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"Child`s Health" 5 (65) 2015

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Age characteristics of the motor disorders in inflammatory pathologies of digestive system

Authors: Reshetilov Yu., Dmitrieva S.
State Institute "Zaporozhye Medical Academy of Postgraduate Education" Ukraine

Categories: Pediatrics/Neonatology

Sections: Specialist manual

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Disorders of functional motor and secretory ties stomach, duodenum, gall bladder and pancreas in different periods of interdigestive cycle considered as the pathogenesis link in formation of combined inflammatory pathology of the digestive system. The study of functional connections of the organs of the proximal digestive tract allows evaluating their activity in different periods interdigestive cycle in healthy children and adolescents, as well as in patients of all ages with disorders of the digestive system.
Material and methods. The motility of the digestive system was studied by the method of complex phase poligastroduodenometiry with ultrasound monitoring of the gallbladder and pancreas. Gastroduodenal motility and intracavitary pressure of stomach and duodenum were investigated by the method of the open catheters. Simultaneous ultrasound was performed according to the phase structure of interdigestive cycle. The study involved 334 persons - 314 patients with inflammatory gastroduodenal pathology and 30 healthy children and adolescents. There were three groups of observed patients: with increased, with saved and with low stomach acid-forming function. The results of investigation were processing with the methods of variation statistics using application packages.
Results. Determined that in healthy children and adolescents in all studied age groups (6-10, 11-14 and 15-18) were observed the phase structure  gastroduodenal motility: phase I  - 22.4 + 2.0 min .; phase II - 42.6 + 2.6 min and the phase III - 5.6 + 1.7 min. Indicator motor phase ratio was 0.3: 0.6: 0.1. Average value of the phase intracavitary pressure in the stomach were: in phase I - 58.0 + 3.5mm water column, II - 62.4 + 3,3mm water column and in phase III - 73.7 + 3, 0 mm water column; in the duodenum: I phase and -70.3 + 2,7mm water column, in the II phase - 76.1 + 3,9mm water column and in the III phase - 95.2 + 3,2 mm water column  (P <0,05).
By simultaneous study of pH and motor activity of the stomach and duodenum in basal conditions was determined the decrease of gastric pH of 1.8 + 0.17 in the I phase to 1.0 + 0.10 in the II phase (P <0,05). In the II phase the intragastric pH was again determined to 1,7 + 0,12 (P <0,05). Therefore, it was concluded that the maximum implementation of acid-forming function of the stomach is in the II phase of interdigestive cycle of motility.
Ultrasound monitoring has shown that in the second phase of the were recorded   increase of size and volume of gallbladder (P <0,05), due to the isolation of hepatic bile and maximum filling of the gallbladder during of period of work. At the same time was  tendency (0,1> P> 0,05) to increase  of the ultrasound- size of the pancreas, although the density and uniformity of the pancreas in all phases of gastroduodenal motility remained without significant changes (P> 0,05).
In survey of the patients with gastroduodenal pathology was found that the cyclic phase structure of gastroduodenal motility can vary. By the reducing of the intragastric pH is usually observed the hyperkinesias and hypertension of gastric and duodenal, and hyper dyskinesias of gallbladder. In the patients with preserved function of gastrics acid the phase parameters of gastroduodenal motility and gallbladder did not differ from controls (p> 0.05). The low pH of the stomach was associated with  hypokinesia of stomach, duodenum and often - with the  hypokinesia of gallbladder. Functional tonic activity of pancreas of children and adolescents was remained normal.
Discussion. The results made it possible to determine the nature of the work of digestive system in every phase between the interdigestive cycles. So, in the period of the work, the stomach and duodenum were reduced; gallbladder relaxes and fills hepatic bile; were allocated gastric juice with pH 1.0 + 0.2, hepatic bile, intestinal juice, a small number of pancreatic juice. Graphically, one duodenogastric reflux registered.  During period of the rest, the stomach and duodenum relax. Gallbladder, in ultrasound monitoring, was reduced in size, it was rounded. Allocated the dark bile from gallbladder, the principal amount of pancreatic juice; increased gastric pH. In inflammatory diseases were registrated  the  violation of this  activity of the organs of digestive system at any  phase of digestive. Comprehensive assessment of functional motor and secretory relations of the digestive system allows to prove the nice methods of differential correction and treatment of gastroduodenal diseases in children and adolescents.
1. In the normal, the activity of the digestive system in children and adolescents is cyclical and characterized by functional relationships of the organs of digestive system in accordance with the phase dynamics of the stomach and duodenum.
2. Violation of functional relationships of organs of digestive system are characterized according to their orientation (hyper- or hypokinesia and hyper- or hypotension) and correspond to the phase  motility dynamics of the stomach and duodenum,  acid-forming function of the stomach and intracavitary pressure.
3. In chronic inflammatory diseases of the gastroduodenal in children and adolescents observed the violations of functional relationships of the digestive system, which depended on the level and extent of lesions of the digestive system.


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