Symptoms of functional dyspepsia in children

According to the Roman criteria III (2006), postprandial (dyskinetic according to Roman criteria II) and pain (ulcerative according to Roman criteria II) are distinguished for functional dyspepsia. The first is characterized by the predominance of dyspepsia, the second - by abdominal pain. An indispensable condition for the diagnosis is the preservation or recurrence of symptoms for at least 3 months.

Pathognomonic for functional dyspepsia is considered to be early (arising after eating) pain, rapid satiety, a sensation of bloating and overflow in the upper half of the abdomen. Often the pain is situational in character: they arise in the morning before leaving for a pre-school or school, on the eve of examinations or other exciting events in the life of a child. In many cases, the child (parents) can not indicate a relationship of symptoms with any factors. In patients with functional dyspepsia, there are often various neurotic disorders, more often in anxious and asthenic type, eating and sleeping disorders. A combination of abdominal pain with pains of other localization, dizziness, sweating is characteristic.

The syndrome of dyspepsia can be a clinical mask of various infectious and somatic diseases, food intolerance. So, in helminthic invasions and giardiasis, along with dyspepsia may develop intoxication. Damage to skin and respiratory tracts of an allergic nature, disruption of digestion and absorption of nutrients. The syndrome of dyspepsia is 2-3 times more often in children with atopic diseases, which is associated with the influence 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 the syndrome of dyspepsia and lesions of the mucous membrane of the upper gastrointestinal tract, in particular, Helicobacter-associated gastritis, has been proved. In addition to the inflammatory response, the symptoms of dyspepsia may be due to a violation of the secretion of gastrointestinal peptides and hydrochloric acid, which often occur when H. Pylori persists on the gastric epithelium. In the case of morphological confirmation of the inflammation of the gastric mucosa and the isolation of the microorganism, the diagnosis is "chronic gastritis with dyspepsia syndrome".

The most common etiological factors of functional dyspepsia in children: neurotic disorders, stress, psychosocial disadaptation, autonomic dysfunction. The provocative role of nutritional deficiencies (lack of a diet, overeating, abuse of carbohydrates, coarse plant fiber, acute and irritating gastric mucosa) and the reception of certain medications have been proven. As a rule, these factors act in combination with helikobakteriozom, giardiasis, helminthic invasions, gastrointestinal allergy. In these cases, we should talk about non-ulcer dyspepsia.

The leading mechanisms in the development of functional dyspepsia are considered visceral hypersensitivity and motor disorders. The first can arise due to central (increased perception of afferent impulses by the CNS structures) and peripheral (decreasing receptor receptivity threshold) mechanisms. The main variants of motor disorders: gastroparesis (weakening of the antral motility of the stomach with slowing of evacuation of the contents), gastric dysrhythmia (violation of anthroduodenal coordination, development of peristalsis of the stomach according to tachy, bradygastritic or mixed type), disruption of gastric accommodation (decreased ability of the proximal stomach to relax after intake of food under the influence of increasing pressure of the contents on its walls).

Distinguish oppressive and stimulating mediators of motor activity of the stomach. The oppressive factors include secretin, serotonin, cholecystokinin, vasoactive intestinal peptide, neuropeptide Y, peptide YY and tyrotropin-releasing peptides; to stimulating - motilin, gastrin, histamine, substance P, neurotensin, endorphins. Therefore, the formation of dyskinetic disorders is facilitated by a change in the hormonal regulation of the gastrointestinal tract.

[1], [2], [3]