Liver fibrosis is a natural outcome of almost any liver disease with a steady increase in incidence throughout the world. Considering the pathogenesis of liver fibrosis, the doctor- researcher is faced with the fact that the balance of regeneration processes in relation to the process of chronic inflammation is disturbed. The extracellular matrix accumulates in the liver tissue. Although this is a genetically determined process, but modifying factors play an important role in the progression of the disease. Liver fibrosis in its dynamic development leads to liver cirrhosis, hepatocellular carcinoma. Current data indicate the possibility of reversibility of liver fibrosis at any stage. Understanding the molecular mechanisms of the development of the pathological process is a key area of work for scientists involved in the development of antifibrotic therapy. The article discusses modern views on the prevention of the disease and the prospects for influencing the processes of liver fibrosis with an emphasis on childhood.

Aims. The study of clinical and diagnostic features of the course of chronic gastroduodenitis in children, taking into account the types of constitution (somatotypes), the impact of these features on the course of the disease and the treatment.
Materials and methods. We studied 250 patients with a diagnosis of “Chronic gastroduodenitis” aged 4 to 17 years, with morphological changes in the mucous membrane of the stomach and duodenum, corresponding to the criteria for gastroduodenitis, as well as contamination with the H. pylori bacterium. An assessment was made of the age, gender composition, types of constitution according to the classifi cation of M. V. Chernorutsky (based on the Pignet index). Clinical- anamnestic and laboratory- instrumental features of the course of chronic gastroduodenitis in one or another somatotype were noted. The analysis and assessment of the infl uence of the constitutional specifi city of the patient on the course of the disease and the results of treatment was carried out.
Results and conclusion. It was revealed that the presence of an asthenic type of constitution predisposes to the frequent development of chronic gastroduodenitis in children, but a milder course with the development of superfi cial gastroduodenitis, in contrast to normosthenic and hypersthenic types, prone to the development of hypertrophic and erosive gastroduodenitis. It was noted that in asthenics and normosthenics, the success of eradication anti- Helicobacter therapy is signifi cantly higher than in hypersthenics.

There is a functional relationship between the thyroid (thyroid) and pancreatic (pancreatic) glands and a high frequency of combined lesions of these organs. The purpose of the study: to assess the morphofunctional state of the pancreas and thyroid in obese children complicated by metabolic syndrome.
Materials and methods. 483 children with various forms and degrees of obesity aged from 6 to 15 years were examined. Group I — 237 children with obesity complicated by MS, group II — 246 children with obesity without signs of MS. A complex of clinical, laboratory and instrumental examination methods was carried out according to standard and author’s methods.
Results. The majority of children of both groups have various changes in the structure of the pancreas. The postprandial reaction in group I was lower than in group II, and in 17% of children in group I it was less than 5%. A tendency to increase the level of glucose, insulin and the index НОМА was established as the postprandial reaction of the pancreas decreased. Changes in the lipid spectrum of the blood were revealed depending on the postprandial reaction of the pancreas. Regardless of the group, the thyroid volume and thyroid hormone levels in most children corresponded to the normative values. Diff use increase in thyroid was detected in 11% of group I children and 4% of group II children. The data indicating the relationship of structural and functional disorders of the pancreas and thyroid gland were obtained. In children with increased thyroid volume, the size of the pancreatic head on an empty stomach was significantly higher than in children with normal thyroid sizes. With a change in the thyroid gland, more pronounced violations of the functional activity of the pancreas were recorded.
Conclusions. In the absolute majority of obese children, regardless of the presence of MS, various structural changes of the pancreas are detected. The most pronounced disorders of the functional state of the pancreas are diagnosed in children with obesity complicated by MS. In 17% of children with MS, there is a significant decrease (less than 5%) of the postprandial reaction of the pancreas, indicating a decrease in adaptive capabilities and the development of a chronic inflammatory process in the pancreas. With a decrease in the postprandial reaction of the pancreas, more pronounced disorders of the carbohydrate and lipid spectrum of the blood serum are noted. Diff use increase in thyroid in children with MS was recorded 2.5 times more often. A tendency to the formation of dysthyroidism with a multidirectional change in the levels of thyroid and thyroid- stimulating hormones has been established. In children with increased thyroid volume, the size of the pancreatic head on an empty stomach was significantly higher than in children with normal thyroid sizes. At the same time, more pronounced violations of the functional activity of the pancreas were recorded in the form of a decrease in the postprandial reaction.

Aim was to study the prevalence of gastrointestinal tract pathology and the state of intestinal biocenosis among bronchial asthma patients.
Materials and methods: 93 patients with asthma in the exacerbation stage who had diseases of the gastrointestinal tract were examined. Instrumental, immunological, bacterial studies of the respiratory and digestive organs were carried out.
The results of our study indicate a relationship between the development of bronchial asthma and gastrointestinal pathology due to negative environmental effects, stress, glucocorticosteroid therapy, changes in general and local protective reactions against a background of a chronic disease involving organ barriers with an autoimmune pathogenesis mechanism in the pathological process.

Purpose of the research. To study the effect of nutritional support on the results of treatment of patients after liver resection for its focal neoplasms.
Materials and methods. Nutritional status at the pre- and inpatient stages was studied based on the examination of 74 patients with focal liver neoplasms. Through a comprehensive clinical and laboratory examination, were identified groups of patients with mild, moderate and severe malnutrition were identified. Comparison groups were formed from them to develop corrective measures aimed at minimizing the phenomena of nutritional deficiency and reducing the frequency of
purulent- septic complications from wounds.
Results. As a result of the study, it was revealed that after undergoing large and extended liver resections, a mild degree of malnutrition was noted in 18 (47.4%) patients in the main group and in 16 (44.4%) patients in the control group (p = 0.796). The average degree of malnutrition was recorded in 7 (18.4%) patients in the main group and in 5 (13.9%) patients in the control group (p = 0.641). Severe malnutrition was observed in 3 (7.9% and 8.3%, respectively) patients in the analyzed groups (p = 0.796). It has been proven that the use of ATP allows accelerating the normalization of nutritional status in patients who underwent liver resection, compared with patients who did not receive nutritional support, up to 5.5 ± 2.2 days compared to 12.8 ± 3.9 in the second group (p <0.001). Nutritional support with the use of enteral nutrition on day 2 after surgery makes it possible to improve PS markers, which, as a result, helps to reduce the number of septic complications by 9% in the main group.
Conclusion. The use of ATP allows to normalize the nutritional status in patients who underwent liver resection, compared with patients who did not receive nutritional support, up to 5.5 ± 2.2 days compared to 12.8 ± 3.9 in the second group (p < 0.001). After liver resection in the early postoperative period, nutritional support with enteral nutrition on day 2 after surgery allows improving PS markers, which, as a result, helps to reduce the number of purulent- septic complications by 9% compared to patients who did not receive nutritional support.

Goals. Determine the causes of overdiagnosis of gluten dependent conditions, based on the level of antibodies (AT) to transglutaminase (tTG) IgA and total IgA, which have high sensitivity and specificity.
Materials and methods. We enrolled patients with an increased level of TG2 antibodies (average level — 45.64 ± 11.3 IU/ml), examined at the Clinical Center for the period 2020–2021. The total number of patients with positive re4sults was 61, up to 4 years old — 49 patients, 12 children — over 10 years old.
Results. Complaints typical for gastrointestinal tract pathology were present in less than 1/3 of cases (most often, abdominal distension — 18/29.6%). Among the extra- gastrointestinal manifestations, complaint that is more common was poor appetite — 46/75.4% (with normal level of physical development) and the presence of allergic manifestations in the form of atopic dermatitis — 35/57.4%. We re-monitoring the level of TG2 antibodies after 3 months (children were on a regular diet). It was shown that in 56 patients the level of TG2 were within the normal range. 5 patients with the exacerbation of the allergic process had the level of TG2 1.5 times higher than normal, followed by normalization as the skin manifestations fade away.
Conclusions. As a result of screening for celiac disease with testing of TG2 antibodies, false- positive results were detected in 1.6% of cases with negative tests for antibodies to endomysium. According to our data, the most common reasons for false positive results were the presence of an allergic pathology in the acute stage, an acute intestinal infection and parasitic infections.

Relevance. The article presents the results of research of intestinal microbiocenosis in young children born from mothers with gestational diabetes. Indicators of functional activity of intestinal microbiome in the studied cohort of children are presented. The article forces the attention of specialists to the possibility of influence of the biochemically altered microbiome of the intestine on metabolism and health of the child in general.
Research objective. To improve the early diagnosis of intestinal microecology disorders in children born to mothers with gestational diabetes by studying the species composition and state of functional activity of intestinal microbiome.
Material and methods. Intestinal microbiome study (MK) conducted in 105 children aged 1–3, of whom 33 children from mothers with gestational diabetes mellitus insulin therapy (GDМ IT), 42 children from mothers with gestational diabetes mellitus on diet therapy (GDМ DT), 30 children from mothers without GDМ (control group — СG). To this end, methods were used: a standard stool study for dysbacteriosis, a functional state of intestinal microflora to determine the concentration of short-chain fatty acids (SHFA) by gas-liquid chromatography of acidified stool supernatant. Estimation of quantitative distribution of the main types of intestinal microorganisms in children of the studied groups using the method of sequencing 16s rRnk of bacteria. The measure of intestinal dysbiosis was the biodiversity of the microbial community, which in biology is quantified by the Shannon index, corresponds to the number of microbial species in the intestine microbial community and is calculated by the formula: = - ∑ 2= 1, where =∑ = 1
The normalized Shannon index has a range of values from 0 to 1, which is suitable for interpreting the state of microbiome. The results were statistically processed using Statistica 8.0. and MS Office Excel 2010.
Results and discussion. The NGS method of stool sequencing identified the distribution of types of microorganisms in the intestine: in the GDМ IT, GDМ DT and CG Actinobacteria and Firmicutes are the dominant types of bacteria, which is a regular distribution for the microbial community at this age. But in order for bacteria not to realize their pathogenic properties, it is important their intraspecific representation and relationship. It has been found that in children born to mothers with GDМ in general, there is a tendency to decrease the representation of Actinobacteria relative to Firmicutes, in contrast to CG. This may indicate an imbalance within the microbiome of the intestine in children from mothers with GDМ and lead to dysbiosis. So Actinobacteria, which are representatives of MK in the norm, in children from mothers with GDМ IT are represented in a reliably lower range of values than in children from CG (p=0,033). And in children from mothers with DSS DT Firmicutes are represented in greater quantities than in CG (p=0,039).
The predominance of these bacteria in old age plays a crucial role in the development of metabolic disorders. According to this study, it has been found that children of GDМ mothers generally have a reasonably higher degree of MK biodiversity than children with GDS. Thus, in the group of GDМ IT 9 dominant types of micro- organisms were identified, in the group of GDМ DT — 7 species, in CG — 3 species. At the same time, children from mothers with GDМ IT have an increased representation of saprophyte flora (Clostridium hiranonis (р=0,023), Actinomyces spp. (р=0,023) and some representatives of resident fl ora (Coprococcus catus (р=0,045), Veillonellaceae (р=0,04) и Blautia producta (р=0,049)) compared to CG, which may indicate a competitive environment for pathogens, but also do not exclude the possibility of adverse changes in the body’s immune system. Children from mothers with GDМ DT found an increase in the level of Cl. hiranonis, compared to CG (p=0,041), as well as members of the genus Eggerthella (p=0,029) involved in mixed infections, which can lead to chronic inflammation of the intestine mucous and disorders of the body’s metabolic system. Revealed changes in MK in young children from mothers with GDМ are accompanied by peculiarities of metabolic activity. In children from mothers with GDМ IT and GDМ DT metabolic activity did not differ reliably. But the total level of SHFA characteristic for a well-functioning microbiota is more common in children in GDМ IT — 29 (88.0%) than in CG — 18 (60.0%), p=0.036. Also, children with GDМ mothers generally have metabolic pathways similar to those found in MK in children of CG, but have strong correlation and pathogenic types of bacteria. Probably, despite dysbiosis, there is the formation of compensatory metabolic pathways between the MK and the host organism. But these processes can not be called stable, because the MK children of these groups can manage their species and size without the participation of macroorganism.
Conclusion. The composition of the MC for young children born to GDМ mothers in general diff ers reliably from the MC for CG children and is dysbiotic.
In children born to GDМ mothers, MK is represented mainly by opportunistic and pathogenic bacteria. In the group of GDМ IT indigenic microflora is stronger.
Metabolic activity of MK in this cohort of children is high, but is achieved due to the activity of both individual and saprophytic fl ora, which in the future may lead to the breakdown of compensatory mechanisms and the start of metabolic disorders in the child.

The aim of the present study was to evaluate exocrine pancreatic function in children with type 1 diabetes mellitus during the course of the disease.
Fecal elastase varied between 24.4 and 169.6 μg /g (median 134.5 μg /g) in children with type 1 DM and concomitant PEI. Number of children with diarrhea was not significantly different between children with low pancreatic elastase levels and those with normal levels (43.0% versus 35.5%, p=0.359). The remainder of the children with type 1 DM had fecal elastase-1 levels between 201.4 and 810.5 μg /g stool (median 650.7 μg /g). Differences between the type 1 DM patients without PEI and the comparison group were not significant (p=0.112).
Median daily fecal fat excretion in type 1 DM patients with PEI was 8.31 g/day (min-mах 7.81–9.21 g/day), which was significantly higher than in type 1 DM children without PEI (3.87 g/day; min-mах 2.97–6.33 g/day; р= 0.0003). There was no significant difference in daily fecal fat excretion between children with type 1 DM without signs of PEI and children in the control group (2.91 g/d; min-max: 2.31–5.74 g/d; р= 0.091).
The results of this study demonstrate PEI in children with long-standing type 1 DM.
Fecal elastase-1 concentration significantly correlates with duodenal exocrine elastase output. Fecal elastase-1 levels have a good correlation with fecal fat excretion, which was measured by employing the acid steatocrit test.

The purpose of the study: To evaluate the clinical and functional state of the pancreas, liver and intestinal microbiota in patients with chronic biliary- dependent pancreatitis (CKD) after cholecystectomy.
Materials and methods. 110 patients with CKD were examined, who were divided into 2 groups: group 1–58 patients (CKD) with a history of cholecystectomy. Group 2–52 patients with CKD with concomitant GI. The control group consisted of 35 practically healthy people. Patients with CKD with preserved gallbladder formed a comparison group with the main group. Cholecystectomy was performed according to urgent indications in most cases, but in some cases it was performed “prophylactically” with asymptomatic GI.
All patients underwent:
• ultrasound elastometry of the liver on the device “FibroScan” (“EchoSens”, France).
• the study of the ability of cells to produce cytokines — TNF-a and TGF-b was determined by the enzyme immunoassay using test systems manufactured by the company “Cytokine” (St. Petersburg) and the company “R&D systems” (USA).
• study of the concentration of pancreatic elastase-1 in feces by ELISA using test systems of the company “ScheBoBiotech” (Germany).
• determination of the absolute and relative content of FGC (C2-C4) by gas-liquid chromatographic analysis in blood serum and faeces on the Crystal 2000 M chromatograph.
Conclusion. In patients with CKD with a history of cholecystectomy, there are more significant violations of the metabolic activity of the intestinal microflora, lipid metabolism, liver fibrosis indicators, the severity of external secretory pancreatic insufficiency (VSN pancreas), which is accompanied by an increase in cytokine levels: TGF-b and TNF-a, an increase in the absolute content of short- chain fatty acids (FFA) in blood serum and feces and multidirectional changes in their spectrum, depending on the severity of the pancreatic VSN, the stage of liver steatosis, cholesterol levels compared with those of patients with CKD with preserved LC.

The article refl ects the results of a study of the infl uence of adverse environmental factors on the formation of pathology of the biliary system in children of the Krasnodar Territory living in ecologically unfavorable territories.
The purpose of the work is to study the features of clinical manifestations of diseases of the biliary system in children living in ecologically unfavorable territories of the Krasnodar Territory. 683 children aged 7–17 years were examined on the basis of the DDC DKKB of Krasnodar.
In the course of the study, the clinical features of various forms of dysfunctional disorders, prevalence and morbidity in relation to the level of environmental pollution were studied according to the method of V. A. Shashel and co-authors. The regularities of the prevalence of diseases of the digestive tract depending on the level of pollution have been revealed.

Introduction. Over the past decade, the incidence of iron deficiency anemia has increased. According to the World Health Organization (WHO), it occurs in every 3 people in the world. Most often, anemia occurs in developing countries and is mainly affected by 2 groups of the population — young children and pregnant women. In pediatric practice, there are single works devoted to the problem of comorbidity, in connection with which our studies are of particular interest.
Target research. To study the incidence of iron deficiency anemia in children and adolescents with cholelithiasis living in the Krasnodar Territory.
Material and methods. The study involved 146 children with cholelithiasis, selected based on the results of applying to the consultative polyclinic and inpatient departments of the Children’s Regional Clinical Hospital, Krasnodar. Children were divided into three groups according to the number of comorbid diseases. Group I consisted of 50 (34.2%) children, including 36 (24.7%) girls and 14 (9.5%) boys, whose average age was 8.6 ± 4.5 years, with 3 somatic diseases. Group II included 55 (37.7%) children — 27 (18.5%) girls and 28 (19.2%) boys, the average age was 9.1 ± 4.4 years, with 4–5 chronic diseases. Group III consisted of 41 (28.1%) children. Of these, 18 (12.3%) girls and 23 (15.8%) boys, whose average age was 10.3 ± 4.7 years, had 6 or more chronic diseases. To establish the diagnosis, laboratory and instrumental research methods were used.
Results and discussions. Among children with cholelithiasis, 12.3% had blood diseases, of which IDA occurred in 7.5% of cases. At the same time, out of 18 (12.3%) observed children with blood diseases, almost everyone had chronic gastroduodenitis — 13 (72.2%), dysfunctional disorders of the biliary tract were detected in every second child — 9 (50.0%), protein- energy deficiency — 8 (44.4%), every third had gastroesophageal disease and hepatitis — 5 (27.8% and 5–27.8%, respectively), every 6 child had chronic pancreatitis and myocardial dystrophy — 3 (16.7% and 2 (11.1%) respectively). In isolated cases, duodenal ulcer, celiac disease, colon anomaly- dolichosigma, liver cirrhosis, hypothyroidism, juvenile rheumatoid arthritis, urinary tract infection, Gilbert’s disease, Niemann- Pick disease were identified. Allergic pathology occurred in every fourth child in the form of bronchial asthma — 4 (22.2%), hay fever — 5 (27.8%) and atopic dermatitis — 3 (16.7%).
Conclusion. The study of the etiopathogenesis of anemia in cholelithiasis in children and adolescents is important. It allows you to outline rational ways to correct the underlying and concomitant diseases. With an increase in the comorbidity index in patients with cholelithiasis, the risk of developing IDA increases. Pollution of the environment with various pollutants in the form of pesticides and household waste introduced into the soil are trigger factors for the development of IDA and cholelithiasis.

 The article summarizes guidelines for endoscopic examinations in children with Crohn’s disease (CD). The article may be useful for endoscopists, pediatric gastroenterologists, pediatricians, pathologists, pediatric surgeons. Issues of endoscopic examinations and monitoring of pediatric CD (esophagogastroduodenoscopy, ileocolonoscopy, video capsule endoscopy, panintestinal capsule) are considered. 

The article provides an analysis of changes in ideas about pathogenetic mechanisms, approaches to the diagnosis and treatment of irritable bowel syndrome in children. Current data on the pathophysiological mechanisms of IBS are presented. Algorithms for the management of children with this pathology are presented, based on the new positions of the Rome IV criteria and Russian recommendations for the diagnosis and treatment of functional disorders of the digestive system in children.

Aim. To study the possibilities of using video endoscopic technologies in the surgical treatment of hiatal hernia and evaluate long-term results.
Materials and methods: 52 patients who underwent laparoscopic correction of hiatal hernia were examined.
Results. Excellent and good results were obtained in 31 patients (73,8%), a group with satisfactory treatment results were 2 (4,8%) patients, and an unsatisfactory result was observed in 9 (21,4%) patients.

 The birth of children with congenital malformations of the small intestine has a correlation with the degree of use of chemical plant protection products and water supply problems in some regions. Surgical treatment of this pathology in this group of surgical patients — in newborns who are extremely difficult to tolerate any diagnostic and treatment interventions, have limited prospects and opportunities. The problem associated with these malformations of the digestive tube in newborns must be addressed with preventive measures. 

 The authors consider nutritional theoretical concepts in the light of the organizational possibilities of their use in modern pediatric practice. Analysis of nutrition problems in an evolutionary aspect implies taking into account the latest achievements in molecular biology, microbiology and biotechnology. As the most important part of medicine and health care, nutrition determines the relationship of a person with the internal and external world and is the basis for the formation of the health of a growing organism. The article discusses the general problems of qualitative and quantitative changes in nutritional parameters during the formation of diseases, their prevention and treatment. 

A review article is devoted to the analysis of scientific and literary data published over the past 10 years, devoted to the problem of studying the role of Helicobacter pylori in the development of iron deficiency anaemia in children and adolescents. Comparative data of domestic and foreign scientists on the mechanism of exposure of Helicobacter pylori (НР) to the pathogenesis of resistant iron deficiency anaemia in children are given.
It was determined that the development of iron deficiency anaemia in children with HP infection is influenced by many mechanisms, therefore, in the treatment of children with this pathology, the appointment of anti- HP bacterial therapy with ferrotherapy, taking into account age-related characteristics and needs, is justified.

The presented literature review raises the problem of sarcopenic obesity in the pediatric population. A number of studies show that with morbid obesity, the level of muscle mass decreases until the development of sarcopenia. Sarcopenic obesity is closely associated with a deterioration in the quality of life and a decrease in human activity. Despite the growing relevance of the issue, many data, such as the mechanism of development, outcomes and epidemiology of the pathological condition in children, are not clearly defi ned. In our article, we provided data on the methods of studying the disease, the advantages of some methods over others, the relationship of the condition in question with disorders of other organs and systems, the pathogenesis of the disease in an adult and a possible mechanism for the development of sarcopenic obesity in children. 

The problem of combined pathology in childhood has an important medical and social aspect. To date, aspects of the pathogenesis of the overlap syndrome are being considered and studied. Despite reliable data on the factors in the development of overlap syndrome in clinical practice, the eff ectiveness of diagnosis and treatment is still low. This review summarizes the current scientifi c data from epidemiological studies of various types of overlap syndrome, therapeutic approaches, and also analyzes a rare clinical case in pediatrics.
The purpose of the review is to present an analysis of current literature data on the prevalence of overlap syndrome in pediatric practice.

The selecting tactics for managing patients with ulcerative colitis, an individual approach is required for each patient, depending on the activity and duration of the disease, as well as on the response to previous therapy.
It is well known that the gut microbiome has a profound impact on the pathogenesis of infl ammatory bowel disease (IBD). The IBD gut microbiome is generally characterized by reduced species richness and diversity, less temporal stability, decreased benefi cial bacteria, and increased pathogenic bacteria.
A search is underway for new opportunities to infl uence the microbiota, the virome of patients to achieve remission or prevent the development of this pathology. After all, earlier, more aggressive management of patients using targeted drugs can dramatically change the course of the disease and reduce the likelihood of relapses, complications, the need for hospitalization and surgical intervention.
A better understanding of the human gut microbiome could provide innovative targets for prognosis, treatment, and even cure for this topical disease.

Aim. To study the indicators of the quality of life in school-age children with abdominal pain in the assessment of children and their parents.
Material and methods. The cross- sectional method collected data on the presence of gastroenterological complaints in 542 schoolchildren aged 7–17 years. To assess the quality of life of children, adapted Russian versions of the Child Health Questionnaire were used: parental (CHQ-PF28) and child (CHQ-PF45). The calculation of indicators was carried out according to the sections characterizing various areas of the child’s life, according to a 100-point system. The studies were approved by the ethics committee and the consent of the examined was obtained.
Results. The indicators of the parent and child versions of the questionnaire indicated that schoolchildren with abdominal pain had a worse quality of life on many scales compared to children who had no complaints.
However, the deterioration of life indicators in schoolchildren with abdominal pain, according to a survey of children, was noted on a signifi cantly larger number of scales, which may be a refl ection of their «social orphanhood».
Conclusion. Thus, a signifi cant decrease in the quality of life in schoolchildren with abdominal pain was established. There are diff erences in the assessment of children and their parents in assessing the quality of life of this category of patients.

Inflammatory bowel disease (IBD) is a group of severe systemic diseases with a multiple intestinal and extraintestinal manifestations (EIM). EIM can affect any organ systems, determine the course, therapy and prognosis of the underlying disease. The frequency of EIM (6–80%) differs significantly in studies depending on the cohort of patients (number, age of patients, IBD phenotype). In 6–10% of children EIM are the first symptoms of the disease. The classification of EIM most often depends on the activity of the disease in the intestine. The most commonly affected «target organs» in children and adults are joints, skin and mucous membranes, eyes, and the hepatobiliary system. Physical development delay is specific for children IBD, not always reversible. The article highlights the incidence of ulcerative colitis and Crohn’s disease EIM in children and adults, analyzes the basics of epidemiology, pathogenesis, clinical manifestations, approaches to the diagnosis and treatment of arthritis, growth disorders, mucocutaneous, ocular and hepatobiliary EIM of IBD in children. Therapy of EIM associated with IBD activity is aimed at controlling the underlying disease and includes a wide range of drugs, ФНОα antagonists are the most effective. The treatment protocols for other EIM are not standardized in either adult or pediatric practice and are significantly less successful.

 A clinical example of the course of erosive Hp-associated refl ux esophagitis in a 5-year-old child is given. The importance of timely esophagogastroduodenoscopy for diagnosis and adequate therapy is shown. 

Foreign bodies (FB) in the gastrointestinal tract are found in children of all age groups, but most often these are patients 1–4 years old. A description of a clinical case of the detection of an omentum bag due to a covered perforation of the stomach in a 2-year-old child is presented. The tactics of child management, a set of diagnostic methods of examination, methods of surgical treatment are described. It has been shown that the clinical picture of FB in the upper gastrointestinal tract in children is nonspecifi c and may not manifest itself in the early stages. FB of the stomach can migrate into the omentum bag without developing a clinical picture of perforation of the hollow organ and peritonitis. Laparoscopic removal is the method of choice for surgical treatment of a FB that has migrated outside the stomach, and timely diagnosis contributes to achieving positive results both in the treatment and in the prevention of complications.

The article discusses the rare and difficult to diagnose and treat Prader–Willi syndrome (PWS). The review part of the article presents the issues of its epidemiology, genetic and clinical manifestations of PWS; the role of hypothalamic dysfunction leading to growth hormone defi ciency, hypogonadism, hypothyroidism, adrenal insufficiency, risk of obesity, metabolic syndrome is emphasized. The results of studies concerning speech and intellectual development delay and neuropsychiatric disorders in children with PWS are presented. On the example of clinical observation of a child with this genetic syndrome, along with known methods of treatment, modern possibilities of using innovative rehabilitation technologies, including transcranial micropolarization and bioacoustic correction, are shown.

We present a rare clinical observation of an 11-year-old boy who, as a result of a fall from a height, received a severe combined injury of the chest, abdomen, retroperitoneal space, which was accompanied by a contusion of the lungs with hydrothorax, contusion of the right kidney, pancreas and duodenal rupture with the development of traumatic shock of the III degree, bile peritonitis. It required emergency surgery, intensive care and was combined with the patient’s chronic reflux esophagitis with esophageal stenosis, erosive gastritis, duodenitis. The development of stenosis of the esophagus may have had a post-traumatic character.

The purpose of the clinical case was to describe combination chromosome abnormaliries in girl with malformations of the large intestine.
Girl A., 1, 9 year old was born prematurely. From birth, multiple stigmas of dysembriogenesis: poor weight gain, absence of an independent stool, marked delayed physical and psychomotor development attracted attention. During doppler echocardiography, a left-sided right- formed heart (chest), an open arterial duct, hemodynamically insignificant, with a diameter of about 1 mm is determined. In the second year of life, cholelithiasis was diagnosed (a single gallbladder concretion of 1.5 mm), erosive- hemorrhagic gastritis, subatrophic duodenoejunitis, an anomaly of the development of the large intestine (dolichosigma, dolichocolon) with hypomotor-type kolodiskinesia. During the examination, multiple stigmas of dysembriogenesis (oblique occiput, ocular hypotelorism, large, protruding auricles, strabismus, umbilical hernia), marked muscular hypotension, marked delayed physical and psychomotor development attract attention. Physical development: body length 70 cm, body weight 6650 g, teeth 8. SDS height –4.5, BMI 13.57 kg/m2, SDS –6.12. A molecular cytogenetic study revealed a normal female karyotype in proband’s mother, an abnormal karyotype 46, XX, der (21) t(4;21)(q31; q22) pat in proband’s mother, and a normal male karyotype with a balanced translocation 46, XX, t(4:21) in the patient’s father(q31: q22). The child has a chromosomal anomaly: partial trisomy of the q-arm of chromosome 4, as a result of translocation between chromosomes 4 and 21 of paternal inherited. Thus, the patient has an unbalanced karyotype, which causes a clinical features characterized by the marked delay in psychomotor and physical development, multiple stigmas of dysembriogenesis and malformations of the large intestine.

Purpose of the study. Based on their own clinical observation, improve the diagnosis of the aberrant pancreas in children.
Materials and methods. The study of the modern scientifi c literary data on the aberrant pancreas. The analysis of own clinical observation data.
Results. Ectopia of the pancreas into the stomach wall is a rare pancreatic abnormality in childhood. Pathology has no pathognomonic symptoms. The presence of the aberrant pancreas in the gastroduodenal zone contributes to the development of morphofunctional changes in the gastric and duodenal mucosa, up to metaplasia of the gastric epithelium.
Conclusions. Given the possibility of complications even in childhood, patients with this defect require dynamic observation of a pediatrician, gastroenterologist and pediatric surgeon.