The relevance of milk-feeding of babies, the importance of not only the composition and properties of breast milk, but also the technology of enzymatic degradation of its nutrients are cosidered In the Assembly speech. First, it is produced according to the type of its own digestion by hydrolases of the digestive glands and the small intestine of the infant, the complex of which is formed antenatally and called the starting multienzyme digestive potential in the newborn child. Its quantitative characterization is possible by determining the main digestive hydrolases in the amniotic fluid, in the blood of the umbilical cord and in the gastric aspirate of the infant. The expression of this potential in the point system is proposed. With incomplete gestation, the digestive potential is reduced. Secondly, hydrolysis of breast milk nutrients is carried out by its own hydrolases in the autolytic type of digestion. The dynamics of secretion of hydrolases by the mammary glands of healthy women during one year of lactation was studied. The quantitative dependence of the hydrolase secretion on its value in the first lactation month is described with a general tendency to a decrease in the hydrolase content in milk with an increase in the monthly lactation period, and the dependence of the secretion of enzymes by the mammary glands from the age of the pregnant women. The dynamic convergence of the multienzyme digestive potentials of the child's digestion system and the mother's milk it takes is relevant in lactotrophy. Based on the results of peptidic analysis of auto-and inragastral proteolysis of breast milk, milk hydrolases are not only considered as trophotropic participants in the degradation of its nutrients, but also in formation of by milk proteases functionally multipotent regulatory peptides with a characteristic change in their number and content in the dynamics of infant feeding and timing of gestation.

Microbiota plays a key role in the physiology and maintenance of homeostasis of the human body. The importance belongs to the processes of the formation of the intestinal microbiota, starting in utero, and the child continues to receive the mother’s microflora during childbirth and breastfeeding. The results of molecular genetic studies indicate that the most intensive process of microbial colonization in infant is associated with features of feeding. The main factor in maintaining the stability and resistance of normal biota is microbial autometabiolites. Considered the most promising probiotic biotechnology and development metabolic of probiotics (metabiotics) probiotics in combination with Prebiotics (synbiotics). Understanding the processes of formation of intestinal microflora allows you to develop effective methods of prevention and correction micro-ecological and motor disorders in the age aspect.

The aim of the research is to study the influence of different pollution levels on clinical and epidemiologic aspects in erosive ulcerous diseases of gastric mucosa and duodenum in children and teenagers. Materials and methods: the research is carried out in Krasnodar region and it consists of two stages. At first stage 47 territories of Krasnodar region are ecologically assessed, at second stage epidemiologic rate (prevalence and sickness rate) of erosive ulcerous diseases of gastric mucosa and duodenum in children and teenagers in Krasnodar region are studied according to data regarding visits to the health care centers and calls of the special medical crews against the ecological condition of the territory. Results. Ecological state of the territories in Krasnodar region differs as per anthropogenic load intensity. Low levels of pollution are indicative for regions with favorable ecology (15 regions), medium levels - for regions with conditional favorable ecology (17 regions), and high levels of pollution - for regions with unfavorable ecology (15 regions). There is a numeric dependency between number of children and teenagers visiting health care centers and the level of anthropogenic pollution of regions where they live. The number of children visiting health care centers in connection with erosive ulcerous diseases of gastric mucosa and duodenum is 2.3 times higher, of teenagers - 1.5 times higher against number of patients from regions with favorable ecology.

The purpose of the study was to reveal the frequency and characteristics of the course of the cholelithiasis on the basis of studying the histories of children hospitalized in the Department of Gastroenterology of the State Children’s Hospital No. 9 named after GN Speransky in 2016-2017. Materials and methods: 3200 case histories of children were analyzed; in 32 children, cholelithiasis was diagnosed, among them 11 boys and 21 girls aged 1-9 months to 17 years 8 months. Anthropometric data, family history, duration of the disease, presence of abdominalgia, episodes of a sharp decrease in body weight were evaluated. Laboratory and instrumental studies were conducted. Results: cholelithiasis occurs in 10% of children with digestive tract diseases, mostly in girls, about half of patients had normal body weight and heredity of cholelithiasis, and in every fifth child, relatives suffered from excessive body weight. In 28% of cases, cytolysis syndrome (> 10 norms) and cholestasis (> 3 norms) were detected, clinical symptoms of cholelithiasis were noted within 3 months, in half of the children developmental abnormalities and a suspension in the gallbladder cavity were diagnosed. 25% of adolescent girls deliberately reduced body weight. Conclusion: when detecting stones in the gallbladder, it is necessary to determine the indicators of liver and pancreas function, despite the possible absence of complaints of pain in the right hypochondrium.

Relevance. Pancreas refers to the organs, the functional state of which is the most significant factor in the development of hormonal and metabolic disorders. Objective: to study the morphofunctional state of the pancreas in children with obesity and to evaluate its relationship with the main components of the metabolic syndrome (MS). Materials and methods. Surveyed 483 children with obesity from 6 to 16 years. 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 methods of examination was carried out using standard methods; 90 children (60 children from group I and 30 children from group II) underwent an ultrasound examination of the pancreas (RV) with the determination of the postprandial reaction. The results of the study. In 94.9% of children I gr. and 89.8% of children II g. various changes in the structure of the pancreas were revealed: an increase in acoustic density (77.6% and 63.8%, respectively), the presence of hyperechoic inclusions in the parenchyma (86.1% and 82.1%, respectively). The total size of the pancreas on an empty stomach in children in I group exceeded the normative figures and was more than that of II gr. (59.85 ± 6.27 mm and 53.11 ± 7.62 mm, respectively, p <0.05). After food stimulation, this indicator amounted to 65.75 ± 7.41 mm in I gr., and about 59.64 ± 5.40mm (p <0.05) in II gr. Exclusively in I gr. (16.7%) postprandial reaction was absent or was sharply reduced (less than 5%). The level of glucose, insulin, C-peptide and HOMA-IR index was higher than in the compared subgroups, and significantly exceeded the standard indicators in children with a reduced postprandial reaction. Triglyceride levels were also significantly higher, and high-density lipoproteins were lower than in other subgroups. In children with non-alcoholic fatty liver disease, the total size of the pancreas on an empty stomach was larger than in children with a normal organ structure (p <0.001), and the postprandial reaction of the pancreas was significantly lower: 7.5% (6.8-8.5%), respectively and 10.4% (11.8-17.9%) (p <0.01). With an increase in the thyroid gland, the size of the pancreas head on an empty stomach was significantly larger than in children with a normal thyroid volume. A decrease in the postprandial response of less than 5% was observed in 33.3% of children with an enlarged thyroid, and in 16.7% of children with normal thyroid size (p <0.05), the normal response of the pancreas (more than 15%) was determined solely in children with not Thyroid gland (11.9%). Findings. Most obese children (up to 95%), regardless of the presence of MS, revealed structural and functional changes in the pancreas. A significant decrease in the postprandial pancreatic response was recorded in children with MS. Only in children with MS (16.7%), the postprandial pancreatic reaction was absent or was sharply reduced (less than 5%), which should be considered as a clinical sign of impaired adaptive capacity of the pancreas against the background of a latent chronic inflammatory process. The relationship between carbohydrate metabolism and lipid metabolism with the total size and size of the pancreatic head on an empty stomach and after food load has been established. Children with NAFLD have a higher risk of developing CP. A close relationship between the morphofunctional state of the pancreas and thyroids has been established.

The purpose of the study is to assess the level of oxidative stress and impaired blood antioxidant capacity in children and adolescents with metabolic active obesity and other components of the metabolic syndrome. Materials and methods. Surveyed 102 children and adolescents aged 10 to 15 years with obesity. According to the results of clinical and laboratory examinations, groups were identified depending on the presence of metabolic disorders: metabolic active obesity (MAO) and metabolically healthy obesity (MHO). The comparison group consisted of 230 schoolchildren of secondary educational institutions of the city of Arkhangelsk. Results. When comparing groups with MAO, MHO and children without metabolic disorders, it was found that the highest average level of total peroxide (PPS) is observed in the group with MAO, the lowest in the comparison group (<0.001). Among the average indicators of the general antioxidant system (GAS), on the contrary, the lowest value is observed in the group with MAO, the highest - in the comparison group, in children and adolescents with MLO - intermediate values of AOS. The average levels of the studied parameters of proatherogenic metabolic disorders (uric acid (UA), lipid spectrum, glucose, C - reactive protein, blood pressure, HOMA index, insulin) were significantly higher in the group with MAO, except for the average level of high density lipoprotein cholesterol (HDL cholesterol), which is significantly lower. Conclusion. In children and adolescents with MAO, changes in the classic indicators of atherogenic disorders (blood lipid spectrum, blood pressure, insulin resistance, hyperinsulinemia, chronic inflammation) and high levels of oxidative stress are found, along with a decrease in the activity of the antioxidant system, which may have not only pathogenetic significance, but also reveals promising areas for the prevention and treatment of atherogenic disorders.

Introduction: Every year, 50-150 thousand babies are born to mothers with diabetes. Currently, there is no doubt that the condition of newborns born in mothers with diabetes requires special attention because of the increased risk of developing diseases of the respiratory tract, cardiovascular system, brain, kidneys etc. Purpose: Evaluation of various types of diabetes during pregnancy in mothers influence at the physical development of newborn children. Materials and methods: 350 full-term babies from mothers with diabetes mellitus, which was born at the N. E. Bauman Hospital which is specialized in the management of such pregnant women. Assessment of the physical development of children was carried out according to WHO standards (2006) using the WHO Anthro program. Comparative analysis of indicators of children in different groups using Student t-criterion. We used the program Statistica 10. Results: The body mass of 350 examined newborns varied within 1590-4710 g, on average, amounted to 3421.1 ± 543.99 g. There were 67 (19.1%) children who had a body weight less than 3000g and 46 (13.1%) more than 4000 g. Growth values of 350 newborns ranged from 40-57 cm, on average, amounted to 51.21 ± 2.54 cm. We analyzed the indicators of physical development of children in all groups depending on gender. We carried out a comparative analysis of the parameters of body mass (m), body length (H), BMI and the ratio of body mass to body length in the experimental and control groups. Conclusion: children born to mothers with various types of diabetes have a higher height, weight to body length ratio, WAZ and HAZ indicators than newborns from mothers with normal glycemia. The weight and height of newborns in the groups of GDM and DM-2 did not differ significantly among themselves. The shortest and most lightweight children are born to mothers with type 1 diabetes,

Purpose of the study. To study the peculiarities of treatment of children with pancreatic diseases on the background of allergic enteropathy in children in out-patient and polyclinic conditions. Materials and methods: 349 children aged 5-18 years with pancreatic diseases were screened against allergic enteropathy. Clinical, biochemical and instrumental methods of examination of sick children were used. Results. Timely diagnosis and treatment of pancreatic diseases on the background of a gastrointestinal form of food allergy (allergic enterocolitis) leads to a persistent improvement in the clinical state and normalization of biochemical parameters in most children.

The aim of this study was to assess the cariesogenic situation in the oral cavity and bone metabolism in children with celiac disease. It is established that in children with early identified with celiac disease, indicators of a cariogenic situation of the oral cavity and the indicators of bone metabolism significantly better than children with later identified with celiac disease. The violation of bone metabolism and a high risk of caries in children with celiac disease were found, and therefore early diagnosis of the disease and compliance with the diet are necessary. And in the treatment of a dentist, a special role is played by medical examination and preventive measures.

Aim of investigation: to study the content and qualitative profile of shot-chain fatty acids in feces and blood serum in patients with NAFLD of different stages as indicators of intestinal microbiocenosis status and systemic lipid metabolism, and to evaluate the effectiveness of course antibacterial (rifaximin) and prebiotic (psyllium) therapy in the period of 6 months for the correction of gut microbiocenosis disorders. Material and methods: The survey included 115 patients (82 (71,3%) men, 33 (28,7%) women) with NAFLD of different stages (steatosis - 40 people, nonalcoholic steatohepatitis (NASH) of minimal activity - 30 people, NASH of moderate activity - 30 people, liver cirrhosis class A Child-Pugh - 15 people) at the average age of 51,83±8,48 years old. All the patients were examined by research of short-chain fatty acids (SCFA) using gas-liquid chromatographic analysis in various biological substrates (blood serum and feces). According to the management scheme, the patients with NAFLD were divided into 3 groups. The first group of 30 people (on the background of lifestyle modification) received a 6-month intake of psyllium. The second group of 35 people in addition to lifestyle modification received a 7-day course of rifaximin (7 - days/800 mg/d) and psyllium during the period of observation (6 months). The third group of 35 people received standard therapy of NAFLD without pharmacotherapy aimed to correction of gut microbiocenosis disorders. In the course of treatment the frequency and severity of clinical manifestations of intestinal bacterial overgrowth syndrome (SIBO) reduced in patients of groups 1 and 2 (in group 1 the complaints on abdominal pain and flatulence decreased by 11%, in group 2 - by 37%, the normalization of stool occurred in both groups), SIBO was not detected according to the results of the hydrogen breath test with lactulose, the level of total endotoxin was determined within normal values. Negative dynamics was noted in group 3: the increase in the number of complaints of abdominal pain by 16%, flatulence and unstable stool - by 10%, the frequency of registration of SIBO increased by 20%, increased level of total endotoxin was detected in 5.7% of patients. Results. The absolute concentration of SCFA in feces in patients with NAFLD (steatosis) is reduced, in patients with NASH of minimal activity, NASH of moderate activity and liver cirrhosis is increased, in the profile of C2-C4 acids there was the increase in the share of propionic and butyric acids and the decline in the share of acetic acid, the anaerobic index (AI) deflected in the region of strongly negative values, the total relative content of isoacids increased in all groups of patients, worsening with the severity of the pathological process (at normal Σ(C2-C6)=10.51±2.50 mg/g, C2=0.634±0.004, C3=0.189±0.001, C4=0.176±0.004, AI= -0.576(±0.012), Σ(isoCn)=0.068±0.004). The obtained results indicate marked changes in the qualitative and quantitative composition of the microflora, the decrease in the number and activity of obligate microorganisms and the increase in facultative and residual anaerobic bacteria. These changes in the microbial landscape lead to the marked disorders in the intestinal phase of lipid metabolism. The absolute concentration of SCFA in serum in patients with NAFLD (steatosis) is reduced, in patients with NASH of minimal activity, NASH of moderate activity is increased, in the profile of C2-C4 acids there is the decrease in the share of propionic acid and the increase in the share of butyric acid, most pronounced in steatosis and NASH of minimal activity. In patients with liver cirrhosis, the absolute concentration of SCFA in serum is increased, in the profile of C2-C4 acids, the share of acetic acid is sharply reduced with an increase in the share of propionic and butyric acids and the total relative content of isoacids. The content of caproic and isocaproic acids is increased in all groups (at normal Σ (C2-C6)=0.195±0.011 mg/g, C2=0.902±0.006, C3=0.071±0.004, C4 = 0.027±0.002, Σ (isoCn)=0.040±0.007, isoC6+C6=0.025±0.004). This fact can be explained by the changes in the functional state of hepatocytes, and, consequently, in the metabolic function of the liver (in particular with respect to lipid metabolism). The clinical efficacy of therapeutic management with the use of drugs aimed at the relief of the intestinal microflora disorders (course of rifaximin (if SIBO is identified) on the background of prolonged ingestion of psyllium) in patients with NAFLD of different stages, is supported by the normalization of the content and profile of SCFA in various biological substrates. In patients of group 3 there was noted the negative dynamics of estimated parameters SCFA. Thus, the results of the undertaken research of the parameters of SCFA in various biosubstrates indicate the marked changes in the intestinal microbiocenosis and their contribution to the development and enhancement of systemic metabolic processes. The inclusion of means aimed at correcting the microecological status disorders in the complex management of NAFLD is not only effective, but also pathogenetically necessary.

Aim of the study. To study the status of 25 hydroxyvitamin D in case of food proteins induced enterocolitis syndrome in young children and to determine the relationship between its level and clinical and laboratory manifestations of the disease. Materials and methods. 72 children with Food Proteins Induced Enterocolitis Syndrome aged from 3 months to 3 years were examined. To confirm the diagnosis, clinical-anamnestic, paraclinical (general blood analysis, coprology, feces for latent bleeding, total protein), and immunological (IgE total, IgE-specific antigen-specific method, lymphoquin-producing ability of T-lymphocytes to food allergens) were used. For studying the status of vitamin D in the serum of sick children 25 (OH) D3 was determined. Results. The average values of vitamin D in children with gastrointestinal food allergies had marked differences in comparison with the norm. Thus, in children with FPIES, they were 20.0 ± 4.4 ng / ml, at a rate of 45.1 ±8.04 ng / ml. Lower vitamin D values occurred in children with more severe clinical manifestations of the disease and, in part, with association with Ig E. By criteria, vitamin D deficiency was found in 41.6% of children with FPIES, insufficiency in 18% of children, in 29 (40.2%) cases, the rates were within the normal range. Conclusion. Thus, it was founded a decrease in the vitamin D values by 2.25 times in food protein induced enterocolitis syndrome, compared with the norm, which dictates the need for the children with FPIES to make aqueous solutions of vitamin D.

Growth pathology duodenal among patients of different age groups determines the relevance of the study. Causes duodenal disease sufficiently heterogeneous and include celiac disease, gluten allergy and various proteins, autoimmune disease, atopy, and also bacterial, parasitic and viral infection (Helicobacter pylori infection, giardiasis). One of the characteristics of the mucosal morphofunctional state is its neuroendocrine duodenal activity, which is provided enteroendocrine cells, and chromogranin synthesizing neuropeptides, in particular, chromogranin A (CgA), ghrelin and serotonin. The aim of our study was to determine whether these markers in the duodenal mucosa with similar morphological manifestations duodenitis of various etiologies in children. The material of the study were 40 biopsies of the distal duodenum, obtained by fibrogastroduodenoscopy in children aged 6 to 17 years old with morphologically verified chronic gastroduodenitis (CGD). The first group consisted of children with celiac disease, the second group - with Helicobacter pylori infection (H.p), the third group consisted of children with giardiasis, in the fourth (the control group) - children with reliably excluded above listed diseases and preserved architectonic mucosal duodenum without morphological characters gastroduodenitis.When immunohistochemical study (IHC) expression levels were determined Chromogranin A (Abcam 1: 400); Serotonin (Abcam 1:50); Ghrelin (Abcam 1: 100). The intensity of the reaction was assessed by two indicators - the relative expression area (Ot. Pl) and the optical density (OP). In our study, for the first time we studied markers in enteroendocrine duodenitis of various etiologies. We were looking for a morphological tool that will help differentiate duodenitis with similar clinical and histological features. Increased expression of ghrelin, serotonin and chromogranin A, playing an important role in the mechanisms of disorders duodenum structure in celiac disease. When H.p infections a decrease in all studied markers, while giardiasis is not observed significant changes. All of this allows us to differentiate duodenitis etiology and, therefore, reasonable to appoint therapeutic measures.

The article presents a review of the literature on the etiopathogenesis, diagnosis and treatment of parasitic invasions in children. The etiological structure of parasites infecting the biliary system, their development cycles and places of the most frequent parasitism in the external environment are described. It is convincingly shown that Giardia has nothing to do with the gallbladder and the biliary tract. It is noted that the most frequent pathogens of parasitic invasions of the biliary tract in children are opisthorchiasis, clonorchosis and fascioliasis. The role of parasitic invasions in the formation of gallstones is shown. At the same time, the key pathogenetic mechanisms of stone formation in cholelithiasis on the background of parasitic invasion is the activation of cholesterol and pigment lithogenesis, the deconjugation of direct bilirubin in bile. It is shown that the main in the treatment of parasitic invasions is the use of etiotropic therapy (deworming). Based on a detailed analysis of modern literature, therapeutic tactics algorithms have been developed.

Gestational diabetes mellitus (GDM) develops in 7-18% of women worldwide. The number of pregnant with GDM is steadily increasing. GDM is more likely to develop among obese patients. Women who are obese have features of chronic low-grade inflammation, manifest by increased tumour necrosis factor alpha (TNF-α), interleukin-6 (IL-6), interleukin-12 (IL-12), and high sensitivity C-reactive protein (hsCRP). Obesity is characterised by insulin resistance, and down-regulation of adiponectin and up-regulation of leptin, resistin and retinol-binding protein-4 (RBP4) contribute to this. Obesity and excess gestational weight gain results in a three-fold increased risk of adverse pregnancy outcomes, including long term metabolic syndrome and endocrine diseases for baby. Offspring born from pregnancies complicated by GDM has higher body mass index (BMI) compared with non-GDM offspring and has high risk of obesity throughout all periods of childhood. GDM may have impact on genetic modifications in the offspring.

The article discusses the diagnostic strategy of search and application of modern methods of molecular genetics in the diagnosis of hereditary diseases. The approach of molecular genetic diagnosis using NGS technology (new-generation sequencing). At the clinical example of the patient with Lois-Dietz syndrome, type 2 is shown the significance for diagnosis method of target sequencing of DNA sites relating to the coding areas of the genes associated with contractural arachnodactyly, Marfan’s syndrome and other hereditary diseases with similar phenotypical manifestations.

The article presents a brief information about Langerhans cell hystiocytosis - a rare granulomatous proliferative disease in which there is an infiltration of one or more organs by Langerhans cells. A detailed description of the clinical case of this disease in a child of the first year of life with a rare variant of the onset of the disease in the form of a severe hormone-dependent lesion of the colon, which occurred with the leading symptom of hemocolitis.

This article describes the historical information about advances in the study of peptic ulcer in historical context. Submitted to the dramatic collision of different theories of occurrence ulcers. Examples from the study of diagnosis, treatment and prevention of ulcers shows the dialectics of scientific and clinical progress both in our country and abroad. Special attention is paid to ulcers in children, because historically that the issue in the USSR and Russia became studied earlier and at a higher level. Endoscopic examinations of children in our country have been put in place much earlier, which allowed based on the results of years of research to formulate appropriate recommendations and prepare highly qualified specialists. Particular attention is paid to the success of surgery in the treatment of peptic ulcer disease, the role of Helicobacter pylori in Genesis of ulcers. The results presented in the article clear understanding the achievements of medical practice practitioners have managed to improve the quality of life of patients with peptic ulcer and significantly reduce their disablement.

The article is devoted to the 30th anniversary of the Department of Pediatrics with Infectious Diseases in Children of the Russian National Research University. N. I. Pirogov Ministry of Health of Russia, to the history of the formation and development of the department. Many scientific works and research directions present the priority and importance for modern science and practical healthcare. The structure of clinical bases, and therapeutic activity are described. Highlighted the Fragments of the department’s tight cooperation with both in personnel training and in medical work with the health authorities of various regions of Russia. Outlined future prospects of the departments’ activity.