Chronic gastroduodenitis in children of industrial Kuzbass - Kemerovo and factors contributing to its development

The dissertation is devoted to the study of chronic gastroduodenitis in children and adolescents residing in the industrial region of Kuzbass (Kemerovo). The research examines the epidemiology, etiology, and instrumental-laboratory methods of diagnosing diseases of the upper digestive tract, taking into account the environmental factors of an industrial city. Particular attention is paid to the role of hereditary-determined markers — HLA antigens, group blood properties of the AB0 system, and dermatoglyphics — in the formation of predisposition to chronic gastroduodenitis. Based on a comparison of clinical-anamnestic and instrumental data, differential diagnostic criteria have been developed for distinguishing between Helicobacter pylori-associated and non-infectious forms of the disease.

The practical significance of the work is associated with the organization in Kemerovo of a children's clinical gastroenterological center, the implementation of methodological recommendations on clinical follow-up and rehabilitation of children with nonspecific diseases of the digestive organs, and the use of the obtained results in the educational process of the medical academy. The formulated diagnostic and prognostic criteria are oriented toward physicians of hospitals, polyclinics, and adolescent offices.

Diseases of the gastrointestinal tract in children and adolescents are a pressing contemporary problem. Over the past decade, qualitative changes have occurred in the structure of diseases of the digestive system, in which esophageal and gastroduodenal pathology have taken priority positions (A.A.Baranov, 1995, 1997, 1999; N.A.Druzhinina et al., 1999; A.I.Volkov et al., 2000; E.V.Dudnikova et al., 2000).

In many regions of the country and, first of all, in industrial regions, which include the Kemerovo Region, a marked increase in diseases of the digestive organs has been observed, reaching in Kemerovo, the regional center of Kuzbass, 346 per 1000 child population (E.V.Zvyagina, 2000). The elevated content of toxic substances in the atmospheric air has led to their accumulation in the soil and water sources. The content of heavy metals in the soil of household plots of Kemerovo residents exceeds background levels by 2-20 times, and the main waterway, the Tom River, is extremely polluted with phthalates, amines, and bromine- and chlorine-organic compounds (A.P.Mikhailuts et al., 1997).

According to data from the Kemerovo Branch of the International Center for Ecological and Medical-Biological Research, the underground waters of Kuzbass contain carcinogenic hydrocarbons, and soil aerosols contain substances with cytotoxic action. In this regard, physicians of many specialties (therapists, pediatricians, hygienists, ecologists, valeologists, public health organizers) attribute gastrointestinal pathology to diseases of industrial production (Yu.V.Chernenkov, 1997; E.V.Klimanskaya et al., 1998; G.E.Zaika et al., 2000; V.A.Shashel et al., 2000; Chenard L. et al., 1987; Schwenk M., 1988; Roth R.A. et al., 1990; Ennis G.P., 1995).

Observations by clinicians, histologists, and laboratory specialists indicate a catastrophically rapid increase in the number of people suffering from gastroduodenitis of infectious, predominantly Helicobacter-related etiology (K.P.Sinchikhin, 1998; R.R.Kildiyarova et al., 2000; N.N.Petrova, 2000; L.A.Naumova et al., 2001). This circumstance dictates the need to reconsider routine views on the etiopathogenesis, clinical picture, and treatment of chronic diseases of the upper digestive tract.

In this connection, it should be recognized as paramount the implementation of Order No. 76 of the Ministry of Health of Russia dated March 5, 1999, "On the introduction of instructional and methodological guidelines for the diagnosis of diseases of the digestive organs in children."

Particular significance and relevance in addressing the problem of gastroduodenal morbidity is acquired by medical-genetic assistance in the matter of timely diagnosis and treatment (E.M.Lukyanova et al., 1993; V.I.Simonenkov, 2000; I.E.Botviniev, 2001). Our participation in the implementation of the regional program "Quality of Life of the Population of Kuzbass" provides for the study of hereditary-determined risk factors for the formation of chronic gastroduodenitis (the role of HLA antigens, group blood properties of the AB0 system, dermatoglyphics, and their associations with the disease).

We have established fundamental differences in the clinical-anamnestic and instrumental-laboratory signs between gastroduodenitis associated with Helicobacter pylori and that of non-infectious origin. The obtained results will contribute to a differentiated approach to competing diagnoses, treatment, and rehabilitation of sick children.

We have placed our practical activities beyond the scope of the dissertation being carried out, coordinating further research with scientists of the medical academy, the Central Research Laboratory at KGMA, and the regional rehabilitation center.

The aim of the study.

To determine the most informative diagnostic and prognostic tests for chronic gastroduodenitis in children and adolescents of the industrial region of Kuzbass - Kemerovo.

Tasks of the study.

1. To analyze the diagnostic capabilities of inflammatory alterations in the stomach and duodenum.

2. To substantiate the influence of local environmental factors on the realization of gastroduodenal pathology (according to data from the State Sanitary and Epidemiological Surveillance of Kemerovo, 2000).

3. To study hereditary-determined risk factors for the formation of chronic gastroduodenitis.

4. To develop informative criteria for the differential diagnosis of gastroduodenitis associated with Helicobacter pylori and of non-infectious etiology.

Scientific novelty of the study.

In the regional center of Kuzbass - Kemerovo, a scientific center for clinical observation of children with gastrointestinal pathology has been established. An assessment is given to the results of laboratory and instrumental examination (FGDS, examination of H.p. in an "imprint smear," pH-metry, ultrasound, ECG, etc.).

Statistically significant correlations have been established between the formation of chronic gastroduodenitis and negative environmental factors. The obtained results made it possible to consider this disease a pathology of ecological maladaptation.

New is the identification of risk factors for the chronicity of diseases of the stomach and duodenum through the study of hereditary predisposition to the disease. Criteria for the differential diagnosis of chronic gastroduodenitis associated with Helicobacter pylori and of non-infectious etiology have been developed.

Such studies have been conducted in the region for the first time.

Practical value of the work.

In connection with the organization in Kemerovo of the children's clinical gastroenterological center and our many years of work in it, timely primary diagnosis of diseases of the digestive organs in children and adolescents has become possible.

A day hospital for sick children has been opened, performing all diagnostic and treatment procedures. Continuity of medical care is maintained: day hospital - round-the-clock hospital - restorative treatment (rehabilitation) at the local children's sanatorium "Zhuravlik."

The principles of diagnosis, clinical follow-up, and prognosis of chronic gastrointestinal pathology have been scientifically substantiated for physicians of hospitals, polyclinics, and adolescent offices.

City gastroenterological seminars and conferences are systematically conducted. The materials of the dissertation have been incorporated into the curriculum of the medical academy for the course: "Physiology and Pathology of Adolescence."

Implementation into practice.

In medical institutions of Kemerovo and the region, the methodological recommendations published by us are used: "Cartogram for the Study of the Prevalence and Prognosis of Gastroenterological Pathology in Children" (Kemerovo, 1997), "Clinical Follow-up and Rehabilitation of Children and Adolescents with Nonspecific Diseases of the Digestive Organs" (Kemerovo, 1998), "Nonspecific Diseases of the Digestive Organs in Children" (Kemerovo, 2000).

Volume and structure of the dissertation.

The dissertation consists of an introduction, 5 chapters, a discussion of the results of the conducted research, conclusions, practical recommendations, and a bibliography comprising 311 domestic and 150 foreign sources. The work is presented on 179 pages of computer-typed text, containing 18 tables, 8 figures, and one diagram.