Журнал «Здоровье ребенка» 4 (47) 2013

The structure of the pathology of the digestive system in children prevails chronic gastroduodenal disease (CGD). In childhood, there are certain features that distinguish the course from CGD adults. Researches don’t pay enough attention to defense mechanisms of mucosa protection gastroduodenal zone (GDZ), main line which is the blood supply of mucosa membrane (MM). Important role in restoring the oxygen supply to the tissues, as well as providing recovery microvessels with lesions stomach MM (SMM) plays bioregulators angiogenesis - vascular endothelial growth factor (VEGF). To date, almost no data on the characteristics of microcirculatory changes MMS and duodenum in children, while such data would allow an individual to come to the appointment regimens and prevention of CGD to reduce the frequency of relapses.

Objective: study features microcirculatory changes in MMS MM duodenum in children with CGD depending on the duration of the disease.

Materials and methods: We observed 76 children aged 8 to 16 years old with CGD. Depending on the length of CGD patients were divided into 2 groups: I group - 29 (38,2±5,6%) children, who has diagnosed CGD at first time diagnosed, II group - 47 (61,8±5,6%)  children with recurrent exacerbation CGD. To verify the diagnosis all children were held fibrogastroscopy upper gastrointestinal tract. Endoscopy was accompanied with biopsy of body, antrum and duodenum MM for further morphological and immunohistochemical study. To assess morphological changes MM of stomach, duodenum tissue sections were stained with hematoxylin-eosin and pykrofuxin by Van-Gisone. For immunohistochemical studies was used indirect streptavydin-peroxidase staining. To determine the expression of the receptor VEGFR - 1 in endothelial cells of the stomach. used a monoclonal antibody (DAKO, Denmark).

Results and discussion. In the morphological study of MM fundus and antral stomach and duodenum MM in the acute stage in 68 (89,5 ± 3,5%) children chronic non-atrophic gastritis were observed, in 60 (78,9 ± 4,7%) patients – non-atrophic chronic duodenitis, at 7 (9,2 ± 3,3%) patients - chronic atrophic gastritis in 16 (21,1%) - chronic atrophic duodenitis in 1 (1,3%) children - chronic granulomatous gastritis. Among children with newly diagnosed CGD, unlike patients Group II observation prevailed microcirculation disorders: perivascular edema, the phenomenon of multiple hemorrhage, thrombosis, erosive changes in SMM MM duodenum. In our opinion, these changes are associated with age-related structural features SMM MM duodenum. Given that among children with and observation of a majority of patients 8-10 years, with further study, we analyzed age morphological features of cell infiltration SMM. Regardless of the duration of illness in patients 8-10 years noted the increasing infiltration SMM eosinophils, which are known to contain high concentrations of peroxidase, which increases vascular penetration and leads to the development of vasculitis. In assessing the frequency and severity of disturbances of microcirculation found that in a group of children of primary school age (8-10 years) course in the majority of CGD was associated with a violation of local homeostasis with symptoms of multiple hemorrhage and thrombosis. More than half of patients 11-13 years, SMM almost equally often (58,3 ± 14,2% and 54,5 ± 15% respectively and II group) noted inflammation with predominantly lymphocytic infiltration, a group of children 14-16 years significantly higher (66,7 ± 19,2% and 63,6 ± 10,3% respectively I and II group) met pronounced infiltration of neutrophils SMM own plate. Our data indicate the intensity of local immune responses, slowing of physiological and reparative regeneration, proliferation of specialized cells, namely with increasing age of the child increased incidence of fibrosis in SMM stroma, degradation and atrophy of the glands. In conducting the analysis we have identified features localization erosive changes of MM GDZ depending on the basal secretion of the stomach. Regardless of the length of CGD erosive changes in the antrum (66,7 ± 15,7% and 60,0 ± 21,9%, p <0.05) and erosive changes of MM duodenum (50 ± 17,7% and 42,9 ± 18,7%, p> 0.05) were diagnosed mainly in children with lowered background APF stomach. Installed features we exclude a direct role of acid hydrochloric acid mechanisms of erosive changes of CO GDZ. It is known that the parietal cell is one of the most high energy-consuming in the body, and the process of gastric acid secretion is strictly aerobic and provides energy for these metabolic requirements of circulation. So, we can assume that the distribution of blood disorders in these areas of the stomach affect not only the formation of CGD, but the processes of secretion of hydrochloric acid. This is confirmed by our findings of immunohistochemical study of receptor expression level of vascular endothelial growth factor (VEGFR - 1). In immunohistochemical studies of biopsies of the stomach and duodenum was found that most children (70,6 ± 11,1%) with newly diagnosed CGD expression of the receptor VEGFR - 1 was more than 10% and less than 50% positively stained cells (2 points). At relapsing course of CGD in 67,7 ± 8,4% expression of VEGFR - 1 was less than 10% positively stained cells (1 point). These data, in our opinion, indicate that the formation of CGD comes amid pronounced microcirculatory disorders of MM GDZ. Analysis of the expression of the receptor VEGFR - 1 depending on the age of the children showed that expression of 2 points was the most children 8-10 years (72,7 ± 13,4%), which is statistically significant (p <0.05) differs from that indicator in patients 14-16 years (33,3 ± 11,1%) which, in our opinion explains before our findings regarding the prevalence of disorders of microcirculation (micro-thrombosis, hemorrhage, erosion) is for children 8-10 years. To confirm our results preliminary study to exclude the effects of hydrochloric acid on mechanisms of erosive changes of MM GDZ, we had evaluated the level of expression of the receptor VEGFR - one regarding the level of basal secretion. According to the results, with increased levels of acidity statistically significant (p <0.05) higher (1,94 ± 0,06 points) was the index expression of the receptor VEGFR - 1 than in normo-hypoacid level of basal secretion (respectively 1.39 ± 0,10 and 1,56 ± 0,18 points). Given the findings, we can assume that one of the mechanisms of erosive changes of the stomach and duodenum is a violation of their due to angiotrophic hypoxic-ischemic injury. Therefore, we can assume that microcirculatory disorders SMM inhibit the functional activity of parietal cells, resulting in damage to the structural integrity of acid-forming glands. These data indicate the need for treatment CGD prescriptions that improve microcirculation and trophic SMM and duodenum.