Objective was to study the level of tumor necrosis factor α (TNF-α) and interleukin 1α (IL-1α) in the blood of children with various forms of functional dyspepsia in accordance with various endoscopic changes of the gastric mucosa. Materials and methods. 79 school age children with functional dyspepsia were examined. The diagnosis was made in accordance with the recommendations of the Rome Criteria IV (2016). All patients underwent endoscopic examination of the esophagus, stomach and duodenum to exclude destructive changes of the mucous membrane. The level of TNF-α and IL-1α in the blood serum was determined by enzyme immunoassay. Statistical processing of the results obtained was performed using Microsoft Excel 2010. Results. The average level of TNF-α in the total group was 463.22±27.4 pg/ml, which statistically significantly exceeded this indicator in the control group (26.76±1.10 pg/ml; p<0.01). The IL-1α value in the total group was 148.6±6.06 pg/ml and was significantly higher in comparison with the control group (53.29±3.28 pg/ml; p<0.01). The level of proinflammatory cytokines in the group of children with epigastric pain syndrome was significantly higher than in the group of children with postprandial distress syndrome. Endoscopic examination showed the presence of unchanged mucous membrane in only 25.3% of children. Erythematous gastroduodenopathy was observed in 74.7% of children and was typical mainly for patients with epigastric pain syndrome (97.7%; p<0.05). Conclusions. The level of pro-inflammatory cytokines in children with functional dyspepsia is increased. When comparing the clinical variants of the disease, a significant increase in the level of TNFα, and IL-1α in children with epigastric pain syndrome was found. In the same group of children, endoscopic changes in the gastric mucosa were more pronounced. Further study of changes in the level of pro-inflammatory cytokines in children with functional dyspepsia may allow this to be used as one of the methods for the differential diagnosis of functional dyspepsia and chronic gastritis.

The concept of comorbidity – simultaneous lesion of two or more organs or systems of the body – has found a fairly wide coverage in the literature of recent years. Comorbidity in diseases of the digestive system has been known for a long time: combined damage to the organs of the gastroduodenal zone and the hepatobiliary system, esophagus, intestines is one of the distinctive features of the course of diseases of the digestive system in children, which requires careful diagnostics and adequate therapy of combined disorders. The article presents literature review on the comorbidity of esophageal and gastroduodenal diseases in children. The problems of comorbidity in diseases of digestive system in children are discussed. Various definitions of the term of comorbidity and its types are given. The issues of the prevalence of combined lesion of the organs of the upper digestive tract in pediatric practice are highlighted. The role of common causative and pathophysiological factors in the occurrence of comorbid diseases of the esophageal and gastroduodenal zone is considered. The authors also discuss the role of Helicobacter pylori infection in the occurrence of esophageal lesions accompanying the pathology of the stomach and duodenum. The necessity of timely diagnostics and adequate treatment of associated abnormalities is emphasized. Понятие коморбидности – одновременного поражения двух или более органов или систем организма – нашло достаточно широкое освещение в литературе последних лет. Коморбидность при заболеваниях пищеварительной системы известна давно: сочетанное поражение органов гастродуоденальной зоны и гепатобилиарной системы, пищевода, кишечника является одной из отличительных особенностей течения заболеваний пищеварительной системы у детей, что требует тщательной диагностики и адекватной терапии сочетанных нарушений. В статье представлен обзор литературы по коморбидности заболеваний пищевода и гастродуоденальной зоны у детей. Обсуждаются вопросы коморбидности при заболеваниях пищеварительной системы у детей. Даны различные определения термина «коморбидность», а также видов коморбидности. Освещены вопросы распространенности сочетанного пораженияорганов верхних отделов пищеварительного тракта в педиатрической практике. Рассмотрена роль общих причинных и патофизиологических факторов в возникновении коморбидных заболеваний пищевода и гастродуоденальной зоны. Авторы также обсуждают роль инфекции Helicobacter pylori в возникновении поражений пищевода, сопровождающих патологию желудка и двенадцатиперстной кишки. Подчеркивается необходимость своевременной диагностики и адекватной терапии сочетанных нарушений.

Pathology of the upper digestive tract is the most common among gastroenterological diseases in children of different ages and is 48-50 %. Recently, there has been an increase in combined lesions of the esophagus and organs of the gastroduodenal zone. Currently, microelements are considered to play a role in the etiopathogenesis of the diseases of the gastrointestinal tract. The aim of the work was to study zinc level in the blood of children with combined gastroesophageal reflux disease (GERD) and chronic gastroduodenal pathology. Materials and methods. 110 children with combined GERD and lesions of the gastroduodenal zone at the age of 10–18 years were under observation. In order to verify the diagnosis, esophagogastroduodenoscopy was performed. The level of zinc in the blood of children was studied using photometric method. Results. 52.5 % of children with concomitant GERD and chronic gastroduodenal pathologies had a reduced zinc level in the blood. According to the results of the study, the risk factors of zinc deficiency in children with combined pathology of the upper digestive tract include male sex, age older than 14 years, the duration of the disease longer than 3 years. The level of zinc in the blood of children was significantly reduced in destructive lesions of the esophagus, as well as with more pronounced inflammation of the gastric mucosa, in duodenitis and erosions in the duodenal bulb. Conclusions. Thus, the results of the study showed the importance of studying the level of zinc in the blood of patients with combined GERD and chronic gastroduodenal pathology to achieve positive changes by its correction. Zinc deficiency more often develops in boys over 14 year old, who has inflammatory changes of digestive tract.