State of the Biliary System and Pancreas After Rota Virus Infection in Children Aged Up to 3 Years

The dissertation is devoted to a comprehensive study of the state of the biliary system and pancreas in children aged up to 3 years after rota virus infection. The research analyzes clinical, laboratory, and instrumental indicators of the functional state of the digestive organs in various periods of convalescent observation, identifies risk factors for the development of digestive disorders, and develops approaches to their early correction. The study employed enzyme-linked immunosorbent assay for the determination of elastase-1 levels in stool and ultrasonographic cholecystography for the evaluation of the functional state of the biliary system and pancreas.

Acute intestinal infections occupy one of the leading positions in infectious pathology in children of early age [Vasilyev B.Ya. et al., 2000; Vorotyntseva N.V., Mazankova L.N., 2001; Novokshonov A.A. et al., 2002; Uchaykin V.F., 2003; Armon K. et al., 2001]. This is due to the anatomo-physiological features of the gastrointestinal tract and the immaturity of the immune system in children of this age group.

The etiological structure of acute intestinal infections is diverse. One of the causes of severe forms of acute intestinal diseases in children is rota virus infection (RVI) [Grigorovich M.S. et al., 1999; Vasilyev B.Ya. et al., 2000; Meskina E.R. et al., 2003; Lieberman J.M., 1994; Frühwirth M. et al., 2001; Coluchi N. et al., 2002].

According to WHO data, annually among children under 5 years of age, 111 million episodes of mild forms of rota virus gastroenteritis, 25 million episodes of moderate-severe forms, 2 million episodes of severe forms, as well as 352 to 592 thousand fatal outcomes are registered [Parashar U.D. et al., 2003]. The morbidity with rota virus infection is highest in children aged 6 to 24 months [Bokov A.G. et al., 2002; Perez-Schael I. et al., 1997; Rosa e Silva M.L. et al., 2002].

In recent years, new data have appeared on the mechanisms of development of diarrhea in acute intestinal infections, including rota virus infection. Agents of intestinal infections, affecting the mucous membrane of the intestine through various mechanisms, ultimately lead to its damage [Mazankova L.N., 2004; Guerin-Danan S. et al., 1998; Brunet J.P. et al., 2000; Halaihel N. et al., 2000; Estes M.K. et al., 2001; Spiller R.C., 2002]. The consequence of this damage are secondary motor, enzymatic, and dysbiotic disorders of the digestive organs [Zraudnov A.M. et al., 1994; Korovina N.A. et al., 2000; Zraudnov A.M., Mazankova L.N., 2001; Novokshonov A.A. et al., 2002].

Penetrating into highly differentiated enterocytes of the upper parts of the small intestine, rota viruses cause their death and shedding, thereby disrupting digestive and absorptive processes [Tikhomirova O.V. et al., 2003; Uchaykin V.F. et al., 2003]. In the modern literature there are studies mainly concerning the study of pathological changes and therapy in the acute period of rota virus infection [Kagan Yu.D., Shenel' M.A., 2001; Gorelov A.V., Ploskireva A.A., 2002; Mazankova L.N. et al., 2003; Armon K. et al., 2001; Bentley D. et al., 2001]. In separate works, data are provided on the functional state of the pancreas in rota virus infection [Gorelov A.V. et al., 1998; Vorotyntseva N.V., Mazankova L.N., 2001]. Data on disorders of the digestive organs in the period of convalescence from rota virus infection, acquiring a protracted and chronic character, are found less frequently [Uchaykin V.F. et al., 2003].

The adverse effect of rota viruses on functionally immature digestive organs in infants and young children determines the interest in studying the consequences of rota virus infection.

The significant risk of formation of chronic gastroenterological pathology in children who have had acute intestinal infections is at the present stage one of the important problems of preventive pediatrics.

In 2004, among hospitalized children with acute intestinal infection in the children's infectious hospital No. 1 of Saratov, in the epidemic season, rota virus etiology was established in 52% of patients.

The high level of morbidity with rota virus infection in children of early age, the possibility of its influence on the formation of chronic pathology of the gastrointestinal tract organs, determine the subsequent quality of life of the child and justify the practical significance of this research.

RESEARCH OBJECTIVE

To evaluate the state of the biliary system and pancreas after rota virus infection in children aged up to 3 years and to develop approaches to the correction of identified changes.

RESEARCH TASKS

1. To study the clinical course and outcomes of moderate-severe and severe forms of rota virus infection in children aged up to 3 years at the present stage.

2. To determine the frequency and nature of functional disorders of the biliary tract in children who have had rota virus infection, in various periods of convalescent observation depending on the severity form of the disease.

3. To determine the frequency and nature of changes in the pancreas in children who have had rota virus infection, in various periods of convalescent observation depending on the severity form of the disease.

4. To establish clinico-laboratory criteria for the occurrence of disorders of the biliary system and pancreas functions after rota virus infection.

5. To determine the possibilities of correction of functional disorders of the pancreas and biliary tract in convalescents of rota virus infection by improving dietary therapy schemes and prescribing medicinal plants with a spasmolytic effect.

SCIENTIFIC NOVELTY

For the first time, based on the analysis of the functional state of the biliary system and pancreas, the periods of dispensary observation after rota virus infection in children aged up to 3 years have been established.

For the first time, clinico-laboratory criteria for the occurrence and predisposition to a chronic course of digestive disorders involving the biliary system and pancreas in children aged up to 3 years have been determined, and the influence of rota virus infection on these processes has been established.

For the first time, an algorithm for the correction of functional disorders of the pancreas and biliary tract in convalescents of rota virus infection has been proposed.

PRACTICAL SIGNIFICANCE

Convalescent observation of children who have had rota virus infection has been conducted with clinico-laboratory and instrumental examination over a six-month period.

Risk factors for the development of digestive disorders in children after rota virus infection have been identified.

Clinico-laboratory criteria for initial disorders of biliary system and pancreas function in convalescents of rota virus infection have been established.

The expediency of using enzyme-linked immunosorbent assay (ELISA) for quantitative assessment of elastase-1 levels in stool and ultrasonographic cholecystography for evaluating the functional state of the pancreas and biliary system after rota virus infection in children aged up to 3 years has been established.

Methods of rehabilitation for children in whom changes in the pancreas and biliary system persist after rota virus infection have been determined.

IMPLEMENTATION OF RESULTS

Based on the dissertation materials, 12 publications have been published. An informational letter "Observation and Stage-by-Stage Treatment of Convalescents of Acute Intestinal Infections" has been issued.

The materials of the dissertation research are used in the educational and therapeutic processes at the departments of pediatric infectious diseases and hospital pediatrics of Saratov State Medical University.

Recommendations have been developed for the prevention of functional disorders of the biliary tract and pancreas in children after rota virus infection.

PRESENTATION OF THE WORK

The main provisions of the dissertation were reported and discussed at annual scientific-practical conferences of young scientists and students of SGMU (Saratov, 2002, 2003, 2004), 1st, 2nd, and 3rd congresses of Russian pediatric infectiousists (Moscow, 2002, 2003, 2004), the 7th Congress of Russian Pediatricians (Moscow, 2002), the 9th, 10th, 11th, and 12th congresses of Russian pediatric gastroenterologists (Moscow, 2002, 2003, 2004, 2005), at meetings of the scientific pediatric society (Saratov, 2003), the problem commission on pediatrics of SGMU, and the interdepartmental conference of the departments of hospital pediatrics, pediatric infectious diseases, faculty pediatrics, and polyclinic pediatrics.

MAIN PROVISIONS SUBMITTED FOR DEFENSE

Rota virus infection influences the occurrence and development of functional disorders of the biliary tract and pancreas in children aged up to 3 years.

The severity of functional disorders of the biliary system and pancreas depends on the premorbid background, the nature of feeding, dietary features, and hereditary predisposition to gastrointestinal tract diseases in children.

Timely dietary correction and therapy with medicinal plants having a spasmolytic effect make it possible to prevent the development of chronic changes in the biliary system and the structure of the pancreas and substantially improve the quality of life of children.