Method for predicting chronic gastroduodenitis and functional dyspepsia in children

FIELD: medicine, gastroenterology.

SUBSTANCE: a patient should be tested, moreover, due to gas-chromatography technique one should detect salivary acetic, propionic and butyric acids and at concentration of any of these acids being: acetic acid above 0.910 mM/l, propionic acid above 0.150 mM/l and butyric acid above 0.013 mM/l one should diagnose chronic gastroduodenitis, and at concentrations of acetic acid ranged above 0.010 to 0.910 mM/l, propionic acid up to 0.150 mM/l and butyric acid up to 0.013 mM/l - functional dyspepsia. The innovation enables to increase objectivity and information value of the method suggested.

EFFECT: higher accuracy of diagnostics.

3 ex, 2 tbl

 

The invention relates to medicine, namely to Pediatrics. For the diagnosis of chronic gastroduodenitis and functional dyspepsia are clinical, instrumental and laboratory methods of examination; methods additional research is considered to be the most informative results esophagogastroduodenoscopy with biopsy, histological and cytological study (Instructional guidelines for diagnosis of diseases of the digestive system in children. - M., 1999. - P.10-14, Zablotsky A.N. Gastrointestinal endoscopy in children. - M.: Medicine, 2002. - Page 287).

Esophagogastroduodenoscopy is not used for mass screening and preventive examinations due to the complexity of this instrumental study and possible complications in patients. Known contraindications to esophagogastroduodenoscopy, a possible failure of the patient or the parent of a sick child from this instrumental study, which limits the scope of application of this method for the diagnosis of diseases of the digestive system in children. The bioptates of several parcels at esophagogastroduodenoscopy damage the mucous membrane of the stomach and duodenum. Disadvantages esophagogastroduodenoscopy with biopsy and histological examination as metagovernance gastroduodenitis and functional dyspepsia is a visual assessment, the use of qualitative and semi-quantitative parameters without precise quantitative indicators. This reduces the accuracy of the diagnosis of chronic gastroduodenitis and functional dyspepsia. Histological and cytological examination of biopsy specimens obtained during esophagogastroduodenoscopy, requires a considerable investment of time.

We were determined by gas chromatography the concentration of acetic, propionic, somaclonal and oil acids in saliva in healthy and sick children. Statistically significant increase in mean values of concentrations of acetic, propionic and butyric acids in the saliva of children with chronic gastroduodenitis in comparison with the performance of children with functional dyspepsia, and a statistically significant increase in the average value of the concentration of acetic acid in the saliva in children with functional dyspepsia compared with values in healthy children. The upper limits of the concentrations in the saliva of acetic, propionic, butyric acids in children with functional dyspepsia (table 1, 2) and the range of concentration of acetic acid from the upper limit in healthy children up to the upper limit in children with functional dyspepsia were selected as the most informative diagnostic criteria.

Tab the Itza 1

The values of the upper limits of concentrations of acetic, propionic and butyric acids in the saliva (in mmol/l) in groups of healthy and sick children.
The upper limit of the acid concentrationThe group and the number of surveyed children
Healthy (n=8)Patients
with functional dyspepsia (n=11)with chronic gastroduodenitis (n=28)
Acetic0,0100,9107,900
Propionic0,0040,1500,670
Oil0,0060,0130,570
Table 2

Examples of values of the concentrations of acetic, propionic and butyric acids in the saliva (in mmol/l) in children with chronic gastroduodenitis
The concentration of acidsPatients with chronic gastroduodenitis
K.H..F.DZM.A. O.SCaptain James kingPM
Acetic1,2001,7001,9000,5500,6301,4000,430
Propionic0,1900,6700,0140,5600,035to 0.0320,380
Oil0,0020,5700,0050,0050,0610,0540,210

In biopsies of the mucosa in inflammatory-erosive-ulcerative gastroduodenal lesions detected bacteria Helicobacter pylori that cause gastro, and other opportunistic pathogens (Bondarenko V.M., etc. // Ukr. microbiol. - 2003. No. 4. - Page 11-17). Acetic, propionic and butyric acid - microbial products of fermentation of sugars - have a toxic effect on the human body and disrupt the function of platelets and leukocytes (Istratov VG etc. // Herald of ROS. The AMS. - 1996. No. 2. - P.41-43). The increase in the content of acetic, propionic, butyric acids in saliva reflects the increase in the total number of microbial cells, including opportunistic, microor is Anisimov, in the oral cavity and mucous membranes of the stomach and duodenum. By increasing the concentration of acetic acid and the number of microbes in Association develops functional dyspepsia, with a significant increase in the concentrations of acetic and/or propionic and/or butyric acid and abundance of microorganisms in Association develops chronic gastroduodenitis.

The technical result is achieved by including additional clinical and survey method for the diagnosis of chronic gastroduodenitis and functional dyspepsia in children involves identifying children acetic, propionic and butyric acids in the saliva, and when the concentration of any of the three acids: acetic more 0,910 mmol/l propionic more 0,150 mmol/l, more oil of 0.013 mmol/l diagnosed with chronic gastroduodenitis; and at concentrations of acids: acetic within more 0,010 to 0,910 mmol/l propionic 0,150 to mmol/l, oil to 0,013 mmol/l diagnosed with functional dyspepsia.

The diagnostic method is performed as follows.

Analyze the data from history and physical examination of the patient. After pre-rinsing of the mouth with boiled water intake saliva by direct allocation of patients into the vial. Sample preparation involves the acidification of 1 ml of saliva 1 " " the lei 10% sulfuric acid. Gas-liquid chromatography for the quantitative determination of acetic, propionic and butyric acids perform on a glass column of 1 m length, 3 mm in diameter, filled with "Porapak" Q (USA) coated with a phosphoric acid under isothermal conditions at a temperature of 200°C. the Chromatograph MOSH - model 3700. The detector is a flame ionization, carrier gas - helium (Akishin AS, Boulygina VV // Klin. lab. diagnosis. - 1999. No. 6. - P.45-47). Identification and quantitative determination of acetic, propionic and butyric acids perform using analytical standards.

The practical implementation of the proposed method does not require an esophagogastroduodenoscopy with biopsy and Cytology, so it can be used in all children with clinical signs of chronic gastroduodenitis and functional dyspepsia in clinics and in addition to the standard diagnosis in hospitals. The use concentration of the acid increases the accuracy of diagnosis through the use of quantitative parameters reduces the time required for diagnosis, this diagnosis is carried out without damage to the mucosa of the gastrointestinal tract without complications.

To prove the adequacy of the diagnosis of chronic gastroduodenitis is functional dyspepsia in children indicators acetic acid, propionic and butyric acids in the saliva conducted a comparison of diagnostic results by the proposed method and the conventional method. The diagnosis of chronic gastroduodenitis or functional dyspepsia in children has established a standard method, according to surveys in accordance with the "Guidance-guidelines for the diagnosis of diseases of the digestive system in children using clinical, instrumental and laboratory methods of examination. We studied patients aged 12-15 years: 28 - chronic gastroduodenitis, 11 - with functional dyspepsia. The control group consisted of 8 healthy children. The oral cavity in all children was sanitized. The proposed method allowed us to diagnose all 11 children with functional dyspepsia (match with a final diagnosis - 100%) and 27 of the 28 children with chronic gastroduodenitis (match with a final diagnosis - 96%).

Thus, the concentrations of acetic, propionic and butyric acids in saliva can be used to diagnose chronic gastroduodenitis and functional dyspepsia in children. Examples of the method in children with chronic gastroduodenitis: 7 examples are presented in table 2; and 2 out of 7 examples described in more detail below.

1. K.H., 12 years. Complaints of recurrent pain in geotemperature region whining character, not associated with food intake. Abdomen palpation soft, painful in piloroduodenalnoy zone. The results of chromatographic studies: concentration of acid in the saliva (mmol/l): acetic 1,200; propionic - 0,190; oil of 0.002. Clinical signs and concentrations in the saliva of the patient acids (mmol/l): acetic more 0,910, propionic more 0,150 diagnosed with chronic gastroduodenitis. Additional tests: esophagogastroduodenoscopy: revealed inflammation of the mucous membrane of the stomach and duodenum; urease test positive; microscopy imprint identified Helicobacter pylori. Final diagnosis: chronic gastroduodenitis coincides with the diagnosis of the claimed method.

2. .F., 12 years. Complaints of recurrent epigastric pain whining character, not associated with food intake, occasional heartburn, belching air. Abdomen palpation soft, painful in piloroduodenalnoy zone. The results of the determination of acids in saliva (mmol/l): acetic 1,700; propionic - 0,670; oil - 0,570. Clinical signs and concentrations in the saliva of this patient's acid: acetic more 0,910, propionic more 0,150, more oil 0,013 diagnosed with chronic gastroduodenitis. Additional tests: esophagogastroduodenoscopy: chronic, the inflammation of the mucous membrane of the stomach and duodenum; urease test positive; microscopy imprint identified Helicobacter pylori. The result of histological examination of biopsy: chronic moderate active gastro. Final diagnosis: chronic gastroduodenitis coincides with the diagnosis of the claimed method.

An example of the method in patients with functional dyspepsia.

3. IM 14 years. Complaints of recurrent epigastric pain whining character, not associated with food intake, nausea. Abdomen palpation soft, moderately painful in the epigastrium. The results of the determination of acids in saliva (mmol/l): acetic 0,170, propionic - 0,072, oil - 0,013. Clinical characteristics and concentrations of acids: acetic within more 0,010 to 0,910, propionic up 0,150, oil to 0,013 diagnosed with functional dyspepsia. Additional tests: esophagogastroduodenoscopy: inflammatory changes in the mucous membrane of the stomach and duodenum are not identified; urease test is negative; histological examination of the biopsy revealed no inflammatory changes in the mucous membrane of the stomach and duodenum. Final diagnosis: functional dyspepsia coincides with the diagnosis of the claimed method.

Thus, the claimed method is the volume of the positive and informative, and using clinical signs of disease and the concentration of acetic, propionic and butyric acids in the saliva, it is possible to diagnose the presence of chronic gastroduodenitis or functional dyspepsia. The diagnostic method allows to improve the accuracy of diagnosis through the use of quantitative parameters without any unwanted side effects in children.

Method for the diagnosis of chronic gastroduodenitis and functional dyspepsia in children by examination of the patient, wherein the gas chromatography method determines in saliva acetic, propionic and butyric acid at a concentration of any of the three acids: acetic more 0,910 mmol/l propionic more 0,150 mmol/l, more oil of 0.013 mmol/l diagnosed with chronic gastroduodenitis, and at concentrations of acids: acetic within more 0,010 to 0,910 mmol/l propionic 0,150 to mmol/l, oil to 0,013 mmol/l diagnosed with functional dyspepsia.



 

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