[PEDIATRIC GASTROENTEROLOGY: ORIGINS, PROBLEMS, AND PROSPECTS OF THE RESEARCH].

The nomenclature of digestive diseases in children was supplemented by the "new" diseases: of esophagus--gastroesophageal reflux disease (GERD), Barrett's esophagus, Zenker's diverticulum; of stomach and duodenum--gastroduodenitis, peptic ulcer disease, polyps, ectopic pancreas in the stomach wall; of the intestine--jejunitis, ileocolitis, Crohn's disease, celiac disease, bacterial overgrowth syndrome in the small intestine; of biliary tract--cholelithiasis, gallbladder cholesterosis, anomalies of the biliary tract; of pancreas--acute and chronic pancreatitis, annular pancreas (2). The features of gastrointestinal diseases in children experiencing the action of factors, not always positively affecting the growing organism, were established. These features include: presence of allergic background; high level of neuro-autonomous and psycho-emotional changes in modern children, not only in schoolchildren, but even in preschoolers; polymorbidity or a combination (syntropy) of lesions of the digestive system; adverse outcomes of certain diseases as chronization, complications development, and as a consequence--a high risk of disability in children; "rejuvenation" of certain diseases of the digestive system (cholelithiasis, gallbladder cholesterosis, Crohn's disease), typical for adults. It is important to emphasize the clinical and social importance of gastroenterological diseases in childhood. Axiomatic is that the origins of many diseases of the digestive organs in adults lie in childhood. Early manifestation of certain diseases such as peptic ulcer disease, gluten enteropathy, Crohn's disease, and others, significantly impact the quality of life of sick children and their parents. It is worth to emphasize high costs of medical and prophylactic (tertiary prevention) activities using the drugs of latest generations. All this causes problems in both applied and scientific pediatric gastroenterology.

[ENZYME THERAPY OF POSTCHOLECYSTECTOMY SYNDROME IN CHILDREN].

The article provides pathogenetic justification of the need and the effectiveness of enzyme replacement therapy (ERT) of postcholecystectomy syndrome (PHES) in children. Special focus will be on the possibility of using the ERT in PHES in children of different age groups. Personal experience with these drugs in children with cholelithiasis is provided, considering their mechanism of action and side effects of ERT. Advantages of Creon are demonstrated for correction of exocrine pancreatic function in PHES in children.

[Dyslipidemia in children with cholelithiasis as a marker of metabolic syndrome development].

In the article based on own research shows changes in lipid and carbohydrate metabolism in children with gallstone disease (GSD), characteristic of the metabolic syndrome (MS). The data obtained suggest that obesity is not always a marker of the metabolic syndrome. A key element in the development of MS are the changes of lipid and carbohydrate metabolism.

[The treatment of gallbladder cholesterosis in children].

The article contains the results of studies indicating the benefits of conservative therapy in children with gallbladder cholesterosis (GBC). The high efficiency of ursodeoxycholic acid in the treatment of GBC in childhood is shown in the study. Our research in the field of GBC in children allows the authors to propose management algorithm of such patients.

[Modern aspects of the prevention of diseases of the digestive system in children ].

The article reviews the modern aspects of the prevention of diseases of the digestive system in children. It analyzes the levels of prevention activities, starting with the first days of a child's life. Great value is given to healthy ways of parents' lives, in the future - of the children: monitoring the course of pregnancy, genetic counseling and prenatal diagnostics of the pathology of the fetus. Heredity plays an important role in the cause-significant factors of diseases of the digestive system, violations of the calendar of vaccination, etc. One of the bases of prevention is a staged treatment of diseases of the digestive system, the identification of risk factors that can cause an aggravation or a continuously-recurrent course. The selection of rehabilitation programmes and hospital replacement technologies to improve and maintain the quality of life of sick children were substantiated.

[Risk factors and mechanisms of the postcholecystectomy syndrome development in children].

Cholelithiasis has long ceased to be casuistry in childhood. In connection with the steady tendency for it to grow, it has increased the number of surgical interventions on the occasion of holelitiazis. The removal of the gall bladder in some patients is accompanied by disorders on the part of the digestive system, identified as postcholecystectomical syndrome. The article describes the risk factors and mechanisms of the formation of the postcholecystectomical syndrome in children.

[The role of metabolism disorders in genesis of gallstone disease in children].

Identified changes lipid metabolism in children with biliary disease, characteristic of the metabolic syndrome. The correlation between indices of lipid metabolism with body weight in children with cholelithiasis. However, the degree of impairment of carbohydrate metabolism was independent of body mass index. Obtained data allow us to state that obesity is not always a marker of the metabolic syndrome.

[Constipation in children].

Chronic constipation (HZ) in children remains one of the most urgent and complex problems of pediatric gastroenterology and form a wide range of health and social and psychological problems. Due to the lack of clear understanding of the pathogenesis, classification, diagnosis and treatment of constipation are complicated. A significant role belongs to the nervous system and in the development of other forms of HZ, which should be considered during diagnostics and treatment.

[Therapeutic tactics in cholelithiasis in children].

Biliary tract diseases in children in recent years increasingly attracted the attention of not only physicians and surgeons, but this problem is becoming increasingly important in pediatric practice. Thus, gallstone disease in childhood is becoming a serious medical and social problem because of its chronic relapsing course, the development of severe complications, reduced quality of life and social adaptation of children. A particular difficulty is to select treatment tactics at cholelithiasis in childhood. The aim of this study was to demonstrate on the basis of own experience observing children with cholelithiasis, advantages and disadvantages of both surgical and conservative treatment of cholelithiasis in children, suggest alternative approaches for different periods of childhood.

[Successful cytolytic at three months child with gallstone disease].

Gallstone disease (GSD) in childhood is no longer a casuistry. In connection with it pediatricians have some questions: which method of treatment should be preferred? How to prevent disease progression? Despite the vast experience gained by physicians, gastroenterologists in the study of cholelithiasis in pediatric pharmacotherapy issues of GSD are under study, because it isn't possible to extrapolate the turned internists data in pediatrics, should be considered with the anatomical and physiological characteristics of children, to take into account peculiarities of formation and chemical composition of gallstones. Recent advances in operative and endoscopic techniques allow for the revision of treatment policy for children with cholelithiasis. The aim of the study was to determine the effectiveness of conservative therapy of gallstone disease in infants. Materials and methods. We observed 74 children with cholelithiasis in age from birth to 3 years. Was shown efficiency of gallstones litholysis with help of ursodeoxycholic acid.

[Current aspects of diseases biliary tract in childhood].

This article describes the current status of the issue of biliary tract disease in children. There were shown current differences according to age-appropriate. Was presented a new structure of the bile-excreting system diseases, among them dysfunction of the gallbladder and Oddi's sphincter, bile duct abnormalities, biliary sludge, cholelithiasis; cholesterosis of the gall bladder isn't casuistry. Was established necessity of modern intrascope research methods for the differential diagnosis of these diseases. Were identified promising areas of study of biliary tract diseases in childhood.

[Clinique--pathogenetic features of postcholecystectomy syndrome in children].

UNLABELLED: Years of experience observing children with GSD made possible to determine the clinical course and to clarify some of mechanisms of postcholecystectomical syndrome formation in children. Material and methods. There were observed 148 children who underwent cholecystectomy at the age of 3 to 15 years. There were 44 boys and 104 girls. Diagnosis refined was conducting by ultrasonography, magnetic resonance imaging. Degree of biliary insufficiency was assessed based on dynamic of gepatobilliarscintigraphy. The clinical picture of disease was assessed according to age and sex of the child. RESULTS: We described the clinical course and pathogenetic mechanisms of postcholecystectomical syndrome in children in the age aspect. Based on the results of our research, were found ways of correction of postcholecystectomical syndrome in children with cholelithiasis.

[Clinical and morphological features of gallbladder cholesterosis in children].

Although that the first reports of cholesterosis gall bladder were in the second half of the XIX century, there is still insufficient information about the frequency of its detection in children. According to some researchers, this disease was detected in patients aged 13 to 14 years. In other periods of childhood gallbladder cholesterosis is considered to be casuistic rarity. Multiyear study conducted by the authors in the study of diseases of biliary tract showed that almost a third of children had combined with cholelithiasis with gallbladder cholesterosis. However, prior to cholecystectomy is diagnosed only 5% of children. In connection with this the aim of our work was to learn the peculiarities of the clinical picture and morphological changes in children at gallbladder cholesterosis. Material and methods. There were observed 54 children with gallbladder cholesterosis (GBC) aged from 1 year to 15 years (20 girls, 34 boys) . The diagnosis was confirmed histologically in the walls of GB. Gallbladder cholesterosis was differentiated from polyps and concrements of GB in the performance of traditional and endoscopic ultrasound. According to testimony performed endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance imaging of the abdominal cavity. The material was processed statistically using a specially program developed by Medstat. Results. There were showed clinical course features and morphological picture of the gallbladder wall. There were brought the attention of pediatricians to the reversibility of the pathological process in childhood, which suggests alternative methods of treatment in gallbladder cholesterosis the in children--traditional treatment.

[Essential microelements and gallstones in children]. / Essentsial'nye mikroélementy i zhelchnokamennaia bolezn' v detskom vozraste.

The article presents a study of particular features of the essential microelements content in the hair, blood, bile and gallstones in infants with cholelithiasis. It was shown that this disease is accompanied by a lack of microelements, which appears as a lack of selenium, imbalance of zinc and accumulation of iron and copper in biological objects. In conjunction with other factors (vegetative dysfunction, comorbidities of the gastrointestinal tract and maldevelopment of the bile-excreting tract), the lack of microelements can promote the formation of gallstones in infants. It is possible to obtain complete information on particular features of microelements changes with the help of simultaneous studies of tissues of the hair, blood, bile and gallstones.

[Clinical and pathogenetic significance of biliary tract abnormalities in a child with cholelithiasis]. / Kliniko-patogeneticheskoe znachenie anomalii zhelchnovyvodiashchikh putei u detei s kholelitiazom.

The clinical peculiarities of cholelithiasis in the children with biliary tract's anomalities are presented in this paper. The data of clinical, instrumental examinations and anamnesis are analysed. Although, there are some clinical peculiarities of cholelithiasis in the patients with biliary tract's anomalities, intrascopic methods of examination are preferable. Ultrasonography is used as quick method during before hospital examination. Retrogdade cholangiopancreatography in special hospital is the main diagnostic method in such patients, that defines the date, volume and kind of operation.

[Distant thermography in the diagnosis of digestive organ diseases in children]. / Distantsionnaia termografiia v diagnostike zabolevanii organov pishchevareniia u detei.

The authors review the most urgent problems of alimentary diseases in children: diagnosis, differential diagnosis and early detection with the use of remote thermography, an up-to-date noninvasive and atraumatic research method. The method was demonstrated to be highly informative in diseases such as gastroduodenitis, peptic ulcer, chronic pancreatitis and others. The significance of remote thermography in revealing functional pathology of the alimentary organs in children is emphasized.