Functional gastric disorder in children

Functional gastric disorder is a disorder of the motor or secretory function of the stomach, occurring with symptoms of gastric dyspepsia, in the absence of morphological changes in the mucous membrane.

In the structure of gastroduodenal diseases in children, functional disorders of the stomach account for about 40%.

Causes of functional gastric disorder. The cause of the development of functional gastric disorder is often not one, but several factors, often against the background of a hereditary predisposition.

Exogenous factors are important, of which the most significant in children are:

• neuropsychic overload;
• failure to comply with the regime and inadequate nutrition;
• force feeding;
• physical and vestibular overload.

Endogenous causes may be background diseases:

• neuroses;
• neurocirculatory dysfunctions;
• various diseases of internal organs;
• food allergy;
• foci of infection and parasitosis.

Pathogenesis of functional gastric disorders. Functional gastric disorders are based on disturbances in the normal daily rhythm of gastric secretion and motility due to:

• changes in neurohumoral regulation through the hypothalamic-pituitary system;
• changes in the tone and reactivity of the autonomic nervous system;
• excessive stimulation of the production of gastrointestinal hormones (for example, smoking, helminthic infestations, etc.) or their suppression (overheating, heavy physical work, overfatigue, etc.).

Classification.

There are primary (exogenous) and secondary (endogenous) functional disorders of the stomach. By the nature of the disorder, functional disorders of the stomach are divided into two groups:

• by motor type (gastroesophageal reflux, duodenogastric reflux, cardiospasm, pylorospasm, etc.);
• by secretory type (with increased and decreased secretory function)

Symptoms of functional stomach disorders in children are varied. Common to them are:

• episodic nature of manifestations, their short duration and non-stereotypicality;
• absence of signs of organic damage to the stomach at the macrostructural and histological levels;
• dependence of symptoms on the functional state of the central and autonomic nervous systems;
• connection of manifestations with both alimentary and non-alimentary factors, neurotic background or the presence of diseases of other organs and systems.

A frequent background for functional disorders of the stomach are phenomena of neurovegetative instability (increased emotionality, irritability, sweating, sleep disturbances, lability of pulse and blood pressure).

The most constant symptom is abdominal pain. The pain is often paroxysmal, colic-like, with variable localization (mainly in the navel area). The effectiveness of taking antispasmodics is diagnostically significant.

Dyspeptic symptoms are not typical, however, in some cases (with pylorospasm) vomiting is possible, in others (with cardiospasm) - difficulty swallowing and regurgitation of undigested food.

When examining the patient, pain during palpation is localized mainly in the epigastrium, but soon after the attack of pain disappears.

Diagnosis of functional gastric disorder. In most cases, the diagnosis of functional gastric disorders can be established based on anamnesis and examination data without the use of special instrumental studies.

Endoscopically, the gastric mucosa in functional disorders of the stomach is usually unchanged, but superficial “working” hyperemia is possible (which often serves as a reason for overdiagnosis of gastritis) without histological signs of chronic inflammation.

The secretory function of the stomach (according to pH-metry or fractional probing) can be normal or impaired, more often increased.

Motor disorders may be detected: sphincter spasm, increased peristalsis, duodenogastric reflux, cardiac insufficiency.

To identify functional disorders, along with studying the basic level of gastric functions, it is sometimes necessary to conduct special tests (pharmacological tests with secretion stimulants, tests with physical loads).

When diagnosing, it is extremely important to establish the underlying disease. According to the indications, the central nervous system, the autonomic nervous system are assessed, foci of infection, parasitosis, etc. are excluded.

Differential diagnosis is carried out with diseases accompanied by acute or recurrent abdominal pain.

Functional disorders of the stomach should be differentiated from chronic diseases of the stomach - chronic gastritis, gastroduodenitis, peptic ulcer.

Treatment and prevention of functional disorders of the stomach are based on eliminating its cause. The main directions of therapy:

Normalization of lifestyle and nutrition. The diet involves eliminating the most irritating foods: spicy, fatty, fried foods, smoked foods, carbonated drinks, coffee, chocolate, chewing gum. Meals should be regular, 4-5 times a day, at the same time.

Treatment of underlying diseases.

Correction of neurovegetative disorders:

• In case of vagotonia, non-selective anticholinergics with sedative action (belloid, bellataminal) are indicated.
• In case of neurosis - sedative herbs (motherwort, valerian), minor tranquilizers (sibazon, tazepam, nozepam, meprobamate, etc.), psychotherapy
• For depressive states, suspiciousness - antidepressants in small doses (phenibut, eglonil, amitriptyline, melipramine), adaptogens (ginseng, eleutherococcus, Chinese magnolia vine, golden root, etc.).
• In order to influence neuroregulatory mechanisms, acupuncture, electropuncture (Axon-2), physiotherapy (Electrosleep, Transair, electrophoresis with calcium or bromine on the collar zone, exercise therapy, point and segmental massage, water procedures (underwater massage, circular shower, etc.) are successfully used.

Correction of impaired gastric functions is an auxiliary task. Usually, in case of functional gastric disorders, it is sufficient to conduct therapy aimed at eliminating the cause of the disorder.

Correction of motor disorders.

• For cramping pain, antispasmodics (papaverine, no-shpa), non-selective anticholinergics (belladonna preparations, buscopan), and herbal antispasmodic infusions (mint, chamomile) are indicated.
• For cardiospasm and pylorospasm, a combination of sedatives and anticholinergics, nitrates (nitroglycerin) and calcium channel blockers (nifedipine) are prescribed.
• In case of sphincter insufficiency and pathological reflux, prokinetics are used: dopa receptor blockers (cerucal, motilium, sulpiride) and selective cholinomimetics (coordinax, propulsid).

Correction of secretory disorders. In case of increased secretory function of the stomach, antacids are prescribed (maalox, phosphalugel), in case of very high acid production - selective anticholinergics (gastrocepin, pirenzepine, telenzepine).

Prevention consists of creating conditions for a rational daily routine, optimizing nutrition, and an adequate level of physical and psycho-emotional stress.

Outpatient observation is carried out for 1 year, subjective complaints, objective condition of the patient are assessed, control EGDS with biopsy of the gastric mucosa is carried out. In the absence of morphological changes at the macro- and microstructural level, the patient is removed from the register. With proper treatment, identification and elimination of the cause of functional disorders of the stomach, they end in recovery, but transformation into chronic gastritis and even peptic ulcer disease is possible.

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