Background. Duodenal ulcer (DU) in children is a serious problem in clinical medicine. At present, the main cause of DU is considered to be infection of the mucous membrane with H.pylori. Data from the scientific literature on quantitative and qualitative changes in the intestinal microflora differ. The purpose was to analyze the state of intestinal microbiocenosis in children with Helicobacter pylori-associated duodenal ulcer. Materials and methods. A comprehensive clinical and instrumental-laboratory examination of 90 children aged 7–18 years with DU associated with H.pylori was conducted. The classical method of seeding faeces was used. Results. Among children with DU, 90 out of 110 patients were infected with H.pylori, which is 81.8 %. In patients with DU associated with H.pylori, the detection of bifidobacteria, lactobacilli, enterobacteria of the genus Pantoea is significantly reduced against the background of increased opportunistic anaerobic bacteria of the genus Clostridium, P.niger, facultative anaerobic and aerobic enterotoxigenic and enteropathogenic escherichia and opportunistic proteas and staphylococci. The most common deviations are those towards growth of yeast-like fungi of the genus Candida. Conclusions. The prevalence of H.pylori in children with DU is 81.8 %. In most children with this pathology, various disorders of the intestinal microflora are registered, which can complicate the course, aggravate the chronicity of the process, reduce the effectiveness of antihelicobacter therapy.
The aim: To evaluate the efficacy of the drug VitD children with H.pylori-associated duodenal ulcer. Materials and methods: Two treatment groups of children with DU were formed: I - 60 children with H. pylori-associated DU, who received the optimal scheme of anti- Helicobacter therapy (AHBT) for Chernivtsi region; II - 62 children with H. pylori-associated DU who received a modified treatment regimen: AGBT + VitD at a dose of 2000 IU / day for 1 month. The effectiveness of the treatment was evaluated taking into account the Relative Risk Reduction (RRR) of the adverse event and Number Needed to Treat (NNT). Results: All children with DU and a positive H. pylori infection test showed changes in serum VitD levels: 81.9% deficiency and 18.1% insufficiency. Successful eradication was achieved in 77.1% of children, in particular in the first group 73.3%, in the second - 82.2%. Predictors of successful eradication are the duration of infection, H. pylori CagA (+), VitD level. When using the VitD treatment regimen in children with DU associated with CagA (+) strain H.pylori, RRR was observed 2.29 times (χ2 = 6.34, pφ<0.05) with NNT 1.59. Conclusions: Due to the reduced level of serum VitD in children with H. pylori-associated DU, it is advisable to include in the treatment regimen the adjuvant component of AHBT in the form of VitD. Predictors of effective eradication of H. pylori are CagA (+) strain of H. pylori, duration of infection and VitD level.
The most serious pathology of the of gastrointestinal tract in children remains duodenal ulcer (DU). Interesting is the study of the role of endothelin-1 and nitrogen oxide in the formation of DU.The aim. To evaluate the nature of changes in the level of nitrogen oxide (NO) and endothelin-1 (Et-1) in the blood of children with H pylori-associated DU.Methods. A single-center study was conducted in 42 children with DU aged 6-18 years and 20 children comparison group. Diagnostics of H. pylori was performed primary 262 endoscopy and 4 weeks after the end of treatment. Blood samples were collected in each visit to measure plasma Et-1 using an enzyme immunoassay kit and NO (nitrate/nitrite) levels Golikov's method.Results. In 37 (92.5%) the ulcers went through re-epithelialization, while successful eradication of H. pylori was achieved in 32 people (80%). The NO level in the blood plasma of the children of the main group was 9.78 ± 1.13 mmol/l, after treatment -11.09 ± 1.2 mmol/l. After eradication of H. pylori, the level of Et-1 decreased from 2.39 ± 0.08 to 1.14 ± 0.07 pg / ml. Conclusion. Levels of endothelin-1 (Et-1) and nitrogen oxide (NO) in children with duodenal ulcer vary depending on the stage of the disease. After H-pylori eradication, ulcer defect healing is associated with decreased of Et-1 in plasma and increased NO activity.
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