Considers the problem of rare diseases and syndromes in children c diseases and syndromes of the esophagus, stomach and duodenum. Emphasizes the difficulty of diagnosis and the complexity of the clinical interpretation of rare diseases and syndromes of the upper digestive tract in children, isolation of these diseases from the most common diseases of the upper digestive tract, the need to work together with other professionals: children's surgeons, morphologists, geneticists, specialists on methods of medical introscopy etc. Indicated on the scientifically-practical importance of rare diseases and syndromes of the upper digestive tract contributing to new searches etiology pathogenesis, diagnosis, clinical manifestations and treatment of these diseases.

The aim was to investigate the role of autonomic disorders and abdominal postprandial hemodynamics in the development of malnutrition syndrome in young adults. Materials and methods: There were examined 121 young adults (mean age 22,28 ± 3.7 years), 60 men and 61 women. The control group - 43 young adults without malnutrition, matched for gender and age. Individuals with acute or chronic diseases, associated with malnutrition; operations on the digestive system in history; taking drugs affecting the circulation were excluded. Nutritional status, vegetative nervous system and abdominal blood flow in the common hepatic artery, splenic artery, superior mesenteric artery, the portal vein 30 minutes after food samples, standardized by fats, proteins and carbohydrates were studied. Results: The predominance of the sympathetic nervous system activity and the lower volume rate of blood flow in all studied vessels (by Doppler ultrasonography) in the postprandial period have been registered in patients with malnutrition. Changes of the abdominal hemodynamics have been correlated with indicators of autonomic dysfunction.

The purpose was to study the state of the hepatobiliary system in children with metabolic syndrome (MS). Materials and methods. Surveyed 286 children 10-16 years: the main group of 236 children with MS (IDF, 2007), a comparison group of 50 children with normal body weight with diseases of the hepatobiliary system. Performed complex included biochemical examination, ultrasound examination of hepatobiliary system, a CT scan. Statistical processing of results was performed using the package “STATISTIKA 6.0”. The results of the study. Non-alcoholic fatty liver disease (NAFLD) was diagnosed in 70,0% of children of the main group. The mean values of ALT, bilirubin, γ-GTP in children of the main group were significantly higher than in the comparison group, increased ALT was observed in 27,4% of children in the main group. Cholesterosis of gallbladder was detected in 29,9% of children in the main group and 12,0% of children in the comparison group (p < 0,05). Violation of lithogenic properties of bile was observed in 36,7% of children in the main group. The comparison group of children with cholelithiasis was 36,0%. In children of the main group were detected more frequently biliary sludge (BS) (93,1%), in comparison group - stones (77,7%). Waist circumference in children with BS constituited 108,8 ± 12,25 cm, in children with stones - 94,5 ± 6,35 cm, in children without BS and stones - 100,75 ± 11,88 cm. In children with steatosis and different stages of cholelithiasis and cholesterosis of gallbladder were recorded significantly frequently than without it. Conclusions. NAFLD was diagnosed in 70,0% of children with MS, structural changes of the liver parenchyma characterized by the development of diffuse-source process with simultaneous presence of various-sized parcels changed according to the type of steatosis and steatohepatitis. 27% of children wish MS have increased ALT and high risk of developing steatohepatitis. In children with MS are formed by expressed human functional state of the biliary tract - 37% of patients was recorded cholelithiasis and 30% - cholesterosis.

The materials and methods. In total, the study included 41 children with atopic dermatitis in the average age of 10.95 ± 0,51 years (5-16 years), 20 boys and 21 girl, with a SCORAD index above 45, i. e., a severe disease. Patients the study was conducted in the electrical activity of the digestive system using the peripheral electrogastroenterography method (PAGEG), as well as the study of the content of short chain fatty acids (SHQ) to the chair by means of high performance liquid chromatography. The results of the study. In children with AD was observed discomfort in the abdomen (from 92.7% of children), also in more than half cases was observed (in descending order) rumbling in the abdomen, abdominal pain, flatulence, nausea. It was found a significant increase of the average values of the coefficient of rhythm and a tendency to increase the relative strength of the duodenum). In the colon on an empty stomach these parameters were generally reduced, which points to geometric. SHQ spectrum disorders, reflecting the metabolic activity of the intestinal microflora, was characterized by the increase in almost all children’s products by the microorganisms of the intestine acetic, propionic, butyric, valeric acid, and isovaleric acid, while significant increase in the level of isoacid production.

Type 1 diabetes mellitus (DM1) and an autoimmune gastritis often occur together. Gastric autoimmunity is evident in 20% of adult patients with DM1. We screened DM1 children in Russian Federation for autoimmune gastritis. The initial cohort included 108 children with DM1 (61 female/47 male, mean age 13 ± 1,9 years) and 31 non-diabetic controls with chronic gastritis. We assessed parietal cell antibodies (APCA) presence, as well as gastric morphology. In addition, gastrin-17 and pepsinogen basal levels were measured in 42 patients with DM1 and in 31 controls. We observed APCA in 10,1% of DM1 children (7 female/4 male). All of them had DM1 for more than 10 years. A morphologic picture of autoimmune gastropathy was found in all APCA positive patients. One (out of 11) patient with APCA had a gastric colonization by Helicobacter pylori. Hypergastrinemia was diagnosed in all DM1 patients with autoimmune gastritis. Screening for gastric autoimmunity is particularly advised in children with type 1 diabetes mellitus.

The article describes a study of cytokines IL-1β, IL-6, IL-8, TNF-α, IFN-γ, IL-10 in serum blood of children with connective tissue dysplasia and chronic gastritis. The concentration of IFN-γ, TNFα in children with connective tissue dysplasia with chronic gastritis was decreased.

Objective. Establish positive predictors of virologic response to interferon in children with chronic hepatitis C on the basis of a comprehensive evaluation of clinical and diagnostic procedures to justify the selection of individualized therapy. Study participants. 148 children of 3-17 years of age (mean age - 9.2 ± 0.3 years) with chronic hepatitis C: 97 (65.5%) of them had HCV 1 genotype, 51 (34.5%) - HCV 2-3 genotype. We measured anthropometric parameters (weight, height), determined viral load level in blood serum PCR and analyzed lymphocytic immunophenotype parameters, serum interferon induced synthesis of alpha and gamma interferon of all children before the interferon therapy course and over time (4, 12, 24 and 48 weeks after the therapy initiation). Results. Efficiency of treatment with recombinant interferon alfa-2a (rIFN-2a) and recombinant interleukin-2 (rIL-2) is increased when included in the treatment regimen rIL-2, the percentage of a primary virological remission (PVR) increased by 2 times. In the treatment of pegylated interferon alfa-2b and ribavirin positive predictors of virologic response is the child’s age of >6 years, weight >23 kg, height >115 cm, serum interferon 16-22 U/ml and the level of the absolute number of neutrophils 2000-3400/mkl, levels in the absolute number of blood lymphocytes 2500/mkl or more at the start of therapy. In the treatment of rIFN-2a and rIL-2 levels are predictive of the absolute number of lymphocytes 2500/mkl or more, and lymphocyte CD16+56+ 540/mkl or more at the start of treatment. Given the identified positive predictors of virologic response algorithm selecting individualized therapy for children with CHC. Conclusions. Individualized treatment decisions for children with chronic hepatitis C, taking into account the identified positive predictors of virologic response can increase the effectiveness of treatment to 83.0%.

The article «Drug-induced liver injury in children with tuberculosis» describes data on the prevalence of drug-induced liver injury during TB therapy in children, recommendations for the diagnosis and the results of a randomized controlled trial of efficacy therapy with ursodeoxycholic acid of the drug-induced liver injury in children.

In the article on the basis of the conducted own studies changes in lipid and carbohydrate metabolism in children with gallstone disease (GSD), characteristic for metabolic syndrome (MS) have shown. The obtained data suggest that the pathogenesis of the development of metabolic syndrome in children as in adults, is hyperglycemia and insulin resistance.

Objective: to identify the features of stay magnetic foreign bodies (MFB) in the gastrointestinal tract in children, to determine the diagnostic and therapeutic measures. Materials and methods: we studied 14 cases of ingestion MFB. Results: the presented clinical examples revealed variability of stay MFB in the digestive tract, presents options for surgical removal of magnetic objects. The presence of multiple MFB led to the development of severe complications. Conclusion: the developed tactics of conducting patients with the presence of magnetic foreign bodies in various parts of the gastrointestinal tract. X-ray examination of the abdominal cavity in children is required for the diagnosis of foreign MFB and for intraoperative exclusion of the remaining magnetic objects in the digestive tract.

The article presents the results of an experimental study of pathogenetic therapy of acute intestinal infections on the example of the biological model. Gelatin Tanat and dioctahedral smectite have a protective effect on the mucosa of the colon with a viral intestinal infection. This is manifested by a reduction in the severity of acute enteritis. The results of the experiment convincingly demonstrated the benefits of early appointment cytoprotective medicine and sorbents in the treatment of acute intestinal infections.

Functional diseases (FD) of the gastrointestinal tract in children - a combination of gastrointestinal symptoms, the presence of which can not be explained by structural or biochemical abnormalities. Emphasis FD 2 categories for young children and for children and adolescents. The most common reason for seeking medical attention is abdominal pain, and children above all, necessary to exclude reason, requiring surgery. The most commonly in children and adolescents pain can be a manifestation of irritable bowel syndrome, dyspepsia, abdominal migraine, functional abdominal pain syndrome and functional abdominal pain. Also the subject of pain treatment can be constipation in children. In treatment in children and adolescents most convincingly proven antispasmodics and antidepressants, non-pharmacological methods.

There is the review of the literature about the pathogenesis, risk factors and clinical picture of hypomotor biliary dysfunction and cholelithiasis in obesity in children.

The aim of the present study is to investigate clinical variations and prognosis of gastroesophageal reflux disease (GERD) in children. 98 children 12-16 years of age were examined. All children underwent esophagogastroduodenoscopy and 24-hour pH-monitoring. A follow-up study was performed during 1 to 5 years. Results: classification of GERD in children has been added, divided into classic, dysplastic, transitory and stressor variations. The data of binary logistic regression revealed factors of poor prognosis: erosive esophagitis, alkaline reflux, insufficient autonomic response, dysplasia of connective tissue. Extended classification gives an opportunity for individual patient maintaining.

The article presents a review of the literature on the state of microbiotics of upper parts of gastrointestinal tract and its connection with metabolic diseases. Shows the relevance of studying the qualitative and quantitative composition of microbiota of the digestive tract and its role in the pathogenesis of hormonal and metabolic disorders.

The article focuses on the effectiveness and safety of using multicultural probiotics for correction of intestinal microbiocenosis in children. The study included 90 children aged 4 to 12 years. Shown the benefits and safety of using a new multicultural probiotic in the treatment of functional dyspepsia (constipation, diarrhea) and atopic dermatitis in children on the basis of the analysis of the results of their clinical trials in this area are Quantitative indicators from both indigenous and conditionally pathogenic microflora of the intestine was restored in 80% of examined children. In children with atopic dermatitis showed a significant positive dynamics of symptoms, more than half of the children for 2-3 days disappeared irritability, anxiety, abdominal pain, normal stool and simultaneously disappear: rash, skin peeling, itching of the skin. The number of children with reduced appetite decreased by 5 times as more, abdominal pain by 3 time as more, flatulence by twice as more in children. In the placebo group effect on these parameters was 1.2 : 1 : 1,1.

In the article is represented the observation of the case of the aberrant pancreas in the 5 year old child with the complaints of the paroxysmal abdominal pains and the dyspeptic manifestations in the form of liquid chair, vomitings with the use of separate products. It’s represented detailed clinical laboratory, instrument and the morphological dynamics of the clinical picture of disease, the stages of diagnostic search.

Primary sclerosing cholangitis - autoimmune chronic cholestatic liver disease characterized by progressive course of latent and may proceed for many years. Naturally, the earlier the disease is detected, the longer lifespan. The article presents the clinical observation of a long asymptomatic autoimmune disease of the liver that is manifest only 6 months prior to an adverse outcome, but at the time of the manifestation of the child has already formed cirrhosis.

In the last decade Clostridium difficile infection (CDI) has become a major cause of antibiotic-associated inflammatory lesions of the colon. Against the backdrop of the widespread increase in the frequency allocation of highly virulent strains C. difficile growing number of hard-to-therapy forms with recurrent infections. Standards of the treatment of recurrent CDI in children have not been developed. At the same time questions the effectiveness of primary and secondary prevention of CDI in recent years acute in the daily practice of pediatricians. The paper presents a clinical case of recurrent course of antibiotic-associated intestinal lesions caused by infection with C. difficile, a child of 13 years. Analysis of the case has highlighted the problems of diagnosis and treatment of recurrent CDI, the solution of which may include the following measures. When questionable results of screening to identify C. difficile toxins A and B in the feces of patients with diarrhea syndrome by enzyme immunoassay is necessary to continue studies reliable methods (isolation of toxigenic culture), that is to use multi-stage algorithms for diagnosis, as suggested by the existing recommendations. Treatment of the first episode of non-severe forms of the CDI with Metronidazole does not provide proof of clinical effect, which should be considered in practice. The results of continuous monitoring of the level of regional peculiarities C. difficile resistance to Metronidazole can help in selecting initial therapy CDI. The first CDI recurrence is more severe than the first episode, and accompanied and supported expressed by intestinal dysbiosis, demanding compensation active. The use of Vancomycin long course with a gradual reduction of the dose for the treatment of recurrent CDI does not guarantee the development of subsequent relapse, indicating that long-term maintenance of inflammatory changes in the intestinal mucosa, reduction of non-specific resistance of the organism against the backdrop of recurrent CDI and urges the need to find and use effective means of local anti-inflammatory therapy.