In the review there are presented the modern scientific concept of the shaping of irritable bowel syndrome (IBS) in children, giver significant etiological aspects of IBS. Genetic and epigenetic, immure and inflammatory, neurological, and psychological factors, chamges im the imtestimal microbiota with emvirommemtal imfluemces were determimed to superimpose manifestations of visceral hypersensitivity and disorders of intestinal motility in the clinical picture of IBS, which in turn depends or a complex interaction between the intestine and the nervous system in the regulation of the digestive system of a growimg orgamism. There has beem formulated the statememt that IBS is a biopsychosocial disorder imvolving disturbances at different levels of the regulation ofpathological mechanisms - from the psycho-social impact to the sensory-motor dysfunction due to a combination of disorders of visceral sensitivity and motor activity of the intestine. New diagnostic methods and means of comprehensive treatment of this common form of the disease in children are described, diagnostic features of IBS in the ambulatory conditions are determined. There are considered various groups of pharmacological agents used in the treatment of IBS, mechanisms of action of artispasmodic drugs of new generations, features of the use ofprebiotics and probiotics, as well as medications for psychosomatic correction.
Aim. To establish the etiological structure and to present clinical and laboratory and instrumental characteristics of bronchiectasis (BE) not associated with cystic fibrosis (CF) in children. Materials and methods. Sixty-seven hospitalised patients with BЕ not related to CF were followed up between 2017 and 2022. Examination methods: clinical-anamnestic method, general clinical laboratory investigations, investigation of allergological and immune status, phagocytosis system, determination of concentration of specific IgE and IgG to fungi of genus Aspergillus, sweat test, radiological examination and computed tomography (CT) of chest organs, bronchoscopy, Bacteriological examination of sputum and/or tracheobronchial aspirates, nasal and/or bronchial ciliary motility, esophagogastroduodenoscopy, 24-hour pH-metry, intra-esophageal combined impedance-pH-metry, genetic study, lung biopsy. Results. Etiologic factors of BЕ not associated with CF in children were severe pneumonia (22%), primary ciliary dyskinesia (22%), bronchial asthma (13%), Williams-Campbell syndrome (7%), bronchial foreign bodies (7%), gastroesophageal reflux disease (6%), Bronchopulmonary dysplasia (6%), postinfectious bronchiolitis obliterans (5%), allergic bronchopulmonary aspergillosis (3%), chronic granulomatous disease (3%), AIDS (1%), prolonged bacterial bronchitis (1%), brain-lung-thyroid syndrome (1%). The clinical picture is characterized by cough (91%), shortness of breath (67%), fever during exacerbation (48%), chest pain (24%), exercise intolerance (55%), drumstick symptom (9%), moist (76%) and dry wheezing (37%). CT-semiotics of BЕ not associated with CF is characterized by localization in one (58%) or several (42%) lobes; traction (42%), non-traction (49%) B and their combination (9%); increased broncho-arterial ratio 0.9; thickening of bronchial wall; "mosaic perfusion"/"air-trap" symptom (9%); more frequent involvement of lower lungs (64%). The main infectious agents in BЕ not associated with CF were Haemophilus influenzae, Pseudomonas aeruginosa, Staphylococcus aureus. Conclusion. On the basis of a multicentre study, the etiological structure, clinical and laboratory and CT-characteristics of non-CF ВE in children were established.
The review presents the special significance of changes in the intestinal and skin microbiota in the formation of atopic dermatitis (AD) in children. AD is considered as a form of allergic pathology directly related to the state and quality of the microbiota of a growing organism. The microbiota of the skin of patients with AD is characterized by a small species diversity of bacteria; a decrease in the number of actinomycetes and proteobacteria; increased colonization of various types of staphylococci (S. aureus, S. epidermidis, S. haemolyticus, etc). The relationship between the rate of development of AD and violations of the microbiota of the skin in children is shown. The necessity of maintaining high biodiversity of the microbiota of a growing organism as a strategy for optimizing the microecology of children through the use of adaptive probiotics in a healthy microenvironment is substantiated. The restoration of the barrier function of the skin and the normalization of the composition and quality of the intestinal microbiota are determined as the most important task of the general concept of the treatment of AD, where new dermatological cosmetics and proper skin care play an important role. The possibilities of normalizing the microbiome of the affected skin areas to restore the skin barrier with the help of dry skin care cosmetics are shown.
Objective. To evaluate the composition of intestinal microbiota in children with atopic dermatitis (AD) aged 1–5 years depending on the disease severity. Patients and methods. We have examined 60 children aged between 1 and 5 years diagnosed with AD. In outpatient settings, they have undergone comprehensive clinical and laboratory examination that included analysis of patient's medical history, physical examination, assessment of clinical status using the SCORAD scale, complete blood count, urinalysis, analysis of feces, liver function tests, measurement of total IgE and specific IgE, and bacteriological analysis of feces. The composition of intestinal microbiota was assessed using bacterial 16S rRNA gene sequencing with subsequent bioinformatic and statistical analysis. Results. The analysis of intestinal microbiota in 60 AD children aged 1–5 years using 16S rRNA sequencing demonstrated an association between the composition of intestinal microflora and disease severity. Both bacterial count and species diversity directly depend on the disease course. Children with complicated AD had a very poor diversity of intestinal microorganisms compared to those in remission (р ≤ 0.002). Children with signs of AD exacerbation demonstrated an increased count of Actinobacteria species (р = 0.018) and a decreased count of Proteobacteria species compared to children without clinical manifestations of AD (р = 0.033). We also observed a decrease in the amount of bacteria belonging to Oscillospiraceae and Erysipelatoclostridiaceae families (р = 0.03 : 0.034) in children with AD exacerbation and children with signs of secondary infection. Patients with acute disease and patients with signs of secondary infection were also more likely to have lower level of Bifidobacterium longum (р = 0.03 : 0.034) than patients in remission. Conclusion. Our findings suggest that the intestinal microbiota of children in remission differs from that in children with AD exacerbation or complicated AD. The composition of commensal flora, as well as species richness directly depend on the disease severity. Children with AD exacerbation were found to have lower concentration of Oscillospiraceae species and B. longum that are crucial for normal functioning of the gastrointestinal tract and modulation of the immune response. Understanding of the metabolic potential of bacteria will enable adequate diet correction of the intestinal microbiota. Thus, sequencing of bacterial 16S rRNA genes is very helpful in the diagnosis of AD. It also opens new horizons in the search for new treatment methods. Key words: alpha diversity, atopic dermatitis, children, intestinal microbiota, molecular genetic methods, 16S sequencing
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