndrome is not obvious to date. It is conclusively proven that the persistence of H. Pylori causes inflammatory changes in the gastric mucosa, but these disorders often do not correlate with the clinical symptoms of dyspepsia. Epidemiological studies have not found significant differences in the incidence of H. Pylori in the group of individuals with dyspepsia and without it, and therefore the testing of H. Pylori is advisable only in cases where the eradication of the pathogen is regulated by the current standards (Maastricht, 2000).

An important factor that can cause dyspepsia. - helminthic and parasitic infestations. The leading mechanism in this case is not the inflammation of the mucous membrane of the upper gastrointestinal tract, but the effect of toxins on the functional state of the muscular and secretory apparatus. In addition to Giardia, belonging to the simplest, there are at least 10 helminthiases occurring with a dyspeptic syndrome. Signs of invasion: combined lesions of various parts of the digestive tract, allergic conditions, eosinophilia or anemia, pronounced asthenovegetative syndrome. In such cases, a coprological study is required with enrichment or concentration of the material (according to Füllleborn, Schulman or formalin-ether enrichment). Native examination of feces for eggs of helminths and lamblia cysts, even multiple, does not have sufficient sensitivity, and the false-negative result of the study deceives the doctor. The immunological examination of the blood, the detection of parasite antigens in a calcified material, are more informative.

When combined functional dyspepsia with bowel dysfunction should be eliminated diseases that occur with malabsorption syndrome, for example, lactase deficiency or celiac disease. For this purpose, a coprological examination, samples for reduced carbohydrates, specific immunological tests are carried out.

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