medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-17-130-136medsovet-4695Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYХронический запор в сочетании с дисфункцией билиарного тракта у детей: коморбидность или клиническая закономерность?Chronic constipation combined with biliary tract dysfunction in children: comorbidity or clinical regularity?https://orcid.org/0000-0003-4200-4598ЗахароваИ. Н.ZakharovaI. N.

Захарова Ирина Николаевна, доктор медицинских наук, профессор, заслуженный врач России, заведующая кафедрой педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Irina N. Zakharova, Dr. of Sci. (Med.), Professor, Honoured Doctor of Russia, Head of Speranskiy Chair for Paediatrics with Polyclinic Paediatrics Module

b. 1, 2/1, Barrikadnaya St., Moscow, 125993

kafedra25@yandex.ruБережнаяИ. В.BerezhnayaI. V.

Бережная Ирина Владимировна, кандидат медицинских наук, окружной детский гастроэнтеролог СЗАО г. Москвы, доцент кафедры педиатрии с курсом поликлинической педиатрии им. Г.Н. Сперанского

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Irina V. Berezhnaya, Cand. of Sci. (Med.), District Children’s Gastroenterologist for Northwest Administrative District of Moscow, Assistant Professor of Speranskiy Chair for Paediatrics with Polyclinic Paediatrics Module

b. 1, 2/1, Barrikadnaya St., Moscow, 125993

berezhnaya-irina26@yandex.ruШишкинаС. В.ShishkinaS. V.

Шишкина Светлана Вячеславовна, кандидат медицинских наук, врач-педиатр, гастроэнтеролог

143081, Московская область, Одинцовский район, д. Лапино, д. 111

Svetlana V. Shishkina, Cand. of Sci. (Med.), Pediatrician, Gastroenterologist

111, Lapino village, Odintsovo district, Moscow region, 143081

tymma_88@mail.ruРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuing Postgraduate EducationRussian FederationООО «Хавен» — клинический госпиталь «Лапино», Детский клинико-диагностический центрРоссияHaven LLC – Medical Hospital Lapino, Children’s Clinical Diagnostic CenterRussian Federation201924112019017130136Copyright © Захарова И.Н., Бережная И.В., Шишкина С.В., 20192019Захарова И.Н., Бережная И.В., Шишкина С.В.Zakharova I.N., Berezhnaya I.V., Shishkina S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/4695

Functional disorders of the gastrointestinal tract (GIT) are a common problem in children. The Roman IV criteria adopted in 2016, devoted to the problem of constipation and biliary tract dysfunction in children are developed in accordance with age and are idendoitified by the letter code. This article presents data on the correspondence of the Roman IV criteria and ICD-10 in the combined problem of constipation and biliary tract dysfunction in children. The development of upper gastrointestinal tract pathology caused by increased intracavitary pressure associated with impaired colon motility (chronic constipation) is natural during a prolonged course of chronic constipation. The study based on a specially designed questionnaire in Russia showed that an average of 54% of children in different age groups suffer from chronic constipation, that is, almost every second child. Studies showed that the frequency of biliary tract dysfunction in children with chronic constipation accounts for 42.3 to 100% cases. The survey that we conducted among pediatricians showed that a quarter of doctors found it difficult to establish diagnosis, and 41% of pediatricians struggled with prescribing therapy for persistent constipation in children, especially constipation combined with motor-tonic dysfunction of the colon in children with biliary tract dysfunction. A total of 201 children aged 6 to 15 years (96 boys and 114 girls) were enrolled in the study. In addition to pain syndrome, cellular energy exchange disorder in the form of decreased level of intracellular antioxidant catalase enzyme and plasma antioxidant activity (PAO) was identified against the background of chronic constipation and biliary tract dysfunction in this group of children, which is evidence of decompensation of antioxidant protection in the acute stage of biliary tract dysfunctional disorders in children. The identified changes make a strong case for prescribing a drug with hepatoprotective, choleretic and antioxidant effects. The use of herbal extract of fresh artichoke leaves (Chophytol®, Mayoly Spindle, France) showed the relief of pain syndrome by Day 14 of treatment in 92% of patients (75% in the comparison group), nausea in 74% of children, constipation in 88% (50% of patients in the comparison group). It is important to detect an elevated α-tocopherol level and significantly reduced catalase level, which indicates the need to choose a drug with selective antioxidant activity, which does not change the α-tocopherol level. The introduction of the herbal extract of fresh artichoke leaves (Chophytol®) in the complex therapy of the studied patients accelerated the relief of the clinical symptoms of functional biliary tract disorders and reduced the frequency of constipation in children by 4 times as compared with the control group without significant effect on the α-tocopherol level.

желудочно-кишечный трактдетифункциональные гастроинтестинальные расстройстваРимские критерии IVХофитол®α-токоферолперекисное окисление липидовмалоновый диальдегидзапорgastrointestinal tractchildrenfunctional gastrointestinal disordersRoman IV criteriaChophytol®α-tocopherollipid peroxidationmalondialdehydeconstipationReferencesPeppas G., Alexiou V.G., Mourtzoukou E., Falaga M.E. Epidemiology of constipation in Europe and Oceania: a systematic review. BMC Gastroenterology. 2008;(8):5. doi: 10.1186/1471-230X-8-5.Peppas G., Alexiou V.G., Mourtzoukou E., Falaga M.E. Epidemiology of constipation in Europe and Oceania: a systematic review. BMC Gastroenterology. 2008;(8):5. doi: 10.1186/1471-230X-8-5.Van den Berg M.M., Benninga M.A., Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol. 2006;101(10):2401– 2409. doi: 10.1111/j.1572-0241.2006.00771.x.Van den Berg M.M., Benninga M.A., Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol. 2006;101(10):2401–2409. doi: 10.1111/j.1572-0241.2006.00771.x.Bharucha A.E., Pemberton J.H., Locke G.R. American Gastroenterological Association Technical Review on Constipation. Gastroenterology. 2013;144(1):218–238. doi: 10.1053/j.gastro.2012.10.028.Bharucha A.E., Pemberton J.H., Locke G.R. American Gastroenterological Association Technical Review on Constipation. Gastroenterology. 2013;144(1):218–238. doi: 10.1053/j.gastro.2012.10.028.Эрдес С.И., Мацукатова Б.О., Антишин А.С. Эпизодические и хронические запоры у детей: пошаговый подход к терапии в рамках IV Римских критериев. Consilium Medicum. Педиатрия. (Прил.) 2019;01:71-76.Ehrdes S.I., Matsukatova B.O., Antishin A.S. Occasional and chronic constipation in children: stepwise approach to the therapy under the Roman IV criteria. Consilium Medicum. 2019;(01):71-76. (In Russ.)Drossman D.A. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterol. 2016;150(6):12621279. doi: 10.1053/j.gastro.2016.02.032.Drossman D.A. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterol. 2016;150(6):12621279. doi: 10.1053/j.gastro.2016.02.032.Savino F., Castagno E., Bretto R., Brondello C., Palumeri E. Oggero R. A prospective 10-yearActa Padiatrica. 2005;94(449):129–132. doi: 10.1111/j.1651-2227.2005.tb02169.x.Savino F., Castagno E., Bretto R., Brondello C., Palumeri E. Oggero R. A prospective 10-year study on children who had severe infantile colic. Acta Padiatrica. 2005;94(449):129–132. doi: 10.1111/j.1651-2227.2005.tb02169.x.Stifter C.A., Backer P. Crying Behaviour and its Impact on Psychosocial Child Development. In: Tremblay R.E., Boivin M., Peters R.DeV. (eds.). Encyclopedia on Early Childhood Development. Updated March 2017. Accessed October 16, 2019. Available at: http://www.childencyclopedia.com/crying-behaviour/accordingexperts/crying-behaviour-and-its-impact-psychosocialchild-development.Stifter C.A., Backer P. Crying Behaviour and its Impact on Psychosocial Child Development. In: Tremblay R.E., Boivin M., Peters R.DeV. (eds.). Encyclopedia on Early Childhood Development. Updated March 2017. Accessed October 16, 2019. Available at: http://www.childencyclopedia.com/crying-behaviour/accordingexperts/crying-behaviour-and-its-impact-psychosocialchild-developmentАрдатская М.Д. Функциональные расстройства билиарного тракта: проблемы диагностики и лечения. Фарматека. 2012;(2):71–77. Режим доступа: https://www.gastroscan.ru/literature/authors/6581.Ardatskaya M.D. Functional Disorders Of The Biliary Tract: Problems Of Diagnosis And Treatment. Farmateka = Pharmateca. 2012;(2):71–77. (In Russ.) Available at: https://www.gastroscan.ru/literature/authors/6581.Kомарова Е.В. Хронический запор у детей (медицинские и социальные аспекты): автореф. дис. … д-ра мед. наук. М., 2007. 24 с. Режим доступа: http://medical-diss.com/medicina/hronicheskiy-zapor-u-detey-meditsinskie-isotsialnyeaspekty.Komarova E.V. Chronic constipation in children (medical and social aspects): extended abstract of … Dr. of Sci. (Med.) Dissertation. М., 2007. 24 p. (In Russ.) Available at: http://medical-diss.com/medicina/hronicheskiy-zapor-u-detey-meditsinskiei-sotsialnye-aspekty.Шишкина С.В. Диагностика и коррекция нарушений моторной функции ЖКТ при дисфункциональных расстройствах билиарного тракта у детей: дис. … канд. мед. наук. М., 2013. 25 с. Режим доступа: https://www.dissercat.com/content/diagnostika-i-korrektsiya-narushenii-motornoifunktsiizheludochno-kishechnogo-trakta-pri-di.Shishkina S.V. Diagnosis and management of the gastrointestinal tract motor dysfunction in dysfunctional biliary tract disorders in children: Dissertation of … Cand. of Sci. (Med.). Moscow, 2013. 25 p. (In Russ.) Available at: https://www.dissercat.com/content/diagnostika-i-korrektsiyanarusheniimotornoi-funktsii-zheludochnokishechnogotrakta-pri-di.Tabbers M.M., DiLorenzo C., Berger M.Y. Faure C., Langendam M.W., Nurko S., Staiano A., Vandenplas Y., Benninga M.A. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258–274. doi: 10.1097/MPG.0000000000000266.Tabbers M.M., DiLorenzo C., Berger M.Y. Faure C., Langendam M.W., Nurko S., Staiano A., Vandenplas Y., Benninga M.A. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258–274. doi: 10.1097/MPG.0000000000000266.Gordon M.J., Parker C.E., Akobeng A.K., Thomas A.G. Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database Syst Rev. 2016;(8):CD009118. doi: 10.1002/14651858.CD009118.pub3.Gordon M.J., Parker C.E., Akobeng A.K., Thomas A.G. Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database Syst Rev. 2016;(8):CD009118. doi: 10.1002/14651858.CD009118.pub3.Miller M.K., Dowd M.D., Friesen C.A., Walsh-Kelly C.M. A randomized trial of enema versus polyethylene glycol 3350 for fecal disimpaction in children presenting to an emergency department. Pediatr Emerg Care. 2012;28(2):115–119. doi: 10.1097/PEC.0b013e3182442c0a.Miller M.K., Dowd M.D., Friesen C.A., Walsh-Kelly C.M. A randomized trial of enema versus polyethylene glycol 3350 for fecal disimpaction in children presenting to an emergency department. Pediatr Emerg Care. 2012;28(2):115–119. doi: 10.1097/PEC.0b013e3182442c0a.Захарова И.Н., Пыков М.И., Бережная И.В., Сугян Н.Г., Зайденварг Г.Е., Радченко Е.Р., Степурина Л.Л. Дисфункциональные расстройства билиарного тракта. Что нужно знать педиатру. Медицинский совет. 2018;(11):91-102. doi: 10.21518/2079-701X-2018-11-91-102.Zakharova I.N., Pykov M.I., Berezhnaya I.V., Sugyan N.G., Zaidenvarg G.E., Radchenko E.P., Stepurina L.L. Functional disorders of the biliary tract. What a pediatrician needs to know. Meditsinskiy sovet = Medical Council. 2018;(11):91-102. (In Russ.) doi: 10.21518/2079-701X-2018-11-91-102.Хендерсон Дж.М. Патофизиология органов пищеварения. Пер. с англ. М.; СПб.: БиномНевский диалект, 1997. 287 с.Henderson J.M. Gastrointestinal Pathophysiology. Translation from English M.; SPb.: Binom-Nevsky dialect, 1997. 287 p. (In Russ.)Парфенов А.И. Энтерология. М.: Триада-Х, 2002. 724 с.Parfenov A.I. Enterology. M.: Triada-X, 2002. 724 p. (In Russ.)Семенова Г.Ф., Комарова Е.В., Потапов А.С., Петрова А.В., Шищенко В.М., Петричук С.В. Информативность основного энергообмена митохондрий лимфоцитов периферической крови у детей с хроническими запорами. Вопросы современной педиатрии. 2007;6(3):48-52. Режим доступа: https://cyberleninka.ru/article/n/informativnost-osnovnogo-energoobmenamitohondriylimfotsitov-perifericheskoy-krovi-udeteys-hronicheskimi-zaporami.Semenova G., Komarova E., Potapov A., Petrova A., Shishchenko V., Petrichuk S. Informative energy exchange of peripheral lymphocyte blood mitochondria in children with chronic constipation. Voprosy sovremennoj pediatrii = Current Pediatrics. 2007;6(3):48-52. (In Russ.) Available at: https://cyberleninka.ru/article/n/informativnostosnovnogo-energoobmena-mitohondriylimfotsitovperifericheskoy-krovi-u-detey-shronicheskimizaporami.

The authors declare that there are no conflicts of interest present.