The article is devoted to the results of the training of pediatricians in pediatric gastroenterology based on the experience of the Department of Pediatrics with Infectious Diseases in Children (Head of the Department - prof. L. A. Kharitonova) N. I. Pirogov’s Russian National Research University of the Ministry of Health of Russia. The stages of development of the department are presented in detail. Since diseases of the digestive system have been and remain the main scientific direction of the work of the department staff, the issues of teaching gastroenterology and training both specialist doctors and pediatricians in this area influenced the goal-setting of the pedagogical process. Convincing evidence of the effectiveness of the rapid introduction of scientific and research achievements in practical health care. Fragments of the article highlight how, within the framework of training, joint medical work with organizations of health authorities in various regions of Russia, with which the department closely cooperates, they help spread knowledge. The prospects for the work of the department in the field of age-related non-infectious, infectious gastroenterology, biliary pathology and nutrition, further improvement of scientific and pedagogical activities, the quality of training of specialists in the field of pediatric gastroenterology are outlined. The article is dedicated to the 35th anniversary of the department.

Aims. Study of endoscopic features of the manifestation and dynamics of chronic gastroduodenitis in children, taking into account the types of constitution (somatotypes). Materials and methods. 250 patients diagnosed with Chronic gastroduodenitis aged 4 to 17 years have been studied, having morphological changes in the mucous membrane of the stomach and duodenum that meet the criteria for gastroduodenitis, as well as contamination with the H.pylori bacterium. The age, gender composition, types of the constitution according to the classification of M. V. Chernorutsky (based on the Pinier index). Endoscopic features of chronic gastroduodenitis were noted in a somatotype upon admission to the hospital and in dynamics against the background of the therapy. An analysis was carried out and an assessment was made of the impact of the constitutional specifics of the patient on the course of the disease and the results of treatment. 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 superficial gastroduodenitis, in contrast to normostenic and hyperstenic types, prone to the development of hypertrophic and erosive gastroduodenitis. Despite this, the course of hypertrophic and erosive gastroduodenitis in asthenics is protracted in nature, in contrast to normostenics and hyperstenics.

The study is devoted to the comparison of the results of rapid urease tests (RUT) and the data obtained in histological examination. For this purpose, the semi-quantitative assessment of urease activity of two BUTs was compared: the semi-quantitative Pronto Dry (GASTREX, France) widely used in Europe and the AMA RUT Expert M test registered in Russia (AMA LLC, Russia) with the data obtained by histological and PCR analyses. High correlation of semi-quantitative indices of urease activity according to the results of both tests as well as correlation of these indices with the data obtained by histological examination and PCR analysis was established.

Relevance. The influence of the gut microbiota on the development of various diseases is of great interest to researchers. The conducted studies showed that in patients with chronic liver diseases, the dominant taxa of the gut microbiota were Bifidobacterium longum, Bifidobacterium adolescentis, Blautia massiliensis, and in healthy children - Neisseria flavescens. There is no comparative analysis of data on the taxonomic diversity of the intestinal microbiota in autoimmune and non-autoimmune liver diseases in children. Purpose of the study. To investigate differences in the taxonomic diversity of fecal microbiota in patients with autoimmune and non-autoimmune liver diseases, as well as to evaluate potential biomarkers of 16S rRNA gene amplicons in these diseases by comparing the taxonomic composition. Scope and methods of research. A metagenomic analysis of the intestinal microbiota of 24 children with chronic liver diseases (mean age 10.3±4.7 years) was carried out with the identification of the V3-V4 region of the 16S rRNA gene. The group included 18 children with autoimmune liver diseases and 6 children with non-autoimmune liver diseases. Research results. The conducted study revealed 684 types of microorganisms in the studied samples of patients’ faeces. The analysis of the conducted studies showed that no dominant taxa were found in the faecal samples of children with autoimmune liver diseases, while Veillonella dispar, Veillonella parvula, Cloacibacillus porcorum, Prevotella histicola and Bacteroides eggerthii were the dominant taxa in patients with non-autoimmune liver diseases. Conclusion. Studies have shown differences in the composition of the gut microbiota in children with autoimmune and non-autoimmune liver diseases.

Aim. To characterize the small intestine microbiome in adolescent girls with obesity according to gas chromatography-mass spectrometry of microbial markers (CMSMM). Material and Methods. The research involved 72 adolescents (girls) 12-17 years old, half of the children (group 1) were obese, the other half (group 2) were not obese, as well as did not have any chronic diseases. Microbial markers in blood samples were examined by the CMSMM method. In order to examine correlation between the small intestine microbiota and obesity, a logistic model was formed. ROC analysis was used to determine possible effects of microorganisms on obesity. Results. There were found significant differences in the small intestine microbiome of obese girls, and alike microbiocenosis of children with normal body weight. Obese adolescent girls had higher levels of Nocardia asteroides 504.14[296; 1015] cells/g×10⁵ and Candida spp 241.85[198.09;629.97] cells/g×10⁵. Microorganisms of the opportunistic flora such as Actinobacteria, Firmicutes, Proteobacteria and microscopic fungi, as well as herpesviruses were significantly deficient. Conclusions. Nocardia asteroides and Candida spp. are associated with obesity. The risk of obesity in adolescent girls increases with a growing number of above-mentioned microorganisms.

Aims. Development of optimal schemes of antihelicobacter therapy in children with chronic Hp-associated gastroduodenitis. Materials and methods. 16 600 children aged 3 to 18 years with chronic Hp-associated gastroduodenitis were examined and treated. To verify the diagnosis, endoscopic examination of the stomach and duodenum was used with sampling and further examination of biopsy material from the mucous wall of the stomach and duodenum by histological methods of staining sections with hematoxylin-eosin, impregnation with silver nitrate according to Warting-Starry, Kupriyanov, Campos (6 200 patients). A de-nol test was used to detect Hp in biopsies in 6 320 sick children, a respiratory test for Hp in 7 100 children with chronic gastroduodenitis. Results and conclusion. The optimal scheme of antihelicobacter therapy in children with chronic gastroduodenitis is currently the following combination of drugs: bismuth tricalium dicitrate + nifuratel + amoxicillin or macrolide. The high efficiency of the use of immunocorrecting drugs in the treatment of this pathology has been shown.

Purpose of the study. To conduct a comprehensive assessment of nutritional status and diagnosis of protein-energy deficiency in patients with cerebral palsy. Materials and methods. The nutritional status was studied in 214 children with cerebral palsy and 40 healthy children, the average age of the subjects was 6.7±0.27 years. The diagnosis of protein-energy deficiency in the subjects was based on clinical, anthropometric and laboratory parameters according to the Bilbreri-Kochen method, including subjective global assessment, shoulder muscle circumference, body mass index, skin-fat fold thickness over the triceps, absolute lymphocyte number and serum transferrin. Results. 81.8% of children with cerebral palsy have signs of protein-energy deficiency of varying severity. The highest incidence of mild protein-energy malnutrition (PEM) was observed in forms G 80.1 and G 80.2-64.1% and 62.5%, respectively. The average degree of PEM was observed at form G 80.0 in more than half of children (58.1%), the lowest percentage of occurrence was recorded at G 80.1-10.3% (P<0.001). Severe PEM was diagnosed in cerebral palsy with severe motor deficiency, accounting for 30.2% of cases in children with form G 80.0 and 14.3% of observations with G 80.8, slightly less often with Forms G 80.3 - in 3.2% and with G 80.4 - in 3.8% of cases (P<0.001), which is determined not only by the most significant limitation of the level of physical activity in these forms of cerebral palsy, but also by the most pronounced disorders of oral-motor function in this category of patients.

Purpose of the study. To reveal the features of the nutritional status of patients with cerebral palsy in various forms of the disease, depending on the violations of the oral-motor function. Materials and methods. We examined 214 children with various forms of cerebral palsy, subdivided according to ICD-10 into 6 topographic forms. The average age of children was 6.7±0.27 years. All patients underwent a comprehensive clinical and neurological monitoring, including clinical observation during hospitalization with an assessment of the influence of the neurological status of a patient with cerebral palsy on the severity of changes in nutritional status. The Eating and Drinking Ability Classification System (EDACS) is applied to assess the functional skills and abilities to take fluids and food in daily life; The Drooling Impact Scale (DIS) was used to assess the severity of sialorrhea. Results. The study of oral function showed that 36.9% of children with cerebral palsy had a sensory type of impairment, and 29.9% had a motor type. An analysis of the nutritional history revealed significant differences in the frequency of malnutrition (chewing, swallowing, sucking, introducing complementary foods, etc.) between the examined children with cerebral palsy, depending on the form of the disease, with a predominance of severe disorders in the G 80.0 form in 65.1% of children. The highest percentage of occurrence of oral-motor dysfunction was noted at G 80.3 (80.1%), while the lowest - at G 80.2 (13.1%). A pronounced degree of salivation was significantly more often noted in the forms G 80.0 (38.4±3.8 points; P <0.01), G 80.3 (37.9±3.4 points; P<0.01) and with G 80.8 (28.7±3.2 points; P<0.01) in relation to other forms of cerebral palsy. In general, 72% of children with cerebral palsy over the age of 3 years had some degree of disturbance in the intake of food and liquids in accordance with the EDACS scale.

One of the manifestations of COVID-19 are complaints from the gastrointestinal tract, the frequency of which ranges from 3% to 80% of patients. The article presents up-to-date data on the pathogenesis of irritable bowel syndrome and features of the clinical picture of this disorder in patients who have undergone COVID-19. The influence of SARS-Cov-2 on the main pathogenetic links of irritable bowel syndrome is indicated. The problem of gastrointestinal tract damage in COVID-19 has not been fully studied and remains no less relevant for the occurrence of pathological processes in the respiratory tract.

Objective: to study the age characteristics of pathogens of infectious diarrhea in children and evaluate the possibilities of laboratory diagnosis of intestinal infections in the Tashkent city. Material and methods. The study included 360 children aged 6 months to 18 years, hospitalized in Tashkent with a diagnosis of “Acute diarrhea”. Diagnosis of intestinal infection was carried out by bacteriological, immunochromatographic and PCR methods using RIDA®QUICK tests (R - BIOPHARM AG, Germany) and kits from Inter Lab Service “AmpliSens® OKI screen-FL”. Results. Analysis showed that the majority (56.7%) of children with diarrhea belonged to the age group of 3-7 and 7-14 years. In the etiological structure of diarrhea, the main share was occupied by viral and bacterial agents (30% and 45.8%, respectively). In 3.6% of cases parasitic diarrhea was observed and in 20.6% of patients the etiology of diarrhea remained unclear. A comparative evaluation of laboratory methods demonstrated the high efficiency of immunochromatographic and PCR methods compared with bacteriological examination in terms of early diagnosis of the etiological agent of diarrhea and the identification of viral pathogens. Conclusions. In children in the younger age group, diarrhea of viral etiology is more often observed, in contrast to older age groups, where bacterial ones are more common. Immunochromatographic and PCR methods enable earlier diagnosis of the causative agent of diarrhea and, consequently, the start of etiotropic treatment.

The development of laparoscopic surgery, based on technological progress, and the accumulation of clinical experience makes it possible to reduce operating access, reducе the postoperative complications. Material and methods. SILS cholecystectomy were performed in 27 patients with overweight and obesity. All operations were done as planned for chronic calculousis cholecystitis. Results and discussion. We used assistive technologies for organ traction (Patent N 103722 Russian Federation) in the event of a “conflict” of instruments, which made it possible to reduce the intervention time. The mean intervention time was 55.5±6.9 minutes. In 10 patients with risk factors for the formation of trocar hernias (obesity, advanced age, functional insufficiency of the connective tissue), the access area was preventively strengthened by an implant placed over the aponeurosis. All patients were discharged in a satisfactory condition 3-4 days after surgery. Subsequently, during observation and re-examinations up to 7 years after surgery, patients did not complain about surgical intervention, felt well, and not a single case of postoperative ventral hernia was recorded. Conclusion. The advantages of cholecystectomy in overweight and obese patients using the SILS technique are obvious, associated with a reduction in the invasiveness of the operation, an excellent cosmetic result, and the achievement of a fundamentally different quality of life for patients.

Currently, the evaluation of the effectiveness of surgical treatment for malformations of the colon, in particular, Hirschsprung’s disease, is becoming increasingly important. According to various authors, in approximately 25-30% of patients, despite a technically flawless operation, residual functional disorders are detected, mainly episodic constipation and fecal incontinence. In this regard, the task of objectifying the essence and nature of functional deviations and the development of restorative therapeutic measures arises. The aim of this work: The purpose of this work is to evaluate the effectiveness of the developed methods of rehabilitation of Hirschsprung’s disease in children. Materials and methods. In the period from 2007 to 2022, 54 patients with Hirschsprung’s disease were operated on using the Sauve-Lyonyushkin technique. Depending on the amount of rehabilitation treatment, patients were divided into two groups. Group 1 consisted of 19 patients operated on from 2007 to 2015, group 2 included 35 children operated on from 2016 to 2022.

The aim of this work: to evaluate the eff ectiveness of the developed methods of perioperative treatment of Hirschsprung’s disease in children. Materials and methods. The study was conducted on the basis of the 2nd SamMI clinic in the period from 2002 to 2022. The obtained data were compared by correlation analysis with clinical and laboratory indices and with changes in solar activity by Wolf’s numbers of the period of child embryogenesis, data of Murmansk Department of HMP). Results. The results of the study of the activity of redox enzymes have established the following. When comparing the enzyme spectrum of the affected intestine and intact muscle, only a difference in the activity of SDH and LDH is revealed. Taking into account the activity of all enzymes in relation to the activity of SDH, it can be noted that alternative energy sources have a greater specific weight in the intestinal mucosa than in the muscle.

The aim of the research: to study the structure and epidemiological features of chronic diarrhea in children in different age periods. Materials and methods: data on outpatient cases of children and inpatient care with diseases that are clinically manifested by chronic diarrhea syndrome were analyzed. A survey of 1509 children of different ages was also conducted at an outpatient appointment with a pediatrician on the day of a healthy child, in preschool and educational institutions in the city of Samara. Results of the study: as a result of the study, it was revealed that in the structure of gastroenterological pathology in children, diseases manifested by chronic diarrhea account for 1.8%, while at the outpatient stage, unspecified diseases are more common. Among the children surveyed, it was found that clinical manifestations of chronic diarrhea were observed in 53.4% of cases at the time of the survey, while among these children, only 8% had a gastroenterological diagnosis that explained chronic diarrhea. Slightly less than half of the children surveyed had the so-called causal nature of chronic diarrhea. Conclusion: The relevance of the problem of chronic diarrhea in childhood is confirmed by the data of its high prevalence. It has been shown that insufficient attention is paid to the problem of chronic diarrhea - the registered prevalence is at least 5 times lower than the real one. Particular attention should be paid to children with cause-related diarrhea, and restriction of the use of cause-significant products stops clinical manifestations and leads to a decrease in seeking medical help.

Objective. To study the influence of antibiotic-associated disorders of gut microbiota on cognitive functions using an experimental biological model. Materials and methods. An experimental study was carried out using a biological model (Wistar rats, 80 animals, males of the same age). During the experiment, dysbiosis caused by the antibacterial drugs amoxicillin (Chemopharm, Serbia) and metronidazole (OOO "Ozon", Russia), injected into animals per os in subtherapeutic (1:100 of therapeutic doses) and therapeutic doses were simulated. The course of antibacterial therapy was 3 days. Microbiological examination of the biomaterial was carried out using traditional microbiological methods before and after the injection of antibacterial drugs. To assess the intensity of dysbiotic changes we used Colonization Resistance Index by Ploskireva A. A. (CRI). Neurobehavioral reactions were assessed using automated cameras (Columbus Instruments, USA) with activity analyzers (Opto-Varimex-5 Auto-Track, USA) of motor and research components, followed by automated software post-processing. Cognitive functions of the animals were examined before injection of antibacterial drugs and after the finished course. Statistical analysis of the data was performed using standard methods of descriptive statistics using "Microsoft Office Excel 2010" program. Statistical significance of the differences in the compared indices was assessed using Student's t-test at a significance level of p < 0.05 (t> 2). Results. Injection of antibiotics in animals decreased CRI at both subtherapeutic and therapeutic doses of drugs, indicating the development of microbiota disorders. When subtherapeutic doses of antibiotics were injected there was a decrease in the CRI from 0,48 (value before drug administration) to -1,86 (p<0,01) on the 3rd day after administration of the drug, which was associated with a decrease in the rodents' tentative-exploration activity from 34 (baseline value) to 11 (p<0,01). In the group of animals that received therapeutic doses of antibiotics, the CRI decreased from 0.37 to -2.34 (p<0.01) on the 3rd day of the experiment, which was also associated with a 2-fold decrease in the level of orientational research activity of rodents as compared with the background values, from 34 to 15 (p<0.01). Similar patterns were obtained about the relationship between the CRI and the motor activity of the animals on the parameter of the distance traveled. The action of subtherapeutic doses of antibiotics contributed to a decrease in the CRI, against which there was a 3-fold decrease in motor activity on the parameter of the distance traveled, from 1352 to 457 (p<0,01) on the 4th day of the experiment. Injection of therapeutic doses of antibiotics was associated with a decrease in motor activity on the parameter of the pathway from 930 to 563 (p<0.01) in the period immediately after antibiotic therapy. The changes in short-term memory in the rats were not detected. Conclusion. The effect of antibiotic-associated disorders of gut microbiota on cognitive functions of experimental animals was demonstrated objectively on the example of an experimental biological model. The severity of cognitive function decrease was in correlation with the degree of antibiotic-associated disorders of microbiota and depended on the dose of antibacterial drugs.

Relevance: Crystalloscopy - a method for diagnosing biological fluids (BF) allows you to evaluate the physical properties of BF crystals after dehydration, as well as indirectly determine the state of the BF proteome. Crystallography helps to identify pathological processes (inflammation, oncogenesis, trauma) in the body and further monitor the effectiveness of treatment. A defect in the HAD enzyme leads to a sharp decrease in ketogenesis, the accumulation of long-chain fatty acids, an increase in the formation of dicarboxylic acids that negatively affect the tissues of the brain, heart and liver, and inhibition of a number of enzymes (in particular, gluconeogenesis enzymes). Objective: to conduct a comparative analysis of the results of crystalloscopic examination of biological fluids in normal and metabolic pathology. Materials. Materials and methods: Crystalloscopic examination of saliva of 20 people and urine of 7 examined children without a verified diagnosis associated with metabolic pathology and a child with an established pathology of enzyme systems with liver damage. For a detailed analysis of the results of the study, the case history of child B., 10 months old, hospitalized at the Institute of Pediatrics of the University Clinic of the Volga Research Medical University in 2022, was considered. Discussion: The crystallogenic activity of the biological fluids of a patient with congenital liver enzymopathy is significantly transformed. In dried micropreparations of urine, a moderate increase in the crystal-forming ability of the biomedium was recorded, as indicated by an increase in the level of crystallization and structural index. A sharp increase in the degree of destruction of crystalline structures in the facies testified to the pathological nature of the changes. Also, pronounced shifts in the crystallogenic properties were revealed in the crystallograms of the patient’s blood serum according to the activation of dehydration structurization of the blood serum, as indicated by an increase in crystallization and structure index. Similar to urine samples, a sharp increase in the degree of facies destruction was recorded in this biological fluid compared to samples from healthy children. Conclusions: The method of crystalloscopic examination of biological fluids has the potential in the diagnosis of congenital and acquired persistent metabolic disorders due to the information content and simplicity and cost-effective study within the framework of medical examination.

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.

Introduction. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children [1]. The etiology of the disease is currently unknown, but there are many works on the role of the intestinal microbiota in JIA and its interaction with antirheumatic drugs (methotrexate). There are a number of data on the effect of methotrexate on the intestinal microbiota. The article provides a review of the literature on the involvement of the intestinal microbiota in the induction of autoinflammation and the possible antagonism between the intestinal microbiota and methotrexate.

One of the urgent problems of the world community is to overcome the double burden of malnutrition, which leads to obesity and malnutrition in children and adolescents. Most publications are devoted to the assessment of malnutrition in young children and patients with severe chronic diseases. However, data on the frequency of malnutrition in the Russian child population are presented fragmentarily. The aim of the study is to assess the prevalence of underweight in children and adolescents in Russia using a meta-analysis of published research data. Material and methods. 53 publications of a survey of 94,558 children and adolescents aged 1 to 18 years in Russia and neighboring countries were analyzed according to WHO criteria (“Child Growth Standards”, 2006 and “WHO Growth Reference 2007”). Statistical processing was carried out using MS Excel and MedCalc software packages. The proportions of the feature and their 95% confidence interval were calculated; for groups - odds ratio; the results are statistically significant at p<0.05. Results. Underweight was registered in 12.5% of study participants: girls are underweight more often (12.8%) than boys (10.7%; p=0.0000). Significant underweight, tested as malnutrition, was detected in 3.8% of cases; with a higher frequency in girls (4.6%) compared to boys (4.0%; p=0.0002). The prevalence of underweight varies from 3% to 29%; malnutrition - from 0.6% to 12.5% in groups of children that differ in age, gender and living conditions. Conclusion. A significant proportion of children and adolescents are malnourished, causing underweight. Significant variability in the detection of malnutrition can reveal both the specifics of the formation and representativeness of the sample, and the detection of trouble in the conditions of observation.

The problems of nutrition of children and adolescents are currently of the greatest interest to domestic and foreign researchers. Currently, the issues of early formation of proper eating habits, taste perception and the impact of nutrition on the health of children of different ages are being actively studied. Various foreign and domestic studies of the nutrition structure and nutritional status of children and adolescents point to significant shortcomings in the organization of children’s nutrition, it is worth noting that these factors influence the formation of the health of children and adolescents of various age groups. The purpose of the review is to study the features of eating behavior, in particular, the issues of snacking and catering for children of different ages.

Constipation is one of the most frequent nosologies encountered during outpatient consultations with a pediatric gastroenterologist. This article discusses the diagnosis and treatment of chronic constipation (CC) in children on the basis of both international and Russian clinical guidelines. About 70% of children in the world suffer from CC, most of them have functional nature. In 30-52% of children, symptoms persist for the next 5 years, and about 25% of patients continue to suffer from constipation as adults. Children with CC often see a pediatrician and gastroenterologist, are treated as inpatients, or are hospitalized on an emergency basis. Consequently, chronic constipation represents a significant economic problem for the health care system. Constipation in children needs timely diagnosis and comprehensive treatment.

A description of the clinical observation of a 9-year-old child with foreign bodies of the stomach (2 magnetic balls) and their introduction into the mucous membrane is presented. Timely endoscopic and X-ray examinations contributed to the establishment of the exact localization of foreign objects, and videoesophagogastroscopy using a magnetic extractor made it possible to extract magnets from the mucous membrane with minimal damage to the stomach tissues and prevent the development of complications in this patient.

In many countries fix cases of severe liver damage in children are recorded. A previous or existing coronavirus infection leads to a disruption in the body’s immune response to infections, which can lead to severe inflammation that caused liver damage. This article describes a clinical case of type 2 autoimmune hepatitis, a high degree of biochemical activity, that debuted in an 11-month-old child after a new coronavirus infection (COVID-19). The presented clinical example demonstrates the need for a thorough and comprehensive examination of children with the first clinical manifestations of liver damage and timely prescription of therapy

Obesity in children is often accompanied by organic and functional changes on the part of the organs of the hepatobiliary system and pancreas. The article describes a clinical case of complicated course of gastrointestinal tract and pancreatic steatosis on the background of morbid obesity in a 15-year-old child with the development of choledocholithiasis, in turn, complicated by acute pancreatitis, pancreonecrosis, peritonitis and perforation of the colon. The tactics of child management, a set of diagnostic methods of examination, methods of surgical treatment are described. The necessity of early detection of both obesity itself and timely screening of its complications and comorbid pathology to prevent potentially life-threatening conditions is shown. Ultrasound of the abdominal cavity and biochemical blood analysis are mandatory for obese children. In cases of unclear genesis of jaundice, MRI is recommended to exclude obturation and abnormalities of the biliary tract. The choice of surgical tactics for the treatment of children with GI, acute pancreatitis is determined by the combination of complications, the condition of the child and the results of laboratory-radiation research methods.

The article discusses a clinical case of a combination of achalasia of the cardia complicated by candidal esophagitis, which led to severe dysphagia and a significant decrease in body weight of a patient suffering from hereditary motor and sensory neuropathy - Charcot-Marie-Tooth disease (CMT) type 4 E. The authors highlight the pathogenesis and clinical picture diseases, features of the course of achalasia in a patient with a hereditary neurological disease. In this clinical case, an example of a disease in a 12-year-old girl is considered. A feature of this patient was progressive dysphagia, which ultimately led to the almost complete impossibility of normal food intake and the development of nutritional insufficiency. CMT disease is a heterogeneous group of hereditary disorders affecting the peripheral nervous system, as a result of the progression of the disease, motor and sensory dysfunction develops, such patients are under the supervision of neurologists. The presence of atypical symptoms, including not only progressive muscle weakness and exhaustion, with sensory deficits in the distal parts of the limbs, but also the severity of dysphagia, which from episodic becomes permanent, prevents the passage of not only solid food, but also liquid through the esophagus, the occurrence of esophageal vomiting - should serve as the basis for a complete examination of the patient using methods that allow visualization of the esophagus. In the available domestic literature, no description of the combined course of the pathological conditions indicated in the observation was found; isolated cases are given in the foreign literature, so the description of this clinical observation is relevant for raising awareness and early diagnosis of gastrointestinal smooth muscle dysfunction against the background of polyneuropathy.