Functional indigestion in children

Functional upset stomach - a violation of the motor or secretory function of the stomach, flowing with the phenomena 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 are about 40%.

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

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

• neuropsychic overload;
• non-compliance and inadequate nutrition;
• forcible feeding;
• physical and vestibular overload.

Endogenous causes can be background diseases:

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

Pathogenesis of functional indigestion. The basis of functional disorders of the stomach are violations of the normal daily rhythm of gastric secretion and motor function 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 (eg, smoking, helminthic invasions, etc.) or their oppression (overheating, heavy physical work, overwork, etc.).

Classification.

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

• motor type (gastroesophageal reflux, duodenogastric reflux, cardiospasm, pilorospasm, etc.);
• on a secretory type (with the raised or increased and lowered secretory function)

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

• episodicity of manifestations, their short-term and non-stereotype;
• absence of signs of organic lesions of the stomach at macrostructural and histological levels;
• dependence of symptoms on the functional state of the central and autonomic nervous systems;
• the relationship of manifestations with both nutritional and non-nutritional factors, the neurotic background or the presence of diseases of other organs and systems.

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

The most constant symptom is pain in the abdomen. Pain more often paroxysmal, similar to colic with unstable localization (mainly in the navel region). The effectiveness of taking antispasmodics is diagnostic.

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

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

Diagnosis of functional indigestion. Diagnosis of functional disorders of the stomach in most cases can be established on the basis of data of anamnesis and examination without the use of special instrumental studies.

Endoscopically, the mucous membrane of the stomach with functional disorders of the stomach is usually not changed, but superficial "working" hyperemia is possible (which often serves as an excuse for overdiagnosis of gastritis) without histological signs of chronic inflammation.

Secretory function of the stomach (according to pH-metry or fractional sounding) can be normal or impaired, often elevated.

Motor disorders can be detected: sphincter spasm, increased peristalsis, duodenogastric reflux, cardia deficiency.

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

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

Differential diagnosis is carried out with diseases accompanied by acute or recurrent pain in the abdomen.

Differentiate functional disorders of the stomach should be accompanied by chronic diseases of the stomach - chronic gastritis, gastroduodenitis, peptic ulcer.

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

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

Treatment of background diseases.

Correction of neurovegetative disorders:

• In the case of vagotonia, non-selective anticholinergics with sedative action (belloid, bellataminal) are shown.
• In the manifestations of neurosis - sedative herbs (motherwort, Valerian), small tranquilizers (sibazon, tazepam, nosepam, meprobamate, etc.), psychotherapy
• With depressive states, hypersensitivity - antidepressants in small doses (phenibut, euglon, amitriptyline, melipramine), adaptogens (ginseng, eleutherococcus, Chinese magnolia, golden root, etc.).
• In order to influence the neuro-regulatory mechanisms, acupuncture, electropuncture (Axon-2), physiotherapy: Electroson, Transair, electrophoresis with calcium or bromine on the collar zone, exercise therapy, point and segmental massage, water procedures (underwater massage , a circular shower, etc.).

Correction of impaired functions of the stomach is an auxiliary task. Usually, with functional disorders of the stomach, it is sufficient to carry out therapy aimed at eliminating the cause of the disorder.

Correction of motor disorders.

• With cramping pain, spasmolytics (papaverine, no-shpa), non-selective holinolytics (preparations of belladonna, buscopan), collections of spasmolytic herbs (mint, chamomile) are shown.
• With cardiospasm and pilorospasm, a combination of sedatives and anticholinergics, nitrates (nitroglycerin) and calcium channel blockers (nifedipine) are prescribed.
• In the absence of sphincters and pathological reflux, prokinetics are used: dopa receptor blockers (cerucal, motilium, sulpiride) and selective cholinomimetics (co-ordix, propulsid).

Correction of secretory disorders. With increased secretory function of the stomach, antacids (maalox, phosphalugel) are prescribed, and for very high acid production selective anticholinergics (gastrocepin, pyrenzepine, telenzepine).

Prevention consists in creating conditions for a rational daily routine, optimizing nutrition, adequate level of physical and psychoemotional loads.

Clinical follow-up is carried out within 1 year, subjective complaints, objective condition of the patient are evaluated, a control EGD with a biopsy of the gastric mucosa is performed. In the absence of morphological changes at the macro and microstructural level, the patient is removed from the register. With proper treatment, clarification and elimination of the causes of functional disorders of the stomach result in recovery, but transformation into chronic gastritis and even peptic ulcer is possible.

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