Treatment of functional dyspepsia in children

In the treatment of functional dyspepsia, it is important to observe consistency and consistency. Symptomatic treatment is aimed at the elimination of clinical signs, taking into account pathogenetic mechanisms, begins at the primary reception. Provides a quick, often short-lived effect. Etiotropic treatment is based, as a rule, on instrumental and laboratory data. It helps to eliminate the discovered causes of dyspepsia and provide a long-term favorable prognosis.

To improve the effectiveness of symptomatic treatment, the correct interpretation of a patient's complaints is particularly important, since many modern drugs are highly selective with respect to the mechanism of action and the point of application. It is advisable to apply criteria of functional diseases of the gastrointestinal tract, adopted at the national and international level and allowing rationalizing diagnostic and therapeutic measures.

Domperidone

In the dyskinetic variant, a good effect is achieved by the reception of a peripheral dopamine receptor antagonist domperidone (motilium, motilac). The drug has a prokinetic effect, increases the tone of the lower esophageal sphincter, improves gastric accommodation and anthroduodenal coordination, helps eliminate dyspeptic symptoms. After ingestion quickly absorbed, bioavailability of about 15%, poorly penetrates the blood-brain barrier. The maximum concentration in the plasma - after 1 hour, the half-life is 7-9 hours. Intensively metabolized in the wall of the intestine and liver, is excreted through the intestine 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: with the simultaneous use of cholinolytics, antacids and inhibitors of gastric secretion, the effectiveness of domperidone decreases.

Children aged 5-11 years are prescribed 5 mg 3-4 times a day for 20 minutes before meals, from 12 years 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 autonomic nerve endings. Non-selective myotropic spasmolytic drotaverin (no-sppa) acts by inhibiting the enzyme phosphodiesterase IV, which increases the concentration of cAMP and relaxes smooth muscle. Regardless of the type of autonomic innervation, drotaverin affects the gastrointestinal tract. Cardiovascular, genitourinary, CNS, which is not always desirable. When ingested and parenterally quickly and completely absorbed. The maximum concentration is reached within 45-60 minutes. The half-life is 16-22 hours. Metabolized in the liver, excreted as metabolites with urine and feces.

Indications for use: spasms of smooth muscles of the gastrointestinal tract and urogenital system of any etiology, algodismenorea, headaches, tension. Contraindications: severe renal, hepatic and heart failure, with caution apply for 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 receptions, the course of treatment usually does not exceed 7 days.

In many cases, pain and discomfort are associated with a violation of autonomic regulation of the upper gastrointestinal tract according to the parasympathetic type. In such situations, the appointment of modern highly selective anti-gastrointestinal anticholinergics is justified.

Hyoscine butyl bromide

Puscinum butyl bromide (buscopan) - blocker of M-holinoretseptorov, has a ganglion-blocking effect that provides effective relief of pain syndrome, reduces the secretion of digestive glands. Virtually does not penetrate the blood-brain barrier. After ingestion, the maximum concentration in the blood is reached after 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, bile excretory and urinary tract, algidismenorea, complex treatment of peptic ulcer, cholecystitis and cholangitis. Contraindications: glaucoma, myasthenia gravis, intestinal obstruction, pronounced atherosclerosis of cerebral vessels. Interactions: enhances the anticholinergic effect of antihistamines, tricyclic antidepressants, quinidine, amantadine, enhances tachycardia caused by beta-adrenomimetics.

The drug is prescribed for children from 6 years to 5-20 mg 3 times per day inside or rectally to 2 weeks.

Pyrenzepine

Pirenzepine (gastrocepin) is an antisecretory agent. Selectively blocks M1-cholinergic receptors at the level of intramural ganglia, inhibiting the stimulating effect of the vagus nerve on gastric secretion. Cytoprotective effect is associated with improvement of microcirculation in the mucosa, suppression of intragastric proteolysis. After ingestion, up to 50% of the dose is absorbed from the digestive tract. The maximum concentration in the plasma is created after 3-4 hours, the half-life is 8-20 hours. The absorbed part of the drug is excreted in urine and bile in unchanged form.

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

Assign children from 6 years 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 medicines for the treatment of functional dyspepsia is antacids. Modern non-absorbing antacids based on aluminum and magnesium, in addition to the acid neutralizing effect, have an adsorptive and cytoprotective effect, which reduces the severity of pathological symptoms. However, with monotherapy, the effectiveness of this group of drugs is insufficient. Antatsidy with a low content of aluminum have a moderate laxative effect, which is useful in the combination of dyspepsia and propensity to constipation.

The hydrotalcite (ruticide) preparation has a stratified-mesh structure that provides a slow release of aluminum and magnesium ions, depending on the intragastric pH. Has a protective effect on the mucous membrane of the stomach, reduces the proteolytic activity of pepsin, binds bile acids. Virtually not absorbed from the digestive tract, excreted with feces.

Indications for use: acute and chronic gastritis, non-ulcer dyspepsia, reflux-esophagitis, peptic ulcer of the stomach and duodenum without 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 for children from 6 years to 250-500 mg 3-4 times a day after an hour after meals, the duration of the course is up to 2-4 weeks.

A worthy alternative to antacids - alginates, a group of preparations based on seaweed, with a long-lasting effect, effectively stopping heartburn and improving digestion. Gaviscon after ingestion reacts with acidic contents of the stomach, forming on the surface of the mucous membrane gel, with reflux, protecting the esophagus from the action of gastric juice. The drug is slightly absorbed from the digestive tract.

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

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

Antisecretory drugs in the treatment of nonulcer dyspepsia in children younger than 12 years are rarely used because of age limitations, in addition, hypersecretion in the pathogenesis of the disease in children plays a smaller role than in adults. If necessary in this age group, as a drug of choice, gastrocepin is prescribed.

Various forms of functional disorders are often combined, and biliary dysfunction or irritation of the intestine can join the symptoms of non-ulcer dyspepsia. Such complications often result in the persistence of the pain syndrome during treatment, in connection with which the physician should analyze all the patient's complaints, 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 the advice of a psychotherapist; correction of moderately expressed asthenic and anxiety disorders in children and adolescents with non-ulcer dyspepsia is performed by pediatricians and gastroenterologists at the primary reception. With asthenic syndrome, the appointment of vitamins, plant biostimulators, salt and conifer baths is indicated; patients are recommended to increase the duration of sleep, organize outdoor walks, temporarily reduce the load.

With anxiety disorders, sleep disorders, sedative agents of plant origin are shown: valerian, peppermint, lemon balm. The listed components are part of the drug Persen \ besides the sedative possessing and spasmolytic effect. Indications for use: increased nervous-reflex excitability, insomnia, irritability, complex treatment of functional disorders of the gastrointestinal tract. Contraindications: arterial hypotension, intolerance of the drug components. Interactions: enhances the effect of hypnotics, hypotensive drugs and analgesics of central action. It is allowed for use in children older than 3 years in the form of tablets (1-3 tablets a day), from 12 years - in the form of capsules (1-2 capsules per day).

In outpatient practice, the antidepressant effect of St. John's wort (deprim, neuristin) is widely used. Preparations of St. John's wort are prescribed for children over 6 years of age.