Risk factors for gastrointestinal diseases in children of different age groups

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Introduction. Gastrointestinal diseases in children are a pressing public health issue, and their diagnosis has a significant impact on the health of all age groups [1, 2]. Currently, the main risk factors for the development of gastrointestinal diseases include genetic predisposition (a family history of gastrointestinal diseases), maternal diseases during pregnancy (anemia, gestosis, genitourinary infections), cesarean section, perinatal complications, allergic diseases, and nutritional disorders (early transition to artificial feeding) [1, 3]. It is also worth noting that the most significant increase in morbidity is observed at the beginning of the school year due to a sharp change in the child's lifestyle - a change in the daily routine and diet, the establishment of new social contacts, a decrease in physical activity with a simultaneous increase in mental stress, as well as the need for maximum mobilization of intellectual, emotional and physical resources [4].

The aim of the work was to study the factors predisposing to the development of gastrointestinal tract diseases among children of different age groups.

Materials and methods of research. In order to study the predictors of gastrointestinal tract pathologies in children, an analysis of medical records of 40 children aged 7 to 17 years attending preschool, primary, basic, middle and senior school educational institutions in Voronezh was conducted at the Children's Clinic of Building No. 5 of the State Budgetary Healthcare Institution of the Voronez Region Voronezh City Clinical Hospital No. 4.

Research results. The study revealed that 19 patients (47.5%) were underweight, 4 (10%) were overweight, and the remaining 17 (42.5%) had a body weight corresponding to their age group. It was also noted that patients with a BMI > 25 kg/m2 had cases of pancreatic damage (7.5%), as well as a single case of gastroduodenitis (2.5%). In children with a BMI < 18 kg/m2, symptoms of damage to the digestive tract (35%) and bile ducts (12.5%) were predominantly diagnosed.

From the anamnesis of life it was established that the mothers of 11 (27.5%) examined patients of all ages had complications during pregnancy, among which the most common cases were gestosis (5.5%), chronic toxoplasmosis (5.5%), oligohydramnios (5.5%) and intrauterine hypoxia (11%). It is worth emphasizing that in children born with such complications, the first symptoms of gastrointestinal pathology develop at an early age.

In 5 (12.5%) examined senior school-age children, a positive test for H. pylori was revealed in the anamnesis of the disease. This gram-negative bacterium stimulates local inflammation of the mucosa by producing prostaglandins and the enzyme urease, which breaks down urea into ammonia and carbon dioxide with subsequent production of a protective alkaline "cloud". Thus, patients have gastrointestinal tract damage with characteristic symptoms and malnutrition, therefore nutritional deficiency will develop with the development of asthenic syndrome.

Allergic history was revealed in 8 patients (20%), mainly of primary school age. Modern literature describes the relationship between type I hypersensitivity reactions and the development of inflammatory diseases in the digestive tract with subsequent diagnosis of oral allergic syndrome and gastrointestinal anaphylaxis.

In 5 (12.5%) examined children, mainly adolescents, the history of the disease revealed pathology of the nervous system associated with the detection of autonomic nervous system disorder and the development of hyperexcitability syndrome. As a result, such patients experience impaired contractility of the stomach and duodenum walls, as well as gastrointestinal sphincters.

It is worth emphasizing that 8 (20%) children of all ages also have an aggravated family history - 6 (15%) cases of inherited type 2 diabetes mellitus and 1 (2.5%) case of predisposition to GERD and cholelithiasis. These results indicate the hereditary nature of gastrointestinal diseases.

4 (10%) preschool children, in addition to gastrointestinal diseases, also suffer from urinary tract infections. According to recent studies, E. coli, in addition to bacterial damage to the stomach and intestines, also causes cases of acute glomerulonephritis and pyelonephritis.

In 5 (12.5%) examined children of primary and secondary school age, various pathologies of the cardiovascular system associated with impaired intracardiac conduction and the development of pathological pulsation in the peripheral vessels were detected. The medical literature describes the relationship between the development of pathologies of two organ systems, the main causes of which are the common innervation of the gastrointestinal tract with the heart. In addition, the digestive system is a source of reflexogenic activity that extends to the cardiovascular system, as well as an object of higher vegetative influences. In this study, 3 suspected cholecystocardial (7.5%) and 2 suspected duodenocardial syndromes (5%) were identified.

In 2 (5%) adolescent patients, diffuse goiter of the thyroid gland was also observed with subsequent development of protein-energy deficiency and, as a consequence, gastroduodenitis, which is associated with a violation of the neurohumoral regulation of the digestive tract, caused by increased activity of thyroid hormones (triiodothyronine, thyroxine) and GIG peptides. As a result, such patients have body weight deficiency and premature excitation syndrome associated with autonomic nervous system disorder.

Discussion. The main prerequisites for the development of gastrointestinal tract pathology were complications during pregnancy, hereditary predisposition, aggravated allergic history, bacterial infection and autonomic nervous system imbalance. In-depth study of case histories revealed features of manifestations of concomitant pathology: preschool children had urinary tract infections, primary and middle school children had cardiovascular pathology, and middle and senior school children had diffuse goiter of the thyroid gland.

Conclusion. Diseases of the digestive tract, due to the variety of predictors, as well as their combined and joint effects, are characterized by extensive epidemiology and diverse symptoms. That is why, in the course of establishing the correct diagnosis, it is important to study medical records for concomitant diseases and aggravated family history, and in young children, also the individual medical record of the pregnant woman and the woman in labor.

About the authors

Michail Remezov

Voronezh State Medical University named after N.N.Burdenko

Author for correspondence.
Email: docmikle@mail.ru
ORCID iD: 0000-0003-1598-6768

5th year student of the pediatric faculty

Russian Federation, 394036, Russia, Voronezh, st. Studencheskaya, 10

Violetta Olegovna Lokteva

Voronezh State Medical University named after N.N.Burdenko

Email: violettkuznetsova@yandex.ru
ORCID iD: 0009-0008-9430-1870

Assistant Professor of Faculty and Palliative Pediatrics

Russian Federation, 394036, Russia, Voronezh, st. Studencheskaya, 10

References

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