Diagnostics and Correction of Changes in the Hemato-Salivary Barrier in Gastroduodenal Diseases in Children

The dissertation is devoted to the study of changes in the hemato-salivary barrier in children with gastroduodenal diseases — chronic gastroduodenitis and functional dyspepsia. The research examines contemporary views on the hemato-salivary barrier as one of the forms of histo-hematetic barriers, its biological role, and the mechanisms of its alteration in internal organ pathology. The investigation encompasses the clinico-morphological characterization of patients, analysis of the metabolic profile of blood and saliva (indicators of lipid peroxidation, antioxidant protection, cholesterol, phospholipids, nitric oxide, L-arginine, macroelements, and volatile fatty acids) in various phases of the disease — exacerbation and remission. Particular attention is devoted to the diagnostic informativeness of hemato-salivary barrier parameters and the evaluation of the efficacy of reflexotherapy as a method of correction of barrier function disorders and metabolic profile disturbances in gastroduodenal pathology in children.

Gastroduodenal pathology with a predominance of chronic gastroduodenitis in children is widespread, and there has been no significant reduction in the morbidity rate despite advances in the development of new principles for treating the disease, which makes gastroduodenitis one of the most relevant problems in modern gastroenterology (Volkov A.I., 1999; Zraudnov A.M. et al., 2003). At the same time, in recent years, considerable attention in pediatric gastroenterological practice has been devoted to functional pathology of the digestive organs, which develops during periods of most intensive growth and development of the organism and primarily affects childhood and adolescent ages (Khavkin A.I. et al., 2003).

At the present time, many questions of etiology, pathogenesis, treatment, and prevention of these diseases remain unresolved (Baranov A.A. et al., 2002). For the diagnosis of chronic gastroduodenitis and functional dyspepsia, the most informative results are considered to be those of esophagogastroduodenoscopy with targeted biopsy, histological, and cytological examination. However, one of the essential disadvantages of esophagogastroduodenoscopy is that it refers to highly invasive methods with low resolving capacity for visual evaluation of the structure of the mucosal surface and the impossibility of examining the depth of the tissue (Lysikov Yu.A., 2003).

Today, the study of the mechanisms of realization and chronicization of the pathological process in the digestive organs proceeds from the assessment of the state of the body's barrier systems (Ipatov Yu.P. et al., 1997).

Given that, in light of contemporary concepts, gastroenterological diseases are pathology of the organism as a whole, further investigation of the problem should be carried out comprehensively on the basis of studying the activity of functional systems involved in maintaining homeostasis (Grinевич V.B. et al., 1994; Komarova L.G. et al., 1994). At present, considerable attention is being devoted to the study of histo-hematetic barriers, among which is the insufficiently investigated hemato-salivary barrier. Hence, one of the possible informative and accessible methods of monitoring the state of homeostasis during various pathological processes in the digestive organs may be, in particular, the evaluation of the function of the hemato-salivary barrier (HSB) (Korkotashvili J.T. et al., 2003).

In pediatric practice, the characterization of the hemato-salivary barrier is sufficiently well described for peptic ulcer disease, whereas in children with chronic gastroduodenitis, changes in hemato-salivary relationships depending on the phase of the disease require further clarification. Such investigations are virtually absent in the case of functional disturbances of the gastroduodenal zone. A particularly important task for practical healthcare is the search for new and accessible methods of carrying out controlled monitoring of the clinical course of the disease, based on the study of the features of the histo-hematetic barrier.

In recent times, active search has been underway for new methods of treating diseases of the gastroduodenal zone. Pharmacological treatment is in some cases limited by drug intolerance, as well as by the high cost of medications. In this regard, non-pharmacological therapeutic interventions come to the fore, and in particular, acupuncture. Acupuncture is a highly effective method possessing a general regulatory effect on the organism. However, the application of reflexotherapy with evaluation of treatment efficacy in gastroenterological diseases is quite limited. Acupuncture is a moderate-stress irritant, the action of which develops adaptive changes at the level of central regulatory mechanisms and in effector organs (Samosjuk I.Z., Machèrer E.JL, 1982). These features of acupuncture allow forecasting the broader application of the method in medical practice in the near future, including for the treatment of chronic gastroduodenitis and functional dyspepsia.

All of the above determined the goal and objectives of the research.

Goal of the scientific research

To establish the features of quantitative changes in individual indicators of the hemato-salivary barrier and their significance in various phases of chronic gastroduodenitis and functional dyspepsia, with the aim of proposing diagnostic criteria and methods of correction.

Tasks of the scientific research

1. To identify the features of lipid peroxidation, cholesterol, phospholipids; the level of nitric oxide and L-arginine; the concentrations of macroelements (sodium, potassium, magnesium, calcium), short-chain volatile fatty acids (acetic, propionic, butyric, isobutyric) in plasma and saliva in children with functional dyspepsia and the dependence on the duration of the course of chronic gastroduodenitis.

2. To characterize the metabolic profile of plasma and saliva and changes in the functional activity of the hemato-salivary barrier in chronic gastroduodenitis and functional dyspepsia.

3. To determine the significance of changes in hemato-salivary barrier indicators in the mechanisms of development of chronic gastroduodenitis and functional dyspepsia, their informativeness at various stages of the pathological process.

4. To substantiate the necessity of including the reflexotherapy method in the complex of rehabilitative measures for patients with chronic gastroduodenitis and functional dyspepsia and to study the efficacy of its application.

Scientific novelty of the research

1. The features of the metabolic profile of blood and saliva in chronic gastroduodenitis and functional dyspepsia have been established, the leading distinctive characteristic of which is the level of lipid peroxidation products and antioxidant protection, nitric oxide, lipid metabolism, macroelements, and volatile fatty acids in interrelation with the duration of the disease and the activity of the body's hemato-salivary barrier.

2. The role of changes in the functional status of the hemato-salivary barrier in the regulation of homeostasis of the organism in functional dyspepsia and chronic gastroduodenitis in children has been determined, consisting in the redistribution of metabolites between blood and saliva through changes in the permeability and activity of the barrier.

3. The representations of clinical-functional changes in gastroduodenitis and functional dyspepsia have been supplemented with the characteristic of the hemato-salivary barrier.

Practical significance of the research

1. Quantitative values of indicators of the metabolic profile of saliva and plasma blood in functional dyspepsia and chronic gastroduodenitis depending on the "tenure" of the disease have been provided, formalized tables have been compiled with the determination of the information-diagnostic value of parameters for the verification of the period and pathological form in children.

2. The possibility of differential diagnosis of inflammatory and functional diseases of the gastroduodenal zone has been demonstrated, based on the assessment of the content of volatile fatty acids in saliva, correlating with morphological changes of the mucous membrane.

3. The positive influence of reflexotherapy on the normalization of the function of the hemato-salivary barrier of the organism and the metabolic profile of blood and saliva for the complex rehabilitation of patients with chronic gastroduodenitis has been proven.

The position submitted for defense

In the development of inflammatory and functional diseases of the gastroduodenal zone in children, changes occur in the metabolic profile of blood and saliva, regulated by the hemato-salivary barrier, reflecting the state of metabolism, which depend on the period of the disease, the duration of the pathological process, which substantiates the possibility of their diagnosis and inclusion in the complex of therapeutic and rehabilitative measures of reflexotherapy.

Validation of the work

The main provisions of the dissertation were reported and discussed at the scientific-practical conference of young scientists of IvGMA "Science Week" (2003, 2004); the All-Russian Scientific-Practical Conference "Organization of Medical Care for Children and Adolescents" (Ivanovo, 2003); the All-Russian Scientific-Practical Conference "Arterial Hypertension: Age Aspects" (Ivanovo, 2003); the VIII Congress of Pediatricians of Russia "Modern Problems of Preventive Pediatrics" (Moscow, 2003); the II All-Russian University Scientific-Practical Conference "New in Ultrasonic Diagnosis in Pediatrics" (Tula, 2003); the I All-Russian Congress "Medicine for Children" (Nizhny Novgorod, 2003); the II Russian Congress "Modern Technologies of Pediatrics and Pediatric Surgery" (Moscow, 2003); the X Congress of Russian Pediatric Gastroenterologists (Moscow, 2003); the IX Congress of Pediatricians of Russia "Actual Problems of Pediatrics" (Moscow, 2004).

Implementation of the results

Based on the results of the dissertation, 15 scientific works have been published and a certificate of a rationalization proposal (No. 2360 dated 17.06.03) "Method for the diagnosis of gastroduodenitis in children based on macroelement indicators" has been obtained. A priority certificate dated 08.04.2004 has been received for application No. 2004110742 on the invention "Method for the diagnosis of chronic gastroduodenitis and functional dyspepsia in children."

The results of the research and the recommendations arising from them are used in clinical practice in departments No. 1 and No. 2 of MUZ "1st City Clinical Hospital" of Ivanovo.

Structure and volume of the dissertation

The dissertation is presented on 205 pages of typed text, consists of an introduction, five chapters, a conclusion, conclusions, and practical recommendations. The work is illustrated by 30 tables and 32 figures. The bibliography includes 120 domestic and 56 foreign sources.