Treatment of functional dyspepsia in children

In the treatment of functional dyspepsia, it is important to follow the stages and sequence. Symptomatic treatment is aimed at eliminating clinical signs taking into account pathogenetic mechanisms, and begins at the initial appointment. Provides a quick, often short-term effect. Etiotropic treatment is usually based on instrumental and laboratory data. Allows to eliminate the detected causes of dyspepsia syndrome and ensure a long-term favorable prognosis.

To increase the effectiveness of symptomatic treatment, it is especially important to correctly interpret the patient's complaints, since many modern drugs are highly selective in terms of the mechanism of action and point of application. It is advisable to use the criteria for functional gastrointestinal diseases adopted at the national and international level and allowing for the rationalization of diagnostic and therapeutic measures.

Domperidone

In the dyskinetic variant, a good effect is achieved by taking the antagonist of peripheral dopamine receptors domperidone (motilium, motilak). The drug has a prokinetic effect, increases the tone of the lower esophageal sphincter, improves gastric accommodation and antroduodenal coordination, and helps eliminate dyspeptic symptoms. After oral administration, it is quickly absorbed, bioavailability is about 15%, and poorly penetrates the blood-brain barrier. The maximum concentration in plasma is after 1 hour, the half-life is 7-9 hours. It is intensively metabolized in the intestinal wall and liver, excreted through the intestines and kidneys.

Indications for use: non-ulcer dyspepsia, nausea and vomiting of any etiology, gastroesophageal reflux disease, symptomatic treatment of peptic ulcer. Contraindications: prolactinoma. hypersensitivity to the components of the drug. Interactions: when used simultaneously with anticholinergics, antacids and gastric secretion inhibitors, the effectiveness of domperidone decreases.

Children aged 5-11 years are prescribed 5 mg 3-4 times a day 20 minutes before meals; from 12 years of age, a single dose is 10 mg; the course of treatment lasts from 2 to 4 weeks.

In the painful variant of functional dyspepsia, prokinetics are often ineffective. In these cases, it is preferable to use antispasmodics, myotropic or acting on the vegetative nerve endings. Non-selective myotropic antispasmodic drotaverine (no-shpa) acts by inhibiting the enzyme phosphodiesterase IV, which increases the concentration of cAMP and relaxes smooth muscles. Regardless of the type of vegetative innervation, drotaverine affects the gastrointestinal tract, cardiovascular, genitourinary, CNS, which is not always desirable. When taken orally and parenterally, it is quickly and completely absorbed. The maximum concentration is achieved within 45-60 minutes. The half-life is 16-22 hours. It is metabolized in the liver, excreted as metabolites in the urine and feces.

Indications for use: spasms of smooth muscles of the gastrointestinal tract and genitourinary system of any etiology, algomenorrhea, headaches, tension. Contraindications: severe renal, hepatic and cardiac insufficiency, use with caution in arterial hypotension.

The daily dose for children aged 1 to 6 years is 40-120 mg, for children over 6 years - from 80 to 200 mg in 2-5 doses, the course of treatment usually does not exceed 7 days.

In many cases, pain and discomfort are associated with a disturbance of the autonomic regulation of the upper gastrointestinal tract by the parasympathetic type. In such situations, the use of modern anticholinergic drugs that are highly selective for the gastrointestinal tract is justified.

Hyoscine butyl bromide

Puscin butylbromide (buscopan) is an M-cholinergic receptor blocker, has a ganglionic blocking effect, which ensures effective pain relief, reduces the secretion of digestive glands. It practically does not penetrate the blood-brain barrier. After oral administration, the maximum concentration in the blood is achieved in 1-2 hours. It is completely eliminated from the body within 48 hours. It is metabolized in the liver, then excreted with bile and through the kidneys.

Indications for use: spasms of smooth muscles of the gastrointestinal tract, biliary and urogenital tracts, algimenorrhea, complex treatment of peptic ulcer, cholecystitis and cholangitis. Contraindications: glaucoma, myasthenia, intestinal obstruction, severe atherosclerosis of cerebral vessels. Interactions: enhances the anticholinergic effect of antihistamines, tricyclic antidepressants, quinidine, amantadine, enhances tachycardia caused by beta-adrenergic agonists.

The drug is prescribed to children from 6 years of age at 5-20 mg 3 times a day orally or rectally for a course of up to 2 weeks.

Pirenzepine

Pirenzepine (gastrozepin) is an antisecretory agent. It selectively blocks M1-cholinergic receptors at the level of intramural ganglia, inhibiting the stimulating effect of the vagus nerve on gastric secretion. The cytoprotective effect is associated with improved microcirculation in the mucous membrane and suppression of intragastric proteolysis. After oral administration, up to 50% of the dose is absorbed from the gastrointestinal tract. The maximum concentration in plasma is created after 3-4 hours, the half-life is 8-20 hours. The absorbed portion of the drug is excreted unchanged in the urine and bile.

Indications for use: painful variant of functional dyspepsia, heartburn, complex treatment of gastric and duodenal ulcers of various etiologies. Contraindications: glaucoma, first trimester of pregnancy. Interactions: the effect is enhanced when prescribed in combination with aluminum-containing antacids.

Prescribed to children over 6 years of age in a daily dose of 25-50 mg in 2 doses, the course of treatment is up to 8 weeks.

One of the most widely used and safe groups of drugs for the treatment of functional dyspepsia is antacids. Modern non-absorbable antacids based on aluminum and magnesium, in addition to the acid-neutralizing effect, have an adsorbing and cytoprotective effect, which reduces the severity of pathological symptoms. However, the effectiveness of this group of drugs is insufficient in monotherapy. Antacids with a low aluminum content have a moderate laxative effect, which is useful in the case of a combination of dyspepsia and a tendency to constipation.

The drug hydrotalcite (rutacid) has a layered-mesh structure that ensures the slow release of aluminum and magnesium ions, depending on the intragastric pH. It has a protective effect on the gastric mucosa, reduces the proteolytic activity of pepsin, and binds bile acids. It is practically not absorbed from the gastrointestinal tract, and is excreted with feces.

Indications for use: acute and chronic gastritis, non-ulcer dyspepsia, reflux esophagitis, gastric ulcer and duodenal ulcer outside of exacerbation. Contraindications: renal failure, hypersensitivity to the components of the drug. Interactions: reduces the absorption of tetracyclines, fluoroquinolones, anticoagulants, iron preparations.

Hydrotalcite can be prescribed to children from 6 years of age at 250-500 mg 3-4 times a day one hour after meals, the course duration is up to 2-4 weeks.

A worthy alternative to antacids are alginates, a group of drugs based on seaweed that have a long-lasting effect, effectively relieving heartburn and improving digestion. Gaviscon, after oral administration, reacts with the acidic contents of the stomach, forming a gel on the surface of the mucous membrane, which protects the esophagus from the action of gastric juice during reflux. The drug is slightly absorbed from the gastrointestinal tract.

Indications for use: symptomatic treatment of dyspepsia associated with increased acidity of gastric juice and gastroesophageal reflux (heartburn, sour belching). Contraindications: intolerance to the components of the drug, including mint.

The drug can be prescribed to children from 6 years old at 5-10 ml, from 12 years old - 10-20 ml 3 times a day.

Antisecretory agents are rarely used in the treatment of non-ulcer dyspepsia in children under 12 years of age due to age restrictions; in addition, hypersecretion plays a lesser role in the pathogenesis of the disease in children than in adults. If necessary, gastrocepin is prescribed as the drug of choice in this age group.

Various forms of functional disorders are often combined; biliary dysfunction or intestinal irritation may join the symptoms of non-ulcer dyspepsia. Such complications often cause the persistence of pain syndrome during treatment, in connection with which the doctor must analyze all complaints of the patient, including those that do not fit into the typical picture of non-ulcer dyspepsia, and take them into account when prescribing treatment.

Patients with neurotic disorders and depression need to consult a psychotherapist; correction of moderate asthenic and anxiety disorders in children and adolescents with non-ulcer dyspepsia is carried out by pediatricians and gastroenterologists at the initial appointment. In case of asthenic syndrome, vitamins, herbal biostimulants, salt and pine baths are indicated; patients are recommended to increase the duration of sleep, organize walks in the fresh air, and temporarily reduce stress.

For anxiety disorders, sleep disorders, sedatives of plant origin are indicated: valerian, peppermint, lemon balm. The listed components are part of the drug Persen in addition to the sedative and antispasmodic effect. Indications for use: increased neuroreflex excitability, insomnia, irritability, complex treatment of functional gastrointestinal disorders. Contraindications: arterial hypotension, intolerance to the components of the drug. Interactions: enhances the effect of hypnotics, hypotensive drugs and central analgesics. Approved for use in children over 3 years old in the form of tablets (1-3 tablets per day), from 12 years old - in the form of capsules (1-2 capsules per day).

The antidepressant effect of St. John's wort (Deprim, Negrustin) is widely used in outpatient practice. St. John's wort preparations are prescribed to children over 6 years of age.