Symptoms of functional dyspepsia in children

According to Rome criteria III (2006), postprandial (dyskinetic according to Rome criteria II) and painful (ulcer-like according to Rome criteria II) variants of functional dyspepsia are distinguished. The first is characterized by the predominance of dyspepsia, the second - abdominal pain. A prerequisite for making a diagnosis is the persistence or recurrence of symptoms for at least 3 months.

Pathognomonic for functional dyspepsia are considered to be early (arising after eating) pain, rapid satiety, a feeling of bloating and fullness in the upper abdomen. Often the pain is situational: it occurs in the morning before leaving for a preschool or school, on the eve of exams or other exciting events in the child's life. In many cases, the child (parents) cannot indicate a connection between the symptoms and any factors. Patients with functional dyspepsia often have various neurotic disorders, most often of the anxiety and asthenic type, appetite and sleep disorders. A combination of abdominal pain with pain in other locations, dizziness, sweating is typical.

Dyspepsia syndrome may be a clinical mask of various infectious and somatic diseases, food intolerance. Thus, with helminthic invasions and giardiasis, along with dyspepsia, intoxication, skin and respiratory tract lesions of an allergic nature, and disturbances in the digestion and absorption of nutrients may develop. Dyspepsia syndrome is 2-3 times more often observed in children with atopic diseases, which is associated with the effect of biogenic amines on gastric motility and secretion. In such cases, as a rule, it is not possible to establish a connection between exacerbations of atopic diseases and dyspeptic disorders.

The relationship between dyspepsia syndrome and lesions of the mucous membrane of the upper gastrointestinal tract, in particular, Helicobacter-associated gastritis, has been proven. In addition to the inflammatory reaction, dyspepsia symptoms may be caused by a violation of the secretion of gastrointestinal peptides and hydrochloric acid, which often occur with the persistence of H. pylori on the gastric epithelium. In the case of morphological confirmation of inflammation of the gastric mucosa and isolation of the microorganism, the diagnosis of "chronic gastritis with dyspepsia syndrome" is valid.

The most common etiological factors of functional dyspepsia in children are: neurotic disorders, stress, psychosocial maladaptation, and autonomic dysfunction. The provoking role of alimentary disorders (lack of diet, overeating, abuse of carbohydrates, coarse plant fiber, spicy foods and foods that irritate the gastric mucosa) and the use of certain medications has been proven. As a rule, the listed factors appear in combination with helicobacteriosis, giardiasis, helminthic invasions, and gastrointestinal allergy. In these cases, we should talk about non-ulcer dyspepsia.

The leading mechanisms in the development of functional dyspepsia are considered to be visceral hypersensitivity and motor disorders. The former may arise due to central (increased perception of afferent impulses by the CNS structures) and peripheral (reduced threshold of receptor apparatus sensitivity) mechanisms. The main types of motor disorders are: gastroparesis (weakening of the motility of the antral part of the stomach with a slowdown in the evacuation of contents), gastric dysrhythmia (impaired antroduodenal coordination, development of gastric peristalsis according to tachy-, bradygastritic or mixed type), impaired gastric accommodation (reduced ability of the proximal part of the stomach to relax after eating under the influence of increasing pressure of the contents on its walls).

A distinction is made between inhibitory and stimulating mediators of gastric motor activity. Inhibitory factors include secretin, serotonin, cholecystokinin, vasoactive intestinal peptide, neuropeptide Y, peptide YY and thyrotropin-releasing peptides; stimulating factors include motilin, gastrin, histamine, substance P, neurotensin and endorphins. Consequently, changes in hormonal regulation of the gastrointestinal tract contribute to the development of dyskinetic disorders.

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