Age-related features of the regulation of gastrointestinal functions in newborns. Functional gastrointestinal disorders: causes, symptoms and treatment Functional gastrointestinal disorders in children

Parfenov A.I., Ruchkina I.N., Usenko D.V.

Functional bowel pathology distinguished by the absence of morphological changes that could explain the existing clinical symptoms, and their connection with:

increased excitability of motor skills,

sensory hypersensitivity,

inadequate response of internal organs to CNS signals when exposed to psychosocial factors.

Etiology and pathogenesis

The formation of functional bowel disorders (FBD) is influenced by genetic factors, environment, psychosocial factors, visceral hypersensitivity and infections.

A genetic predisposition to FNK is confirmed by a distorted response of the mucous membrane of patients with irritable bowel syndrome (IBS) to the effects of the neurotransmitter 5-HT, a2-adrenergic receptors and an inadequate response of the hypothalamic-adrenal system to stress.

The influence of the environment is indicated by the facts of the more frequent formation of FNC in children whose parents suffer from this pathology and visit the doctor more often than children of parents who do not consider themselves sick.

It is known that systematic mental stress contributes to the emergence, chronicity and progression of FNC.

A feature of patients with FNK is an increase in motor and sensory reactions, the appearance of abdominal pain in response to stress and neurochemical mediators such as corticotropin. The clinical picture of FNK is decisively influenced by an increase or decrease in the sensitivity of mechanoreceptors and the intestinal muscular system. An increase in visceral sensitivity explains the mechanism of pain in patients with IBS and functional abdominal pain syndrome. These patients have a reduced pain sensitivity threshold when the intestine is distended with a balloon.

One of the reasons for impaired sensitivity may be inflammation of the mucous membrane in patients who have suffered an acute intestinal infection (AIE). Inflammation causes degranulation of mast cells in the vicinity of the enteric plexuses, increasing the production of serotonin and proinflammatory cytokines. This explains the increase in visceral sensitivity in patients with FNK.

Visceral sensitivity disorders often cause acute intestinal infections due to inflammation of the intestinal mucosa. This is the cause of the development of a syndrome similar to IBS in 25% of people who have suffered from acute intestinal infections. According to our data, in 30% of IBS the disease was preceded by ACI. In the pathogenesis of chronic intestinal disease, high bacterial contamination of the small intestine, detected using a hydrogen breath test, as well as damage to the enteric nervous system by OCI antigens against the background of a decrease in the body’s immune defense are important.

Thus, one of the factors contributing to the formation of IBS may be OCI. I.N. Ruchkina found that patients with post-infectious IBS develop dysbiosis to one degree or another (often with excessive growth of microflora in the small intestine) and formulated its criteria.

There are other studies showing the possible role of increased bacterial growth in the pathogenesis of IBS. L. O'Mahony et al. observed a good effect of treating patients with IBS with a probiotic containing Bifidobacter infantis. The authors explain the cessation of pain and diarrhea by restoring the ratio of pro- and anti-inflammatory interleukins 10 and 12.

Classification of intestinal FN

Clinical problems of functional disorders of the digestive organs have been actively discussed within the framework of the Rome Consensus over the past 20 years. Consensus played a leading role in the classification and refinement of clinical and diagnostic criteria for these diseases. The latest classification was approved in May 2006. Table 2 presents functional bowel diseases.

Epidemiology

Epidemiological studies show approximately the same incidence of FNK in Western Europe, the United States and Australia and a lower incidence in Asian countries and among African Americans. Differences may also be explained by the type of criteria used and the effectiveness of treatment.

Diagnostic principles

Diagnosis of FNK according to the Rome III classification is based on the premise that each FNK has symptoms that differ in the characteristics of motor and sensory dysfunction. The consequences of motor dysfunction are diarrhea and constipation. Pain is largely determined by the degree of impairment of visceral sensitivity, explained by dysfunction of the central nervous system. The difficulty is that there are no reliable instrumental methods for assessing function. Therefore, clinical criteria similar to those used in psychiatry are used. By improving the clinical criteria for the diagnosis of IBS and other FNCs, it is possible to prevent gross diagnostic errors and reduce the number of unnecessary diagnostic tests. Thus, the clinical criteria for IBS correspond to abdominal discomfort or pain that has at least two of the following three characteristics: a) decrease after defecation; and/or b) association with changes in stool frequency; and/or c) with a change in the shape of the stool.

Functional flatulence, functional constipation, and functional diarrhea involve an isolated sensation of bloating or bowel dysfunction. According to the Rome III criteria, FNC must last at least 6 months, of which 3 months are continuous. In this case, psycho-emotional disorders may be absent.

An indispensable condition is also compliance with the rule: do not classify as patients with FNC those who have alarming symptoms that are often found in inflammatory, vascular and tumor diseases of the intestine.

These include bleeding, weight loss, chronic diarrhea, anemia, fever, onset of illness in people over 50 years of age, cancer and inflammatory bowel disease in relatives, and nocturnal symptoms.

Compliance with these conditions makes it possible to establish a functional disease with a high degree of probability, excluding diseases in which dysfunction is caused by inflammatory, anatomical, metabolic and neoplastic processes.

According to the severity, FNC is conventionally divided into three degrees: mild, moderate and severe.

Patients with a mild degree of functional impairment are not burdened with psycho-emotional problems. They usually note, although temporary, a positive result from the prescribed treatment.

Patients with moderate severity are more or less psychologically unstable and require special treatment.

A severe degree of functional impairment is characterized by its connection with psychosocial difficulties, concomitant psycho-emotional disorders in the form of anxiety, depression, etc. These patients tend to frequently communicate with a gastroenterologist, although they do not believe in the possibility of recovery.

Probiotic foods in the treatment of FNK

Probiotics and products containing them are increasingly used in the treatment of intestinal diseases every year. Their inclusion in the diet provides the body with energy and plastic material, has a positive effect on intestinal functions, mitigates the effects of stress and reduces the risk of developing many diseases. In a number of countries, the organization of functional nutrition has become state policy in the field of health care and the food industry.

One of the categories of functional nutrition that has been developed in recent years is probiotic products containing bifidobacteria, lactic acid bacteria and dietary fiber.

Since 1997, Danone has been producing Activia fermented milk products enriched with the probiotic strain Bifidobacterium animalis strain DN-173 010 (commercial name ActiRegularis). A high concentration (at least 108 CFU/g) remains stable in the product throughout the shelf life. Specific studies have been conducted to evaluate the survival of Bifidobacterium ActiRegularis in the human intestine. Quite good survival of bacteria in the stomach has been established (decrease in the concentration of bifidobacteria by less than 2 orders of magnitude within 90 minutes) and in the product itself throughout its permissible shelf life.

Of significant interest is the study of the effect of Activia and Bifidobacterium ActiRegularis on the rate of intestinal transit. In a parallel study involving 72 healthy participants (average age 30 years), daily consumption of Activia with Bifidobacterium ActiRegularis was observed to reduce transit time in the colon by 21% and in the sigmoid colon by 39% compared with people taking the product without containing bacteria.

According to our data, in 60 patients with IBS with a predominance of constipation who received Activia, constipation stopped by the end of the second week, the transit time of carbolene was significantly reduced (in 25 patients - from 72 to 24 hours, and in 5 - from 120 to 48 hours). At the same time, pain, flatulence, bloating and rumbling in the abdomen decreased. By the end of the third week, the concentration of bifidobacteria and lactobacilli in the intestines of the patients increased, and the number of hemolyzing Escherichia coli, clostridia and Proteus decreased. The results obtained made it possible to recommend Activia for the treatment of patients with IBS with constipation.

In 2006, D. Guyonnet et al. used Activia for 6 weeks to treat 267 patients with IBS. In the control group, patients received a heat-treated product. It was found that by the end of the second week of using Activia, the frequency of stools was significantly higher compared to the thermized product; After 3 weeks, patients who consumed Activia experienced significant disappearance of abdominal discomfort more often.

Thus, the study showed that Activia reduces the severity of symptoms in patients with IBS and improves their quality of life. The most pronounced positive effect will be noted in the subgroup of patients with a stool frequency of less than 3 times a week.

Summarizing the data from the presented studies, it can be argued that Activia, containing Bifidobacterium ActiRegularis, is a fairly effective means of restoring and normalizing intestinal motility and microflora in patients with IBS.

Conclusion

Features of functional intestinal diseases are their connection with psycho-emotional and social factors, their widespread prevalence and the lack of effective treatments. These features make the problem of FNC one of the most pressing in gastroenterology.

It is becoming increasingly clear that antidepressants should play a major role in the treatment of patients with severe FNK. Tricyclic antidepressants, serotonin and adrenaline receptor inhibitors are important in the fight against pain, because not only reduce unmotivated anxiety and associated depression, but also affect analgesia centers. If the effect is sufficiently clear, treatment can be continued for up to a year and only then gradually reduced the dose. Therefore, the treatment of such patients should be carried out jointly with a psychiatrist.

For the treatment of patients with less severe forms of FNK, as experience shows, including ours, good results can be obtained with the help of probiotics and functional nutrition products. A particularly good effect can be seen in the treatment of patients with post-infectious IBS. The reason for this lies in the direct connection of the etiology and pathogenesis of the disease with disorders of the intestinal microbiocenosis.

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Traditionally, disorders that occur in any system of the human body are divided into organic and functional. Organic pathology is associated with damage to the structure of the organ, the severity of which can vary widely from gross developmental anomalies to minimal enzymopathy. If organic pathology is excluded, then we can talk about functional disorders (FN). Functional disorders are symptoms of physical ailments caused not by diseases of the organs, but by disorders of their functions.

Functional disorders of the gastrointestinal tract (GI tract) are one of the most common problems, especially among children in the first months of life. According to various authors, gastrointestinal dysfunction occurs in 55% to 75% of infants in this age group.

As defined by D. A. Drossman (1994), functional digestive disorders are “a varied combination of gastrointestinal symptoms without structural or biochemical disturbances” in the function of the organ itself.

Taking into account this definition, the diagnosis of FN depends on the level of our knowledge and the capabilities of research methods that make it possible to identify certain structural (anatomical) disorders in a child and thereby exclude their functional nature.

In accordance with the Rome III criteria, proposed by the Committee for the Study of Functional Disorders in Children and the International Working Group on the Development of Criteria for Functional Disorders (2006), gastrointestinal functional disorders in infants and children of the second year of life include:

• G1. Regurgitation syndrome;
• G2. Rumination syndrome;
• G3. Cyclic vomiting syndrome;
• G4. Infantile intestinal colic;
• G5. Functional diarrhea syndrome;
• G6. Pain and difficulty during bowel movements (dyschezia);
• G7. Functional constipation.

Of the presented syndromes, the most common conditions are regurgitation (23.1% of cases), infantile intestinal colic (20.5% of cases) and functional constipation (17.6% of cases). Most often, these syndromes are observed in various combinations, less often - as one isolated syndrome.

In clinical work carried out under the guidance of Professor E.M. Bulatova, devoted to the study of the frequency of occurrence and causes of the development of digestive functional disorders in infants in the first months of life, the same trend was noted. At an outpatient appointment with a pediatrician, parents often complained that their child was spitting up (57% of cases), restless, kicking his legs, experiencing bloating, cramping pain, screaming, that is, episodes of intestinal colic (49% of cases) . Complaints of loose stools (31% of cases) and difficulty defecating (34% of cases) were somewhat less common. It should be noted that the majority of infants with difficulty defecating suffered from infantile dyschezia syndrome (26%) and only in 8% of cases from constipation. The presence of two or more digestive FN syndromes was recorded in 62% of cases.

A number of reasons can be identified at the basis of the development of FN of the gastrointestinal tract, both on the part of the child and on the part of the mother. Reasons on the part of the child include:

• previous ante- and perinatal chronic hypoxia;
• morphological and (or) functional immaturity of the gastrointestinal tract;
• a later start in the development of the vegetative, immune and enzyme systems of the digestive tube, especially those enzymes that are responsible for the hydrolysis of proteins, lipids, disaccharides;
• age-inappropriate nutrition;
• violation of feeding technique;
• force feeding;
• lack or excess of drinking, etc.

On the mother’s side, the main reasons for the development of gastrointestinal dysfunction in a child are:

• increased level of anxiety;
• hormonal changes in the body of a nursing woman;
• antisocial living conditions;
• serious violations of the daily routine and nutrition.

It has been noted that gastrointestinal tract diseases are much more common in first-born children, long-awaited children, as well as in children of elderly parents.

The reasons underlying the development of functional disorders of the gastrointestinal tract affect the motor, secretory and absorption abilities of the digestive tube and negatively affect the formation of intestinal microbiocenosis and the immune response.

Changes in the microbial balance are characterized by inducing the growth of opportunistic proteolytic microbiota, the production of pathological metabolites (isoforms of short-chain fatty acids (SCFA)) and toxic gases (methane, ammonia, sulfur-containing gases), as well as the development of visceral hyperalgesia in the baby, which is manifested by severe anxiety, crying and screaming. This condition is due to the nociceptive system formed antenatally and the low activity of the antinociceptive system, which begins to actively function after the third month of the baby’s postnatal life.

Excessive bacterial growth of opportunistic proteolytic microbiota stimulates the synthesis of neurotransmitters and gastrointestinal hormones (motilin, serotonin, melatonin), which change the motility of the digestive tube according to the hypo- or hyperkinetic type, causing spasm not only of the pyloric sphincter and sphincter of Oddi, but also of the anal sphincter, as well as development of flatulence, intestinal colic and defecation disorders.

Adhesion of opportunistic flora is accompanied by the development of an inflammatory reaction of the intestinal mucosa, the marker of which is a high level of calprotectin protein in the coprofiltrate. In infantile intestinal colic and necrotizing enterocolitis, its level increases sharply compared to the age norm.

The connection between inflammation and intestinal kinetics occurs at the level of interaction between the immune and nervous systems of the intestine, and this connection is bidirectional. Lymphocytes of the lamina propria possess a number of neuropeptide receptors. When immune cells, during the process of inflammation, release active molecules and inflammatory mediators (prostaglandins, cytokines), the enteric neurons express receptors for these immune mediators (cytokines, histamine) protease-activated receptors (PARs), etc. It has been found that toll-like receptors that recognize lipopolysaccharides from gram-negative bacteria are present not only in the submucosal and muscular plexus of the gastrointestinal tract, but also in the neurons of the dorsal horn of the spinal cord. Thus, enteric neurons can respond both to inflammatory stimuli and be directly activated by bacterial and viral components, participating in the process of interaction between the body and the microbiota.

The scientific work of Finnish authors, carried out under the guidance of A. Lyra (2010), demonstrates the aberrant formation of intestinal microbiota in functional digestive disorders, thus, microbiocenosis in irritable bowel syndrome is characterized by a reduced level Lactobacillus spp., increased titer Cl. difficile and clostridia of cluster XIV, with abundant growth of aerobes: Staphylococcus, Klebsiella, E. coli and instability of microbiocenosis during its dynamic assessment.

In a clinical study by Professor E.M. Bulatova, devoted to the study of the species composition of bifidobacteria in infants receiving different types of feeding, the author showed that the species diversity of bifidobacteria can be considered as one of the criteria for normal intestinal motor function. It was noted that in children of the first months of life without physical function (regardless of the type of feeding), the species composition of bifidobacteria is significantly more often represented by three or more species (70.6%, versus 35% of cases), with the dominance of infant species of bifidobacteria ( B. bifidum and B. longum, bv. infantis). The species composition of bifidobacteria in infants with gastrointestinal dysfunction was predominantly represented by the adult species of bifidobacteria - B. adolescentis(p< 0,014) .

Digestive disorders that arise in the first months of a baby’s life, without timely and proper treatment, can persist throughout the entire period of early childhood, be accompanied by significant changes in health, and also have long-term negative consequences.

Children with persistent regurgitation syndrome (score from 3 to 5 points) have a delay in physical development, diseases of the ENT organs (otitis media, chronic or recurrent stridor, laryngospasm, chronic sinusitis, laryngitis, laryngeal stenosis), and iron deficiency anemia. At the age of 2-3 years, these children have a higher incidence of respiratory diseases, restless sleep and increased excitability. By school age, they often develop reflux esophagitis.

B. D. Gold (2006) and S. R. Orenstein (2006) noted that children suffering from pathological regurgitation in the first two years of life constitute a risk group for the development of chronic gastroduodenitis associated with Helicobacter pylori, the formation of gastroesophageal reflux disease, as well as Barrett's esophagus and/or esophageal adenocarcinoma at an older age.

The works of P. Rautava, L. Lehtonen (1995) and M. Wake (2006) show that infants who have experienced intestinal colic in the first months of life suffer from sleep disturbances in the next 2-3 years of life, which manifests itself in difficulty falling asleep and frequent night awakenings. At school age, these children are much more likely than the general population to show attacks of anger, irritation, and bad mood while eating; have a decrease in general and verbal IQ, borderline hyperactivity and behavioral disorders. In addition, they are more likely to experience allergic diseases and abdominal pain, which in 35% of cases are functional in nature, and 65% require hospital treatment.

The consequences of untreated functional constipation are often tragic. Irregular, rare bowel movements underlie the syndrome of chronic intoxication, sensitization of the body and can serve as a predictor of colorectal carcinoma.

To prevent such serious complications, children with gastrointestinal dysfunction need to be provided with timely and full assistance.

Treatment of gastrointestinal FN includes explanatory work with parents and their psychological support; use of positional (postural) therapy; therapeutic massage, exercises, music, aroma and aeroion therapy; if necessary, prescription of drug pathogenetic and syndromic therapy and, of course, diet therapy.

The main goal of diet therapy for FN is to coordinate the motor activity of the gastrointestinal tract and normalize the intestinal microbiocenosis.

This problem can be solved by introducing functional food products into the child’s diet.

According to modern views, functional products are those that, due to their enrichment with vitamins, vitamin-like compounds, minerals, pro- and (or) prebiotics, as well as other valuable nutrients, acquire new properties - have a beneficial effect on various functions of the body, improving not only the state of health humans, but also preventing the development of various diseases.

They first started talking about functional nutrition in Japan in the 1980s. Subsequently, this trend became widespread in other developed countries. It is noted that 60% of all functional foods, especially those enriched with pro- or prebiotics, are aimed at improving the health of the intestines and immune system.

The latest research on the biochemical and immunological composition of breast milk, as well as longitudinal observations of the health status of children who received breast milk, allows us to consider it a functional nutrition product.

Taking into account existing knowledge, manufacturers of baby food for children deprived of breast milk produce adapted milk formulas, and for children over 4-6 months - complementary feeding products, which can be classified as functional food products, since the introduction of vitamins, vitamin-like and mineral compounds, polyunsaturated fatty acids, namely docosahexaenoic and arachidonic acids, as well as pro- and prebiotics give them functional properties.

Pro- and prebiotics have been well studied and are widely used in both children and adults to prevent conditions and diseases such as allergies, irritable bowel syndrome, metabolic syndrome, chronic inflammatory bowel disease, decreased bone mineral density, and chemically induced intestinal tumors.

Probiotics are apathogenic living microorganisms that, when consumed in sufficient quantities, have a direct beneficial effect on the health or physiology of the host. Of all the probiotics studied and produced by industry, the vast majority belong to bifidobacteria and lactobacilli.

The essence of the “prebiotic concept,” which was first presented by G. R. Gibson and M. B. Roberftoid (1995), is aimed at changing the intestinal microbiota under the influence of food by selectively stimulating one or more species of potentially beneficial groups of bacteria (bifidobacteria and lactobacilli) and reducing the number of pathogenic species microorganisms or their metabolites, which significantly improves the patient’s health.

Inulin and oligofructose, which are often combined under the term “fructooligosaccharides” (FOS) or “fructans,” are used as prebiotics in the diet of infants and young children.

Inulin is a polysaccharide that is found in many plants (chicory root, onions, leeks, garlic, Jerusalem artichoke, bananas), has a linear structure, with a wide spread along the chain length, and consists of fructosyl units interconnected β-(2 -1)-glycosidic bond.

Inulin, used to fortify baby food, is commercially obtained from chicory roots by extraction in a diffuser. This process does not change the molecular structure and composition of natural inulin.

To obtain oligofructose, “standard” inulin is subjected to partial hydrolysis and purification. Partially hydrolyzed inulin consists of 2-8 monomers with a glucose molecule at the end - this is a short-chain fructooligosaccharide (ssFOS). Long-chain inulin is formed from “standard” inulin. There are two possible ways of its formation: the first is enzymatic chain elongation (fructosidase enzyme) by attaching sucrose monomers - “elongated” FOS, the second is the physical separation of csFOS from chicory inulin - long-chain fructooligosaccharide (dlFOS) (22 monomers with a glucose molecule at the end of the chain).

The physiological effects of dlFOS and csFOS differ. The first undergoes bacterial hydrolysis in the distal parts of the colon, the second - in the proximal parts, as a result, the combination of these components provides a prebiotic effect throughout the entire large intestine. In addition, in the process of bacterial hydrolysis, fatty acid metabolites of different compositions are synthesized. When fermenting dlFOS, mainly butyrate is formed, and when fermenting csFOS, lactact and propionate are formed.

Fructans are typical prebiotics, therefore they are practically not broken down by intestinal α-glycosidases, and in unchanged form reach the colon, where they serve as a substrate for saccharolytic microbiota, without affecting the growth of other groups of bacteria (fusobacteria, bacteroides, etc.) and suppressing the growth of potentially pathogenic bacteria : Clostridium perfringens, Clostridium enterococcui. That is, fructans, contributing to an increase in the number of bifidobacteria and lactobacilli in the large intestine, are apparently one of the reasons for the adequate formation of the immune response and the body’s resistance to intestinal pathogens.

The prebiotic effect of FOS is confirmed by the work of E. Menne (2000), who showed that after stopping the intake of the active ingredient (ccFOS/dlFOS), the number of bifidobacteria begins to decrease and the composition of the microflora gradually returns to the original state observed before the experiment. It is noted that the maximum prebiotic effect of fructans is observed for dosages from 5 to 15 g per day. The regulatory effect of fructans has been determined: people with an initially low level of bifidobacteria are characterized by a clear increase in their numbers under the influence of FOS compared to people who initially have a higher level of bifidobacteria.

The positive effect of prebiotics on the elimination of functional digestive disorders in children has been established in a number of studies. The first work on the normalization of microbiota and motor function of the digestive tract concerned adapted milk formulas enriched with galacto- and fructo-oligosaccharides.

In recent years, it has been proven that the addition of inulin and oligo-fructose to infant formula and complementary feeding products has a beneficial effect on the spectrum of intestinal microbiota and improves digestion processes.

A multicenter study conducted in 7 cities of Russia involved 156 children aged 1 to 4 months. The main group included 94 children who received an adapted milk formula with inulin, the comparison group included 62 children who received a standard milk formula. In children of the main group, while taking a product enriched with inulin, a significant increase in the number of bifidobacteria and lactobacilli and a tendency to decrease the level of both E. coli with weak enzymatic properties and lactose-negative E. coli were found.

In a study carried out in the department of children's nutrition of the Research Institute of Nutrition of the Russian Academy of Medical Sciences, it was shown that daily intake of porridge with oligofructose (0.4 g in one serving) by children in the second half of life has a positive effect on the state of the intestinal microbiota and the normalization of stool.

An example of complementary feeding products enriched with prebiotics of plant origin - inulin and oligofructose, is the porridge of the transnational company Heinz; the entire line of porridges - low-allergenic, dairy-free, dairy, tasty, "Lyubopyshki" - contains prebiotics.

In addition, the prebiotic is included in the monocomponent prune puree, and a special line of dessert purees with prebiotic and calcium has been created. The amount of prebiotic added to complementary foods varies widely. This allows you to individually select a complementary feeding product and achieve good results in the prevention and treatment of functional disorders in young children. Research into foods containing prebiotics is ongoing.

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N. M. Bogdanova, Candidate of Medical Sciences

Functional disorders of the gastrointestinal tract constitute a group of heterogeneous (different in nature and origin) clinical conditions, manifested by various symptoms from the gastrointestinal tract and not accompanied by structural, metabolic or systemic changes. In the absence of an organic basis for the disease, such disorders significantly reduce the patient’s quality of life.

To make a diagnosis, symptoms must exist for at least six months with active manifestations for 3 months. It should also be remembered that the symptoms of gastrointestinal tract can overlap and overlap each other in the presence of other diseases not related to the gastrointestinal tract.

Causes of functional disorders of the gastrointestinal tract

There are 2 main reasons:

• Genetic predisposition. FGITs are often hereditary. This is confirmed by the frequent “family” nature of violations. During examinations, genetically transmitted features of the nervous and hormonal regulation of intestinal motility, the properties of receptors in the walls of the gastrointestinal tract, etc. are found to be similar in all (or across generations) family members.
• Mental and infectious sensitization. These include acute intestinal infections, difficult conditions of a person’s social environment (stress, misunderstanding from loved ones, shyness, constant fears of various nature), physically difficult work, etc.

Symptoms of functional gastrointestinal disorders

Depends on the type of functional disorder:

• Irritable bowel syndrome (large and small) is a functional disorder characterized by the presence of abdominal pain or abdominal discomfort and combined with disturbances in defecation and transit of intestinal contents. To be diagnosed, symptoms must have existed for at least 12 weeks within the past 12 months.
• Functional bloating. It is a frequently recurring feeling of fullness in the abdomen. It is not accompanied by a visible enlargement of the abdomen and other functional gastrointestinal disorders. A bursting feeling should be observed at least 3 days a month for the last 3 months.
• Functional constipation is an intestinal disease of unknown etiology, manifested by constantly difficult, infrequent bowel movements or a feeling of incomplete release of feces. The dysfunction is based on a violation of intestinal transit, the act of defecation, or a combination of both at the same time.
• Functional diarrhea is a chronic syndrome with relapses, characterized by loose or unformed stools without pain and discomfort in the abdomen. It is often a symptom of IBS, but in the absence of other symptoms, it is considered as an independent disease.
• Nonspecific functional bowel disorders - flatulence, rumbling, bloating or distension, a feeling of incomplete bowel movement, transfusion in the abdomen, an imperative urge to defecate and excessive discharge of gases.

Diagnosis of functional disorders of the gastrointestinal tract

Complete, comprehensive clinical and instrumental examination of the gastrointestinal tract. In the absence of detection of organic and structural changes and the presence of symptoms of dysfunction, a diagnosis of a functional disorder of the gastrointestinal tract is made.

Treatment of functional gastrointestinal disorders

Complex treatment includes dietary recommendations, psychotherapeutic measures, drug therapy, and physiotherapeutic procedures.

General recommendations for constipation: abolition of constipation medications, foods that contribute to constipation, intake of large amounts of fluid, food rich in ballast substances (bran), physical activity and elimination of stress.

If diarrhea predominates, the intake of coarse fiber into the body is limited and drug therapy (imodium) is prescribed.

If pain predominates, antispasmodics and physiotherapeutic procedures are prescribed.

Prevention of functional disorders of the gastrointestinal tract

Increasing stress resistance, a positive outlook on life, reducing harmful effects on the gastrointestinal tract (alcohol, fatty, spicy foods, overeating, unsystematic eating, etc.). There is no specific prevention, since no direct causative factors have been found.

The reasons for such violations are varied. But they are based on the functional immaturity of the children's digestive system 1. With age, the situation is aggravated by the development of a child’s psychological reaction to the problem. Many people are familiar with the so-called “psychological constipation” or “potty syndrome”, which develops in shy children who begin to attend kindergarten, or in cases where the act of defecation is associated with pain.

How do functional bowel disorders manifest in children?

Disorders in this group are very common. It is known, for example, that abdominal pain in children in 95% of cases is caused precisely by functional disorders 2 .

These include:

• functional constipation, flatulence and diarrhea;
• infant colic and regurgitation;
• IBS or irritable bowel syndrome;
• cyclic vomiting syndrome and others 1.

The manifestations of these ailments are characterized by a long-term nature and recurrence. All of them can be accompanied by pain in the abdomen, and pain manifests itself in different ways - from dull aching to paroxysmal, acute 2.

Due to the variety of symptoms, diagnosing functional disorders is quite difficult 2 .

Treatment of functional digestive disorders in children

It is known that the basis for optimal functioning of the digestive tract is diet. Therefore, the first step in treatment should be correcting the nutrition of one child. It should be aimed at 1:

• diet – regular meals ensure balanced functioning of the entire digestive tract;
• diet - introduction into the diet of foods rich in prebiotics, that is, dietary fiber, poly- and oligosaccharides, which help normalize the protective intestinal microflora.

This simple tactic helps restore normal intestinal function and maintain its own microflora.

To normalize digestion, you can also use dietary supplements for children, for example, natural prebiotic in the form of bears with fruit flavor. DufaMishki naturally maintain a healthy balance of intestinal microflora, promoting the growth of its own beneficial bacteria. Thus, Dufa Bears help digestion and proper bowel function, and also promote regular bowel movements in the child.

1. Dubrovskaya M.I. Current state of the problem of functional disorders of the digestive tract in young children // Issues of modern pediatrics 12 (4), 2013. pp. 26-31.
2. Khavkin A.I., Zhikhareva N.S. Functional intestinal diseases in children // RMZh. 2002. No. 2. P. 78.

The human intestine performs one of the important functions in the body. Through it, nutrients and water enter the blood. Problems associated with disruption of its functions in the initial stages of diseases, as a rule, do not attract our attention. Gradually, the disease becomes chronic and makes itself felt with manifestations that are difficult to miss. What could be the reasons that caused a functional disorder of the intestine, and how these diseases are diagnosed and treated, we will consider further.

What does pathology mean?

Functional bowel disorder includes several types of intestinal disorders. All of them are united by the main symptom: impaired motor function of the intestines. The disorders usually appear in the middle or lower parts of the digestive tract. They are not the result of neoplasms or biochemical disorders.

Let us list what pathologies this includes:

• Syndrome
• The same pathology with constipation.
• Irritable bowel syndrome with diarrhea.
• Chronic functional pain.
• Fecal incontinence.

The class of “diseases of the digestive organs” includes a functional disorder of the intestine; in ICD-10 the pathology is assigned code K59. Let's look at the most common types of functional disorders.

This disease refers to a functional disorder of the intestine (ICD-10 code K58). In this syndrome, there are no inflammatory processes and the following symptoms are observed:

• Colon motility disorder.
• Rumbling in the intestines.
• Flatulence.
• The stool changes - sometimes diarrhea, sometimes constipation.
• On examination, pain in the area of ​​the cecum is characteristic.
• Chest pain.
• Headache.
• Cardiopalmus.

There may be several types of pain:

• Bursting.
• Pressing.
• Dumb.
• Cramping.
• Intestinal colic.
• Migration pain.

It is worth noting that pain can intensify as a result of positive or negative emotions, in case of stress, as well as during physical activity. Sometimes after eating. Passing gas and stool can relieve pain. As a rule, the pain goes away when you fall asleep at night, but may return in the morning.

In this case, the following course of the disease is observed:

• After defecation there is relief.
• Gases accumulate and a feeling of bloating appears.
• The stool changes its consistency.
• The frequency and process of defecation is disrupted.
• There may be mucus discharge.

If several symptoms persist for some time, the doctor will diagnose irritable bowel syndrome. A functional disorder of the intestine (ICD-10 identifies such a pathology) also includes constipation. Let us consider further the features of the course of this disorder.

Constipation - bowel dysfunction

According to the ICD-10 code, such a functional disorder of the intestine is numbered K59.0. With constipation, transit slows down and dehydration of feces increases, and coprostasis is formed. Constipation has the following symptoms:

• Bowel movements less than 3 times a week.
• Lack of feeling of complete bowel movement.
• The act of defecation is difficult.
• The stool is hard, dry, and fragmented.
• Cramps in the intestines.

Constipation with spasms, as a rule, does not have organic changes in the intestines.

Constipation can be divided according to severity:

• Easy. Stool once every 7 days.
• Average. Stool once every 10 days.
• Heavy. Stool less than once every 10 days.

When treating constipation, the following directions are used:

• Integral therapy.
• Rehabilitation measures.
• Preventive actions.

The disease is caused by insufficient mobility during the day, poor diet, and disturbances in the functioning of the nervous system.

Diarrhea

ICD-10 classifies this disease as a functional disorder of the large intestine according to the duration and degree of damage to the intestinal mucosa. An infectious disease belongs to A00-A09, a non-infectious disease - to K52.9.

This functional disorder is characterized by watery, liquefied, unformed stools. Defecation occurs more often than 3 times a day. There is no feeling of bowel movement. This disease is also associated with impaired intestinal motility. It can be divided according to severity:

• Easy. Stool 5-6 times a day.
• Average. Stool 6-8 times a day.
• Heavy. Stool more often than 8 times a day.

It can become chronic, but is absent at night. Lasts for 2-4 weeks. The disease may recur. Diarrhea is often associated with the psycho-emotional state of the patient. In severe cases, the body loses a large amount of water, electrolytes, protein, and valuable substances. This can lead to death. It should also be taken into account that diarrhea may be a symptom of a disease not related to the gastrointestinal tract.

Common Causes of Functional Disorders

The main reasons can be divided into:

• External. Psycho-emotional problems.
• Internal. Problems are associated with poor intestinal motor function.

There are several common causes of functional disorders of the intestines in adults:

• Long-term use of antibiotics.
• Dysbacteriosis.
• Chronic fatigue.
• Stress.
• Poisoning.
• Infectious diseases.
• Problems of the genitourinary organs in women.
• Hormonal imbalances.
• Menstruation, pregnancy.
• Insufficient water intake.

Causes and symptoms of functional disorders in children

Due to the underdevelopment of the intestinal flora, functional intestinal disorders in children are common. The reasons may be the following:

• Lack of adaptation of the intestines to external conditions.
• Infectious diseases.
• Infection of the body with various bacteria.
• Psycho-emotional state disorder.
• Heavy food.
• Allergic reaction.
• Insufficient blood supply to certain areas of the intestine.
• Intestinal obstruction.

It is worth noting that in older children the causes of functional impairment are similar to those in adults. Small children and infants are much more susceptible to intestinal diseases. In this case, you cannot manage with diet alone; drug treatment and consultation with a doctor are necessary. Severe diarrhea can lead to the death of a child.

The following symptoms may be noted:

• The child becomes lethargic.
• Complains of abdominal pain.
• Irritability appears.
• Attention decreases.
• Flatulence.
• Increased frequency of bowel movements or absence of bowel movements.
• There is mucus or blood in the stool.
• The child complains of pain during bowel movements.
• Possible rise in temperature.

In children, functional intestinal disorders can be infectious or non-infectious. Only a pediatrician can determine. If you notice any of the above symptoms, you should take your child to the doctor as soon as possible.

According to ICD-10, a functional disorder of the large intestine in a teenager is most often associated with a violation of the diet, stress, taking medications, and intolerance to a number of foods. Such disorders are more common than organic intestinal lesions.

General symptoms

If a person has a functional bowel disorder, symptoms may include the following. They are characteristic of many of the above diseases:

• Pain in the abdominal area.
• Bloating. Involuntary passage of gas.
• Lack of stool for several days.
• Diarrhea.
• Frequent belching.
• False urge to defecate.
• The consistency of the stool is liquid or hard and contains mucus or blood.

The following symptoms are also possible, which confirm intoxication of the body:

• Headache.
• Weakness.
• Cramps in the abdominal area.
• Nausea.
• Heavy sweating.

What needs to be done and which doctor should I contact for help?

What diagnostics are needed?

First of all, you need to go for an examination to a therapist, who will determine which specialist you should see. It can be:

• Gastroenterologist.
• Nutritionist.
• Proctologist.
• Psychotherapist.
• Neurologist.

To make a diagnosis, the following tests may be prescribed:

• General analysis of blood, urine, feces.
• Blood chemistry.
• Examination of stool for the presence of occult blood.
• Coprogram.
• Sigmoidoscopy.
• Colonofibroscopy.
• Irrigoscopy.
• X-ray examination.
• Biopsy of intestinal tissue.
• Ultrasonography.

Only after a complete examination does the doctor prescribe treatment.

Making a diagnosis

I would like to note that in case of an unspecified functional disorder of the intestine, the diagnosis is made on the basis that the patient continues to have the following symptoms for 3 months:

• Abdominal pain or discomfort.
• Defecation is either too frequent or difficult.
• The consistency of the stool is either watery or compacted.
• The process of defecation is disrupted.
• There is no feeling of complete bowel movement.
• There is mucus or blood in the stool.
• Flatulence.

Palpation is important during examination; it should be superficial and deep sliding. You should pay attention to the condition of the skin and the increased sensitivity of certain areas. If you look at a blood test, as a rule, it does not have any pathological abnormalities. An X-ray examination will show signs of dyskinesia of the large intestine and possible changes in the small intestine. Irrigoscopy will show painful and uneven filling of the large intestine. An endoscopic examination will confirm swelling of the mucous membrane and an increase in the secretory activity of the glands. It is also necessary to exclude gastric and duodenal ulcers. The coprogram will show the presence of mucus and excessive fragmentation of stool. Ultrasound reveals pathology of the gallbladder, pancreas, pelvic organs, osteochondrosis of the lumbar spine and atherosclerotic lesions of the abdominal aorta. After examining the stool using bacteriological analysis, an infectious disease is excluded.

If there are postoperative sutures, it is necessary to consider adhesive disease and functional bowel pathology.

What treatment methods are there?

In order for treatment to be as effective as possible, if a diagnosis of “functional bowel disorder” is made, it is necessary to perform a set of measures:

1. Establish a work and rest schedule.
2. Use psychotherapy methods.
3. Follow the recommendations of a nutritionist.
4. Take medications.
5. Apply physiotherapeutic procedures.

Now a little more about each of them.

A few rules for the treatment of intestinal diseases:

• Walk outdoors regularly.
• Do exercises. Especially if the job is sedentary.
• Avoid stressful situations.
• Learn to relax and meditate.
• Take a warm bath regularly.
• Avoid snacking on junk food.
• Consume probiotic foods and those containing lactic acid bacteria.
• If you have diarrhea, limit your intake of fresh fruits and vegetables.
• Perform abdominal massage.

Psychotherapy methods help cure functional intestinal disorders that are associated with stressful conditions. Thus, the following types of psychotherapy can be used in treatment:

• Hypnosis.
• Methods of behavioral psychotherapy.
• Abdominal autogenic training.

It should be remembered that with constipation, first of all, it is necessary to relax the psyche, and not the intestines.

• Food should be varied.
• Drinking should be plentiful, at least 1.5-2 liters per day.
• Do not eat foods that are poorly tolerated.
• Do not eat cold or very hot food.
• You should not eat vegetables and fruits raw or in large quantities.
• Do not overuse products with essential oils, whole milk products and those containing refractory fats.

Treatment of functional intestinal disorders includes the use of the following drugs:

• Antispasmodics: “Buscopan”, “Spasmomen”, “Dicetep”, “No-shpa”.
• Serotonergic drugs: Ondansetron, Buspirone.
• Carminatives: Simethicone, Espumisan.
• Sorbents: “Mukofalk”, “Activated carbon”.
• Antidiarrheal drugs: Linex, Smecta, Loperamide.
• Prebiotics: Lactobacterin, Bifidumbacterin.
• Antidepressants: Tazepam, Relanium, Phenazepam.
• Neuroleptics: Eglonil.
• Antibiotics: Cefix, Rifaximin.
• Laxatives for constipation: Bisacodyl, Senalex, Lactulose.

The attending physician should prescribe medications, taking into account the characteristics of the body and the course of the disease.

Physiotherapeutic procedures

Each patient is prescribed physiotherapy individually, depending on the functional disorders of the intestines. These may include:

• Baths with carbon dioxide bischofite.
• Treatment with interference currents.
• Application of diadynamic currents.
• Reflexology and acupuncture.
• Medical and physical training complex.
• Electrophoresis with magnesium sulfate.
• Intestinal massage.
• Cryomassage.
• Ozone therapy.
• Swimming.
• Yoga.
• Laser therapy.
• Autogenic exercises.
• Warming compresses.

Good results have been observed when using mineral waters in the treatment of the gastrointestinal tract. It is worth noting that after undergoing physiotherapeutic procedures, drug treatment is sometimes not required. Bowel function is improving. But all procedures are possible only after a full examination and under the supervision of a doctor.

Prevention of functional intestinal disorders

It is easier to prevent any disease than to treat it. There are rules for the prevention of intestinal diseases that everyone should know. Let's list them:

1. Food should be varied.
2. It is better to eat fractionally, in small portions 5-6 times a day.
3. The menu should include whole grain bread, cereals, bananas, onions, bran, containing a large amount of fiber.
4. Eliminate gas-forming foods from your diet if you are prone to flatulence.
5. Use natural laxative products: plums, lactic acid products, bran.
6. To live an active lifestyle.
7. Controlling your food leads to diseases of the digestive system.
8. To refuse from bad habits.

By following these simple rules, you can avoid diseases such as functional intestinal disorders.