Журнал «Здоровье ребенка» 4 (64) 2015

Chronic gastroduodenal diseases (CGDD), despite significant improvements in their diagnosis and treatment over the last decade, they occupy a leading position in the structure of the children chronic diseases. In the structure of children CGDD the largest share is chronic gastro duodenitis (CGDD). The feature of chronic diseases of the digestive system in modern terms is the thing of many factors and heterogeneity of pathogenesis and involvement of other organs and systems, including endocrine and cardiovascular.  Recently there greatly increased an interest in the study of thyroid dysfunction influence and iodine deficiency on disease. Due to the intensity of growth, metabolism and development of children, the need for iodine in them has increased, and the possibility of its deficit and distribution of subclinical hypothyroidism (SH) in endemic areas, which include Carpathian region, is particularly high. Iodine deficiency is often asymptomatic, some children may show poor memory; cognitive impairment; muscle weakness; fatigue; cramps in the muscles.  The aim of our study was to determine the characteristics of chronic gastro duodenitis in children with subclinical hypothyroidism and justification of the using iodine in this pathology.

Materials and methods.   A survey of 120 middle and high school age (10-18 years), patients with CGD. Determination of Helicobacter pylori infection in children with CGDD conducted using immuno-enzyme analysis (IEA) and by identifying the bacteria Helicobacter pylori DNA by polymerase chain reaction (PCR). In order to assess lifestyle a questionnaire to 300 children and adolescents, which included questions the nature of power, physical activity, leisure, success. The study of the functional state of the pituitary-thyroid system by determining the level of TSH, T3, T4, T3 index / T4. Acid-forming function of the stomach examined the results of the basement topographic rapid pH meter stretches the stomach by VM Chernobrovym. Fibro-ezo-fago-gastro duodenoscopy (FEHDS) was performed using endoscopic child GIF-K20 company "Olimpus" (Japan), thyroid ultrasonographic examination was performed on the machine Scanner-100. Computer ECG recorded on the unit "Elektrokard" (PA "Metekol", Ukraine).

Research results. In 65 (54.2%) of the 120 children surveyed in the study of CGD pituitary-thyroid system diagnosed with subclinical hypothyroidism (TSH above 2.5 mU / l). The majority of children (56.7%) suffered from CGD from 9 months to 3 years. Was first hospitalized 49 (40.8%) patients with CGD, re - 71 (59.2%) child. The main clinical syndromes in children with CGD were pain (98.6% of children), dyspeptic (92.4%) and asthenovegetative (69.8%) syndromes. Note the high frequency duodenogastric reflux (DGR) - in 38.7% of children with CGD. It was established that the incidence of pain and dyspeptic children’s syndromes with FH in patients without evidence of SG was almost the same. However, the duration of children’s pain with FH was 1.7 times higher than of children with CGD without SG. Astenovegetativnogo syndrome, the main manifestations of which are weakness, headache, irritability, fatigue, insomnia, memory loss, significantly more often observed among children with FH (84.6%) compared with patients with CGD without evidence SG (56 3%, P <0.02). According FEHDS found that 60.8% of patients with CGD vizualizuvalys surface forms of inflammation in 39.2% - erosive. It was observed that the incidence of inflammatory and destructive changes in the gastric mucosa and 12 duodenal ulcer in patients with signs of SG was higher (55.38%) than children without CG (27.3%, P <0.01). The study of the nature of power showed that regardless of thyroid status among children with CGD significant violations of food quality and students were observed. This is primarily concerned suite of products in the diet. Only 8.24% of respondents daily consume meat, 46,47% - get meat once a few days. It was observed that 44.1% of children consuming milk and milk products once a few days and seafood containing iodine, not only daily, but weekly, do not consume any of the respondents.

At admission to the hospital 43.3% of the children complained of pain in the heart and heartbeat that occurred mainly after psycho-emotional overload. Children with CGD based on SG ECG are identified significantly more sinus bradycardia, ektrasystoliyi, lengthening or shortening the interval QT, blockade of His left leg.

In studying the functional state of the pituitary-thyroid system in children with CGD by determining the level of TSH, T3, T4, T3 index / T4. It is established that the content of TSH in children with CGD, combined with FH, was 5.4 + 0.4 mU / L, the content of T3 was 5.45 + 0.42 pmol / L, T4 - 16.5 + 0.75 pmol / l). In patients with CGD no signs SG TSH concentration was 1.3 + 0.15 mU / L (P <0.001), significant differences content T3 and T4 compared with a group of children with FH were found.

Conclusions.

1. The feature of chronic gastro-duodenitis based on subclinical hypothyroidism is a high frequency astenovegetativnogo syndrome, pain duration greater, more pronounced clinical and instrumental signs of functional disorders of the cardiovascular system.

2.  Children with chronic gastro duodenal pathology in Carpathian endemic area is recommended to study the function of the pituitary-thyroid system.

3.   Chronic gastro duodenitis established with subclinical hypothyroidism should be encouraged to use basic therapy with iodine (iodide 100) for 3 months twice a year. In addition, children with chronic gastro duodenitis require correction to include food nutrients fortified with iodine.