Журнал «Здоровье ребенка» (62) 2015. Тематический выпуск "Детская гастроэнтерология"
Вернуться к номеру
Fermentopatiya as reason of skin manifestations atopy at children
Авторы: Lymarenko M.P. — Donetsk National Medical University named after M. Gorky, Ukraine
Рубрики: Педиатрия/Неонатология
Разделы: Клинические исследования
Версия для печати
Atopic dermatitis is an allergic inflammation of skin at the heart of which genetically caused immune mechanisms leading to damage of all layers of epidermis lie. Atopic dermatitis have to 20 % of a children's world's population. Existence of accompanying diseases of a gastroenteric tract at the child with an allergy is often meeting situation in practice of the doctor-pediatrist. Functional violations of digestive organs lead to absorption of defectively split components of food, especially proteins and by that an organism sensitisation to different types of allergens promotes. At atopic dermatitis at children the following functional violations of digestive organs meet: refluxes, dyskinesia, disease of a mucous membrane, relative pancreatic insufficiency, etc.
It is known that the pancreas is the largest and major gland of digestive system and at the same time the most important gland of the internal secretion which is taking part in regulation of a carbohydrate exchange. It secretion in blood (endocrine function) hormones - insulin (essentsialny for life), a glucagon, gastrin, somatostatin, pancreatic polypeptide, amilin. Produces to the digestive highway (ekzokrinny function) enzymes which participate in hydrolysis of all nutrients.
Methods of an assessment of ekzokrinny function of a pancreas divide (usually zondovy) and indirect (bezzondovy) into straight lines.
Direct methods are connected with direct determination of activity of enzymes in duodenal contents, and indirect ‒ with an assessment of processes of digestion of standard substrata. To direct methods carry the sekretin-holetsistokininovy test being «a gold standard» definitions of ekzokrinny function of a pancreas. This test possesses high precision, however its wide application is impossible because of a number of shortcomings: high cost sekretin and holetsistokinin, need of sounding of the patient, duration of procedure, need of intravenous introduction of preparations and, as a result, possibility of collateral reactions.
In modern conditions alternative to expensive and invasive sekretin-holetsistokininovy dough is definition elastazy-1 in feces. Enzyme elastaza-1, produced by a pancreas, not metabolize in intestines and its activity in feces objectively reflects ekzokrinny function of body. This method has big specificity and sensitivity - more than 90 %. Unlike indirect tests, definition elastazy-1 can be carried out, without cancelling preparations of replaceable therapy. Definition elastazy-1 is shown in all cases when ekzokrinny insufficiency of a pancreas and in all cases when application of preparations of pancreatic enzymes since will allow to avoid their unreasonable appointment is supposed is supposed.
About communication of atopic dermatitis with diseases of bodies of the gastroenteric highway, including fermentopatiya, many authors in the publications specify. L. Lange et al. offer the eczema which has begun at the child with 3-month's age, to consider as one of the main symptoms of a syndrome of Shvakhmana-Daymond (the autosomno-retsessivny disease, being characterised insufficiency of a pancreas, a neytropeniya, violation chemiotaxis neutrophils, aplastic anaemia, thrombocytopenia, metafizarny dizostozy and a delay of physical development). In the message of K. Pellegrino et al. describe the 8-year-old boy at whom after the cod use in 5 minutes anaphylactoid reaction and an exacerbation of pancreatitis have developed. The specific immunotherapy is begun. Symptoms of diseases were stopped at the child in 7 days. From the anamnesis it is known that from one-year-old age the boy had atopic dermatitis and chronic diarrhea. In 4 years recurring pancreatitis is diagnosed for the child. N.L.Aryaev et al. surveyed 29 children at the age from 2,5 till 18 months with atopic dermatitis. Demonstration of kinichesky signs of defeat of a digestive path, especially a pancreas, was shown at these patients by belly-ache (intestinal colic), a srygivaniye, vomiting, a meteorizm, frequent liquid excrements. As the most effective method authors have noted complex therapy of atopic dermatitis with inclusion of a fermental preparation «Pangrol 10 000». E.N.Okhotnikova et al. at inspection of 45 children at the age from 3 till 16 years with allergic diseases of skin of violation from digestive organs have revealed at 94 % of patients. Preparation application «Mezim forte 10 000» in complex therapy of allergic defeats of skin promoted fast disappearance painful abdominalny and dispeptichesky a syndrome, positively influenced knocking over of allergic semiology.
Thus, the task of the doctor consists in carrying out profound inspection of bodies of digestive system at children with atopic dermatitis and purpose of complex therapy of the last taking into account the revealed changes.