Characteristics of the Course of Functional Dyspepsia and Chronic Inflammatory Gastroduodenal Diseases in Children in the Conditions of the Far North

The dissertation is devoted to the study of the characteristics of the course of functional dyspepsia and chronic inflammatory gastroduodenal diseases in children and adolescents living in the conditions of the Far North, using the city of Noyabrsk, Yamalo-Nenets Autonomous Okrug, as an example. The study covers the period from 1996 to 2005 and includes an analysis of morbidity of the digestive organs, clinical manifestations, and endoscopic and histological data. Special attention is given to comparative analysis with the indicators of Novosibirsk Oblast.

The work is aimed at identifying regional patterns in the formation and course of the considered pathologies, assessing the role of climatic-geographic and ecological factors, and determining the features of the clinical course of functional dyspepsia, chronic gastritis, gastroduodenitis, and duodenal ulcer disease under the extremality conditions of the North.

Relevance of the topic. The positive therapeutic and statistical trends that emerged in the Russian Federation in 2002 (an increase in the birth rate and a decrease in infant mortality) were unable to offset not only the persistent decline in the natural population decrease, but also the increase in the number of children with disabilities. At present, every third child is already considered ill from the neonatal period onward. Over the past ten years, there has been an increase in the morbidity rates of the gastrointestinal tract among children aged up to fourteen years, as well as among adolescents, by 50% and 64% respectively. At the same time, the rates of chronic disease growth increased by 23% and 26% respectively [15; 162].

A widespread increase in the frequency of chronic diseases of the digestive organs has also been observed. Thus, if in the mid-1960s to 1970s this indicator corresponded to 50–81.6 per 1,000 children, by the late 1990s it had risen to 120–245.5 per 1,000 children, averaging 160.9 across Russia. Within the structure of gastroenterological diseases, 60–70% or more is attributable to chronic gastritis and gastroduodenitis. In unfavorable regions, diseases of the digestive organs are even more prevalent, ranging from 200 to 500 cases per 1,000 population [16; 32; 61; 123; 185].

Of particular concern is the growing prevalence of individual forms of pathology previously rarely encountered in children: cholelithiasis, chronic pancreatitis, reflux disease, nonspecific ulcerative colitis, Crohn's disease, and malignant neoplasms [16, 7; 136; 200; 202].

The overall level of gastroduodenal morbidity is substantially influenced by the climatic and geographic conditions of residence. The impact of climatic and geological conditions manifests not only in the increased frequency of certain forms of pathology, but also in the peculiarities of their clinical course [48; 82]. Under these conditions, there is observed an intensification of metabolic processes, enhanced lipid peroxidation reactions, functional immunodeficiency, and shifts in autonomic regulation, which inevitably lead to changes and a distinctive nosological "panorama" of the North (3; 132; 157; 171).

In this regard, the study of regional features in the formation and course of gastroduodenal diseases in children and adolescents is acquiring increasing importance.

The aim of the study is to analyze the frequency of functional (non-ulcer) dyspepsia and chronic inflammatory diseases of the upper digestive tract among children and adolescents in the territory of Noyabrsk, Yamalo-Nenets Autonomous Okrug, over the past ten years, and to identify features of their clinical course that differ from those characteristic of these diseases in Novosibirsk Oblast.

Research objectives:

1. To study the frequency and structure of diseases of the upper digestive tract in children and adolescents in the territory of Noyabrsk for the period from 1996 to 2005, based on annual reporting documentation from the Bureau of Informatics and Medical Statistics of the Health Department of the City Administration.

2. To identify characteristic features of their course, main clinical variants of progression, and endoscopic manifestations characteristic of the exacerbation period.

3. In patients with chronic gastritis, gastroduodenitis, and ulcer disease, to additionally assess using a visual analog scale the presence and degree of inflammation, erosive processes, atrophy, metaplasia, and H. pylori colonization in biopsy specimens of the gastric and duodenal mucosa, based on morphological criteria.

4. On the basis of a comparative study, to identify common patterns and differences in the clinical course of functional dyspepsia and chronic inflammatory diseases of the upper digestive tract in the territories of Noyabrsk and Novosibirsk Oblast.

Scientific novelty of the study.

Analysis of the overall dynamics of newly manifested diseases of the digestive organs in the territory of Noyabrsk, Yamalo-Nenets Autonomous Okrug, and the increase in the frequency of functional dyspepsia, chronic gastritis, gastroduodenitis, and duodenal ulcer disease among children and adolescents. However, the corresponding calculated indicators were found to be lower compared to the average statistical frequency of registration of these forms of pathology in other regions of the Russian Federation, which allows classifying Noyabrsk as a city with a low level of morbidity of the digestive organs among the population aged up to seventeen years.

Changes have been noted in the structure of pathology of the upper digestive tract: in the rank distribution, functional dyspepsia rose to a higher position, chronic gastritis and gastroduodenitis took second place, and ulcer disease took third. At the same time, among adolescents, chronic inflammatory diseases of the stomach and duodenum hold the leading position, despite the outpacing growth in the frequency of functional dyspepsia and duodenal ulcer disease.

For the first time, the application of a unified visual analog scale of morphological changes made it possible to objectify the assessment of the degree of inflammatory activity, H. pylori colonization, erosive processes, metaplasia, and regression processes in biopsy specimens of the gastric and duodenal mucosa. On the basis of the obtained data, it was established that among residents of Noyabrsk aged up to seventeen years, chronic gastritis and gastroduodenitis are not prone to rapid progression and development of gastric secretory insufficiency, and duodenal ulcer disease proceeds in a non-complicated form.

The ranking of the corresponding diseases by severity of main clinical symptoms, prevalence, and depth of inflammatory changes in the mucosa, conducted on the basis of endoscopic examination results, revealed previously little-known facts. The essence of these is that under the conditions of the Far North, chronic gastroduodenal diseases in children aged up to fourteen years and adolescents generally proceed more mildly than in peers residing in Novosibirsk Oblast. The obtained data serve as the basis for further comprehensive study of the features of neuroregulatory mechanisms determining the rate of recovery processes in the development of gastroduodenal diseases in children under the climatic and ecological extremality of the Far North.

Practical significance of the work.

The obtained results are used in the preparation of annual reports on the dynamics of morbidity of the digestive organs, taking into account the chronic gastroduodenal diseases (CGD) among residents of Noyabrsk aged up to seventeen years; in the planning of screening programs for the detection and prevention of non-ulcer and ulcer diseases of the stomach and duodenum; in determining the need for gastroenterologists, specialized beds, and pharmaceutical preparations, with consideration for and dispensary observation of this category of patients.

On the basis of the obtained data, it has been shown that it is necessary to include non-invasive methods of H. pylori diagnosis in biological environments (colonies, saliva) and exhaled air in the relevant screening programs.

The expediency of organizing hot meals and vitaminization of food for schoolchildren and other categories of students, as well as therapeutic nutrition for children and adolescents with gastroenterological diseases in city schools, has been substantiated.

Dissemination of research results.

The results of the study are used in the work of the children's polyclinic of Noyabrsk, in the study of issues of children's gastroenterology during practical classes, and in lecture material for fourth- and fifth-year students at the Department of Faculty Pediatrics of Novosibirsk State Medical University of Russia.

Positions to be defended:

1. In the period from 1996 to 2005 in Noyabrsk, Yamalo-Nenets Autonomous Okrug, an increase in morbidity of the digestive organs among children and adolescents was observed, rising from 59.1 to 107.5% and to 94.1% respectively, which on average was 1.5–2 times lower compared to the average Russian statistical indicators. At the same time, the frequency of functional dyspepsia, chronic gastritis (gastroduodenitis), and duodenal ulcer disease was also lower than in other regions of Russia, which is one of the features of the formation of morbidity indicators among children and adolescents aged up to seventeen years. Changes in the structure of diseases of the upper digestive tract in children are characterized by a shift toward a predominance of functional dyspepsia, while among adolescents — toward chronic gastritis and gastroduodenitis.

2. In the territory of Noyabrsk, functional dyspepsia occurs with equal frequency in both sexes and clinically manifests predominantly in the discomfort variant; in 85.7% of cases it is combined with a congenital anomaly of the gallbladder, in 65.7% — with dysfunction of the biliary tract and sphincter of Oddi, in 20% — with chronic cholecystitis, and in 25.7% of cases it is associated with H. pylori.

3. According to endoscopic and histological studies, among residents of Noyabrsk aged up to seventeen years, the non-atrophic (superficial) form of chronic gastritis and gastroduodenitis is most prevalent, characterized by minimal and moderate degrees of inflammation, and in 60.8–64.3% of observations is associated with helicobacteriosis. In gastritis, the antral and fundal regions of the stomach are affected with equal frequency, while for gastroduodenitis, antral localization is more typical. Gastroesophageal reflux disease develops rarely, and pyloroduodenal reflux occurs predominantly in chronic gastroduodenitis.

4. In the territory of Noyabrsk, classified as the Far North, chronic inflammatory diseases of the upper digestive tract in children and adolescents proceed more mildly than in peers residing in Novosibirsk Oblast. These diseases are not prone to progression, nor to atrophic changes in the mucosa and gastric secretory insufficiency; in duodenal ulcer disease — to bleeding and other severe complications.