The main problem of research on vitamin D sufficiency is the lack of an integrated approach, that is, a dynamic assessment of 25(OH)D throughout the entire period of childhood and in different seasons of the year. This is necessary to highlight those specific diseases in which priority targeted prevention and therapy of hypovitaminosis will be indicated, taking into account the numerous biological and pathophysiological effects of vitamin D metabolites, in particular, 25(OH)D, which have socially significant clinical consequences. The aim of the study: to assess the level of 25(OH)D in children with various diseases living in Moscow and the Moscow region, taking into account the season of the year and age. Materials and methods. A study was made of the availability of 25(OH)D among 1501 children living in Moscow and the Moscow regions. Discussion. A high frequency of severe vitamin D deficiency was found among children with oncological diseases (41.7%), diseases of the nervous system (12.9) and blood system (10.9). It was shown that 25.0% of children with cerebral palsy, 19.4% of children with chronic kidney disease, 16.7% with type 1 diabetes mellitus, 15.5% with juvenile idiopathic arthritis have a pronounced deficiency of 25(OH)D, 14.8% of patients with anemia, 10.3% with inflammatory bowel disease, 7.9% of children born prematurely. Conclusion. Severe and year-round disorders of 25(OH)D metabolism were noted in children suffering from autoimmune (type 1 diabetes mellitus, inflammatory bowel disease, idiopathic juvenile arthritis), oncological diseases, cerebral palsy, prematurity, and chronic kidney disease.

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.

There is an increase in the incidence of obesity and metabolic syndrome (MS) among children and adolescents. The purpose of the study: to improve the algorithms of diagnostic and therapeutic and preventive measures for MS in obese children. Materials and methods. A comprehensive examination of 483 children with exogenous constitutional obesity aged 6-17 years (285 boys and 198 girls) (SDS BMI ≥ 2.0) was conducted. Results. MS (IDF, 2007) was diagnosed in 49% of the examined children. Adolescents aged 12-17 prevailed (77%). Boys 61%, girls 39% (p<0.05). 61% of adolescents were obese for 5 years or more. 54% of children had a combination of abdominal obesity with two additional components (an incomplete version of MS), 33% - with three, 13% of adolescents had complete MS (a combination of all five components). The analysis of hereditary burden has established a high incidence of obesity, type 2 diabetes, diseases of the cardiovascular system in the mother and maternal grandmother. An increase in blood pressure was detected in 79% of children with MS, arterial hypertension of the I degree - in 34%, hypertension of the II degree - in 22%. Pronounced disorders of glucose metabolism were revealed in the form of a high frequency of IR (81%) and compensatory hyperinsulinemia (55%). Changes in the lipid profile were recorded in 77% of children with MS. An increase in the level of TG and a decrease in HDL cholesterol, which are components of MS, were in 48% and 55% of children, respectively, and their combination was in 27%. Non-alcoholic fatty liver disease was diagnosed in 70% of children with MS, signs of non-alcoholic steatohepatitis - in 13%. In 29%, cholesterosis of the gallbladder was detected, in 34% - biliary sludge, in 7% - gallstones. Conclusion. Based on a comprehensive examination, a diagnostic algorithm and a three-level MS prevention program have been developed, as well as a mathematical model for predicting MS based on the assessment of indicators such as the size of the pancreatic head, thyroid volume, serum alanine aminotransferase (ALT) level, fasting serum glucose level, increased liver echogenicity, according to which it is possible to predict the development of MS in children at the outpatient level at the early stages metabolic disorders.

Diabetes mellitus continues to be the most common endocrine-metabolic pathology. In childhood, type 1 diabetes mellitus prevails - an autoimmune, genetically determined disease, as a result of which this type of diabetes is often combined with other autoimmune diseases. Autoimmune gastritis, the marker of which is antibodies to the parietal cells of the stomach, is quite rare in the children’s population, but with type 1 diabetes, its frequency increases significantly. The article presents the results of recent studies of the relationship between type 1 diabetes mellitus and autoimmune gastritis in children. The results of a study of the prevalence of antibodies to parietal cells of the stomach in type 1 diabetes mellitus in children, factors affecting this indicator are presented. The pathogenetic aspects of the relationship of these diseases are analyzed.

The goal of research. To analyze some features of peptic ulcer of the stomach and duodenum in children, depending on the type of constitution. Material and methods of research. We examined 58 children aged 12-18 years with a diagnosis of peptic ulcer of the stomach and/or duodenum, who underwent endoscopic examination, Hp was detected in the biopsy and aero test. Results. Peptic ulcer disease was more often detected in asthenic children (67.2%), less often in hypersthenic (17.3%) and normosthenics (15.5%). Various research methods in asthenic children (97.4%) revealed the presence of Hp more often than in hyper- or normosthenic children. Conclusion. Children with an asthenic type of constitution are more prone to Hp-associated forms of gastric and duodenal ulcers than hypersthenics or normosthenics.

Coronaviruses, seven of which are known to infect humans, can range from asymptomatic infection to malnutrition and death. Russia has over 12.4 million confirmed cases of COVID-19 at the time of writing, with nearly 334,000 deaths. While all other coronaviruses affect cardiovascular disease, the SARS-CoV-2 virus also has a tropism for the cardiovascular system, gastrointestinal tract, liver, pancreas, kidneys, and nervous system. In this review, we describe the important gastrointestinal manifestations of COVID-19 in children and discuss possible underlying pathophysiological mechanisms for their occurrence.

The aim of the research was to study the association of genetic prerequisites for vitamin D deficiency with the severity of COVID-19 infection and to analyze the association of the severity of the disease with the level of vitamin D in blood plasma. Materials and methods. The study included 72 patients, divided into two groups - group No. 1 and group No. 2. Inclusion criteria for group 1: patients with a history of mild COVID-19 infection and patients who did not have COVID-19. Group 2 included patients with moderate to severe COVID-19 infection. The study for the analysis of nucleotides in the loci rs1544410, rs2228570, rs3829251, rs2282679 of the VDR, NADSYN1, GC genes was carried out by the standard TaqMan PCR method on a Real-Time CFX96 Touch amplifier. The duration of the study was 6 months. Results. Group 1 included 59 patients, the average age of patients in the group was: 41.28±2.00. Group 2 included 13 patients, the average age of patients in the group was 48.10 ± 2.76. When assessing the contribution of the genotypes of polymorphic locus rs1544410 of the VDR gene, rs2228570 of the VDR gene, rs3829251 of the NADSYN1 gene, rs2282679 of the GC gene to the severity of the COVID-19 infection, no statistically significant results were found. Also, of the 72 patients studied, 55 patients had known serum vitamin D levels before they had COVID-19 infection. In 43 people, vitamin D was contained at an adequate concentration (≥30 ng/ml (≥75 nmol/l), of which: 40 patients had mild COVID-19 or did not tolerate this disease and 3 patients had moderate COVID-19 - severe form of an average vitamin level. Twelve people had vitamin D deficiency (≥ 20 and <30 ng/mL (≥50 and <75 nmol/L)). Of these, 7 patients had mild or no COVID-19 and 5 patients had moderate to severe COVID-19. When statistically evaluating the data, a statistical significance was found between the severity of the COVID-19 infection and the level of vitamin D in the blood plasma. Conclusion. An associative relationship was found between the level of vitamin D in blood plasma and the severity of the course of the COVID-19 infection. In the studied sample of patients, no association was found between the genotypes of the studied genes and the severity of the COVID-19 infection.

The study aimed to determine the presence of a relationship between prenatal exposure to potential risk factors and the development of necrotizing enterocolitis (NEC) in premature infants. Materials and Methods: The clinical data of 99 mother-newborn couples diagnosed with Bell’s stage IIA NEC and a comparable comparison group were studied. The clinical characteristics of the main group with NEC were compared with the control group using the Student’s t-test. To assess the severity of the impact of potential risk factors, the Cochran - Mantel - Hensel method was used with the construction of a logistic regression model. Results. A statistically significant relationship was established between ampicillin prescribed to pregnant women and the occurrence of NEC in newborns. The adjusted odds ratio (OR) of prenatal ampicillin exposure was significantly greater for infants with NEC (OR 2.3, 95% CI 1.1, 4.8, P = 0.003) than for infants in the comparison group. Potential influencing factors (arterial hypertension, chorioamnionitis, artificial feeding and male sex) which also contribute to the development of NEC in newborns during prenatal antibiotic therapy, have been identified.

The priority of the national health policy is to preserve the life and a high level of quality of life for every premature baby. The clinical focus is on children born with ELBW. Among this category of children, NEC makes the main contribution to the structure of infant mortality. Based on the analysis of the literature, the authors conclude that the study of cell markers that characterize different depths of damage to enterocytes allows: to assess the likelihood of developing NEC in infants with ELMT; conduct early diagnosis of NEC; rule out NEC in neonates with similar symptoms; predict the course of NEC; propose and substantiate personalized approaches to correcting the low supply of 25(OH)D; to analyze the influence of candidate genes on the implementation of NEC, its outcomes, and 25(OH)D metabolism. To assess damage at the level of the enterocyte, the authors selected the intestinal fraction of fatty acid binding protein (I-FABP) for literature analysis. To determine the depth of damage to intercellular junctions of the intestine - the expression of transmembrane (claudin-2, claudin-3, claudin-4, occludin) and cytoplasmic (zonulin) tight junction proteins. Analysis of the results of studies on the expression of fecal calprotectin, lipocalin-2 (LCN2) and eosinophilic neurotoxin, showing the activity of local inflammation, was carried out in order to assess both the risk of NEC and its course. Intestinal damage is associated with impaired 25(OH)D metabolism, and metabolic bone disease in preterm infants with damage to the intestinal barrier up to NEC is recorded ten times more often at the stage of nursing in the NICU. A huge number of studies have shown a decrease in survival, an increase in the risk of severe complications against the background of a low supply of 25(OH)D in the preterm population. The authors analyze the relationship between 25(OH)D availability, taking into account the influence of exogenous and endogenous factors, the nature of damage to the intestinal wall and the implementation of NEC, and focus on the existing preventive and therapeutic approaches to prescribing various doses of vitamin D in preterm infants with NEC.

The aim of the study was to determine the immunohistochemical features of the lymphoid tissue of the mucous membrane (MM) of the colon in children with different course of Crohn’s disease. Methods: the results of IHC and morphometric analyzes of colonic colony of children with Crohn’s disease of uncomplicated and complicated course are presented. Results: An important role of the ratio and distribution of subpopulations of T-lymphocytes of CO and lymphoid clusters in children with Crohn’s disease is shown, depending on the phenotypic variant of the course of the disease. In children with a favorable prognosis of Crohn’s disease, the immunoregulatory index (IRI) was close to normal with a predominance of the CD4 + T-lymphocyte population against the background of a moderately increased number of CD8 + cells and B-lymphocytes. IRI of children of the II group was significantly increased due to a sharp increase in CD4 +, CD8 + T-lymphocytes and CD19 + B-lymphocyte link. Conclusion: A high level of IRI with a pronounced disproportion of intrapopulation T-lymphocytes is combined with an unfavorable course of the disease. For children with uncomplicated course of the disease, a minimal mismatch in the intrapopulation T-lymphocyte system is characteristic against the background of increased IRI.

Aim. To study the rheological properties of blood and platelet hemostasis in children with inflammatory bowel diseases before and after a course of hyperbaric oxygenation Materials and methods. Aggregation and deformability of erythrocytes, activation and aggregation of platelets were studied in 16 patients with Crohn's disease and 11 patients with ulcerative colitis age from 6 to 17 years. Similar indicators were studied after a course of hyperbaric oxygenation, carried out in a single-seat air-oxygen pressure chamber “BaroOx 1.0”. The course consisted of 5-8 daily sessions in the 1.3-1.4 ata during 40 minutes. Results. In pediatric patients with Crohn's disease and ulcerative colitis a significant violation of the rheological and hemostasiological properties of blood was revealed. After a course of hyperbaric oxygenation a significant decrease in the aggregation of erythrocytes, an increase in their deformability, and a decrease in the functional activity of platelets were noted. Conclusion. The use of hyperbaric oxygenation in children with inflammatory bowel diseases contributes to a significant correction of the rheological and hemostasiological properties of blood.

Aim. To study the activity of the inflammatory process in the gastric mucosa (GM) in gastroesophageal reflux disease (GERD) in schoolchildren living in a region with a high incidence of stomach and esophageal cancer. Material and methods. The transverse method in the Republic of Tyva collected data on the presence of gastroenterological complaints in 1535 schoolchildren aged 7-17 years. The main diagnostic criterion for GERD was the presence of weekly heartburn in the subjects. Subsequently, esophagogastroduodenoscopy was performed with the taking of biopsy material of the mucosa of the antrum and body of the stomach in 246 children. Morphological assessment of GM was carried out in accordance with the Sydney classification after staining biopsy sections with hematoxylin-eosin. Diagnosis of Helicobacter pylori was carried out after staining according to Giemsa. The studies were approved by the ethics committee and the consent of the examined was obtained. Results. Schoolchildren in Tyva have a high prevalence of GERD (9.5%). Associative relationship of GERD with gastritis activity, both in the body (p=0.7338) and in the antrum (p=0.2036) was not revealed. In the antrum, the activity of gastritis was higher than in the body of the stomach (p=0.0001). In children with GERD, when infected with Helicobacter pylori, there was an increase in activity, both in the antrum (p=0.0001) and in the body of the stomach (p=0.0159). At the same time, in children with GERD, the inflammatory process is associated with infection by a microorganism, regardless of its belonging to the Cag A strain. Conclusion. An association of GERD with highly active Helicobacter pylori associated gastritis has been established, regardless of whether the microorganism belongs to the Cag A strain.

The aim of the investigation was to study the level of vitamin D in the blood of adolescents with obesity/overweight compared with a normal body mass index of this age category. Methods. The study included 36 patients of a pediatrician or an endocrinologist who had a deficiency or insufficiency of vitamin D levels in the blood. After a month the therapy the patients included into the study passed the control analysis of the vitamin D levels. The duration of the study was a month. Results. The main group included 18 patients aged from 10 to 18 years, the control group included 18 patients of the same age. The average baseline of vitamin D in the main group in the start of the study was lower (18.39±1.31 nmol/l) compared to the control group (23.83±0.96 nmol/l, p<0.005). The initial concentration in the study groups, didn’t show the clear relationship in terms of insufficiency and deficiency. Regardless body weight, the frequency of the pathology encountered did not have significant differences in the study groups, with the exception of allergic pathology, which is probably due to the randomness of the study group sampling. When comparing the normalization of vitamin D levels in the study groups, it was found that the index had risen higher in the control group, the Mann-Whitney U-test was 96 (p <0.05). Comparing the achievement of the target level of vitamin D after a month of the therapy in the compared groups, we obtained the data that in the control group all children fully reached the target levels, regardless the form of the drug received while in the main group, only 72.2% patients achieved the target level, 27.8% adolescents did not reach it, Fisher’s exact test (two tailed) is 0.022, p<0.05. In the main group, inadequate dosages of vitamin D were taken by 72.2% of patients. Among them 55.5% of patients took higher dose and 16.7% of patients had lower one. In the control group, inadequate dosages of vitamin D were observed in 61.1% of patients: including, 22.2% higher and 38.9% were lower. Conclusion. As a result of the study, it has been found that the levels of vitamin D in overweight or obese adolescents are significantly lower than in adolescents with normal body weight living in the same region and having the similar lifestyle. The most effective method of correcting vitamin D insufficiency and deficiency is the use of vitamin D medicines at the recommended dosage and regularity.

The article presents data characterizing the features and timing of the introduction of complementary foods to children of the first year of life living in the Belgorod region. The purpose of the study was to study the features of feeding children in the first year of life living in the Belgorod region, and to evaluate the success of the implementation of the “National Program for Optimizing the Feeding of Children in the First Year of Life” in pediatric practice. Methods. Subject to the principles of voluntariness and confidentiality, interviews were conducted with 348 women with young children (the first two years of life) born at 38-41 weeks of gestation with an Apgar score of at least 8 points. To conduct the study, a questionnaire was developed that allows retrospectively assessing the duration of breastfeeding and the timing of the introduction of complementary foods. Results. When assessing the nutrition of children in the first year of life, the following problems were identified: early termination of breastfeeding (before the child reaches the age of 3 months) - in 29.8% of cases, violation of the timing of the introduction of complementary foods (earlier than 4 months and later than 6 months - 22% children), the rules for the introduction of complementary foods (52.7%) and the range of selected products. The main source of information for young parents about complementary foods, the timing and methods of its introduction were: in 60.1% - medical workers, in 12.9% - the opinion and advice of relatives, friends and acquaintances, in 3.2% - the exchange of information with other parents with children of the same age, in 18.1% - information contained on the Internet. Research results. The results of the study show the need for further work on the active implementation of the existing recommendations in the practice of pediatricians, aimed at implementing the principles of breastfeeding support to increase the duration of lactation, on the timeliness of the introduction of complementary foods, the implementation of the rules for the introduction and selection of the range of introduced food products.

Purpose of the study. Assessing students’ satisfaction on school meal. Materials and methods. A survey was conducted of 395 elementary school students and 232 high school students) schoolchildren for assessing satisfaction with the school meal. Results. The analysis of the questionnaires showed that 55% of respondents eat in the school cafeteria, half of them are satisfied with the menu, and they also consider the food healthy and complete. The main reasons for refusing hot meals are: cold food (49%), lack of time for eating and small portions (44%), unsatisfactory taste qualities of the products offered (38%). Most of the students paid attention to the monotony of the side dish (buckwheat porridge), the absence of vegetable salads in the menu and the need to increase the amount of poultry meat (chicken). More than half of the respondents (69%) regularly buy buffet products, represented mainly by dough products (pies, buns, etc.).

Background. The article presents modern views on the role of microbiota in the occurrence of atopic pathology. The reasons for the decline in biodiversity, changes in the dynamic balance between macro-microorganisms, violation of the colonization of human ecological niches, which are important in the formation of local and systemic immunity, are considered; the main causes of dysbiosis at an early age, which precedes the formation of allergic diseases (food allergy, atopic dermatitis, allergic rhinitis, asthma), a significant increase in which has been noted in recent decades. Aim: to analyze reviews, articles devoted to the study of the role of the human microbiota, a decrease in its biodiversity in the formation of allergic pathology. Methods: the use of analytical reviews, articles posted in electronic databases: PubMed, Scopus, Web of Science, position of the European Academy of Allerogology and Clinical Immunology (EAACI). Conclusion: the analysis made it possible to present the modern role of microorganisms inhabiting the ecological niches of the human body, their dynamic balance on the function of all organs and systems, with consideration of the reasons for the decrease in biodiversity and the subsequent development of allergic diseases; the need to further study the role of not individual pathogens, but the general properties of the microbial population, which will help to change the approach to disease therapy, based not on replacing individual microorganisms, but on restoring the all population.

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.

Compression stenosis of the celiac trunk or Dunbar syndrome, a clinical and anatomical syndrome characterized by chronic abdominal pain, is a congenital pathology based on compression of the celiac trunk by the median arcuate ligament of the diaphragm. The narrowing of the lumen of the celiac trunk entails hemodynamic disturbances in the artery itself and branches extending from it, which leads to a shortage of blood supply to the organs of the digestive system. Inadequate supply of arterial blood can lead to dystrophic and ischemic tissue damage. The mucous membrane and submucosal layer of the wall of the stomach and intestines are most susceptible to oxygen starvation. The article discusses the features of ischemic gastric and duodenal ulcers with clinical examples in children with Dunbar syndrome. It also describes the compensatory capabilities of the body to minimize the effects of extravasal compression of the celiac artery and methods for their visualization.

The aim: to study the effectiveness of the use of systemic ozone therapy according to the method developed by us in the complex treatment of children with generalized appendicular peritonitis at the stage of postoperative treatment in relation to the correction of indicators of endotoxin aggression. Materials and methods. On the basis of the Clinic of Pediatric Surgery of the Children’s Republican Clinical Hospital (Donetsk) 60 school-age children (from 7 to 17 years old), operated on for generalized appendicular peritonitis, were examined. The group 1 consists of 30 children, who at the stage of the postoperative period in addition to comprehensive therapy received a course of systemic ozone therapy developed by us. 30 patients of the group 2 received the traditional treatment. In all children the initial level of systemic endotoxemia indicators was determined. Blood sampling from patients was carried out initially before surgery. The dynamics of the studied indicators were evaluated on the 7th and 14th days of the postoperative period. Results. In all patients with generalized appendicular peritonitis the development of endotoxin aggression was established. Against the background of a course of systemic ozone therapy by the 14th day of the postoperative period, a statistically significant (p < 0.05) decrease in the level of indicators of endotoxin aggression relative to patients of the comparison group was noted. Conclusions. The results obtained prove that the development of widespread appendicular peritonitis occurs in children with the formation of endotoxin aggression. The use of systemic ozone therapy according to our proposed method in the complex therapy of these patients at the stage of the postoperative period makes it possible to achieve a reduction in laboratory indicators of endotoxin aggression in a shorter time.

An abscess of the round ligament of the liver in children, as a result of an inflammatory process, often leading to necrosis, is an extremely rare occurrence. Formations in the round ligament of the liver must be differentiated from liver tumors, which can be diagnosed using instrumental research methods. In the available literature on the abscess of the round ligament of the liver, the authors speak about the preference for complete excision of the ligament. However, analyzing the experience (5 clinical examples are given) of the surgical clinic of the N. F. Filatov Children’s City Clinical Hospital (Moscow, Russia), the most preferable and safe are puncture and drainage of the abscess cavity from the anterior abdominal wall under visual control of manipulation using a laparoscope.

Fecalitis are one of the key factors of inflammation of the diverticular mucosa and the complications in diverticular disease of the colon. AIM. To study the results of endoscopic treatment with removal of fecalitis in diverticular disease complicated by chronic diverticulitis. Materials and methods. Between 2015 and 2019, the study included 87 patients with chronic recurrent diverticulitis. All patients received the same conservative treatment, and the main group (42 patients) underwent endoscopic rehabilitation of diverticulae. Evaluation of results of endoscopic scale (Mayo), histological scale (Reilly) and laboratory tests (fecal calprotectin) activity of the severity of inflammation of the mucous membrane of the colon showed significantly relief of inflammatory activity in the mucosa of diverticula, which contributed to a more rapid recovery of patients and reducing the frequency of relapses.

High prevalence of food allergy (FA), increasing frequency of severe cases despite the progress achieved in the study of this pathology makes it necessary to develop new methods for diagnosis, treatment and prevention of food allergies. At the Congress of the European Academy of Allergology and Clinical Immunology (EAACI) 2021 current problems of allergology and immunology were considered, such as the influence of environmental factors on the development of FA, including the effects of microplastic contamination in food on development of allergic diseases, global warming, large-scale urbanization, that lead to an imbalance in the microbiota of the macroorganism, reduction in its diversity, followed by alterations in gut microbial colonization and the development of FA; determination of FA markers with detecting previously unidentified allergens that cause severe allergic reactions. Assessment of risk factors and biomarkers of the severity of FA was discussed, as well as the importance of component diagnostics, which allows predicting acute allergic reactions, determining indications for prescribing AIT, and maximizing individualization of treatment. Innovative treatment approaches were presented using biological therapy, the role of pre- and probiotics, fecal microbiota therapy in restoring the microbiome; features of the diet that regulates the gut microbiota. In considering the prevention of FA changes were made to the previous EAACI recommendations for monitoring children in the first year of life, monitoring the state of adolescents with FA.

Type II Gaucher disease is a rare orphan disease and its diagnosis is accompanied by certain difficulties for practitioners. The problem is low clinical alertness and lack of experience with rare patients. In addition, the disease requires tests for the content of enzymatic activity and determination of the severity of the pathological process.

Aim: to demonstrate a child with early ileocecal resection in stenosing Crohn’s disease, taking into account the risk factors of surgical intervention. Crohn’s disease (CD) is a chronic recurrent segmental granulomatous lesion of any part of the gastrointestinal tract, with a wide range of manifestations and various phenotypes of the disease. Despite the great diagnostic and therapeutic possibilities today, there is an increase in primary and secondary resistance to therapy, largely associated with an incorrect assessment of the CD phenotype, patient management strategy. In the above observation of CD in a teenager, clinical signs of ileocecal stenosis were observed 3 months after the supposed onset of the disease, which caused a planned laparoscopic ileocecal resection with the formation of a ileo-colon anastomosis. The start of CD in adolescence, positive ASCA-status are regarded as risk factors for surgical intervention in this child. Timely diagnosis did not allow to avoid surgery. It is necessary to make individual algorithms for the management of a child with CD, taking into account the predictors of surgical intervention, complications and unfavorable course of the disease already at the time of diagnosis.

Introduction. Currently, eosinophilic esophagitis (EoE) is a big and urgent problem for modern pediatrics. Its pathogenesis is associated with the formation of stenoses and strictures of the esophagus during a long course of the disease without treatment, which leads to serious disorders in the nutrition of children. In widespread practice, X-ray contrast examination of the esophagus is used, however, it is also necessary to perform esophagogastroduodenoscopy (EGDS) with taking multiple biopsies with morphological examination to verify the diagnosis. Materials and methods. Boy Y. 12 years, was admitted in March 2021 with complaints of difficulty in swallowing solid food, as well as poor weight gain. From the anamnesis of the disease, it is known that the phenomena of dysphagia were noted from the preschool period. Symptoms have progressed over the past year. EGDS was performed. A biopsy was taken: 6 fragments of the esophagus, 2 fragments from each third. Results. Diagnosed with eosinophilic esophagitis, complicated by esophageal stenosis. Chronic gastritis, Helicobacter pylori-not associated, incomplete remission. Chronic duodenitis, incomplete remission. Protein-energy malnutrition, mild. Appropriate treatment was prescribed. An allergological examination of the child was carried out and recommendations for nutrition were given. Against the background of the therapy, the child’s condition with pronounced positive dynamics - the appetite improved, the phenomena of dysphagia were completely stopped. When the child was re-hospitalized a month later, there was an increase in body weight (900 g) and growth (3 cm). Conclusions. The high efficiency of complex conservative therapy has been shown. The prescribed conservative treatment made it possible to avoid dilatation and bougienage of the esophagus. In this case, all three components of EoE treatment were applied: elimination diet, proton pump inhibitors, and topical corticosteroids. In the future, it is necessary to observe the allergist, taking into account the data obtained on multiple sensitization with a decision on the question of further treatment.