Kryuchko Tetyana O, Nesina Inna M, Tkachenko Olha Ya
Higher State Educational Establishment Of Ukraine "Ukrainian Medical Stomatological Academy", Poltava, Ukraine.
Wiad Lek. 2017;70(2 pt 2):275-281.
The most common medical conditions in infants, which belong to pediatric and gastroenterological disease areas, are functional gastrointestinal disorders, food hypersensitivity and food allergy. First of all, these symptoms can disguise lactase deficiency, cow's milk protein allergy, eosinophilic gastroenteritis, allergic proctocolitis, gastrointestinal manifestations of atopic dermatitis, functional disorders of gastrointestinal and biliary tract, etc. The aim of our study was to develop an algorithm of monitoring for infants with disorders of the gastrointestinal tract and to study the efficacy of probiotic and enzyme replacement therapy. Materials and metods: 47 children aged 1 to 3 years with gastrointestinal and atopic dermatitis symptoms underwent clinical and laboratory examinations.
Analysis of additional examination revealed the causes of gastrointestinal disorders, and the following diagnoses were made: 15 children (32 %) had secondary lactase deficiency, 9 children (19 %) had sensitization to cow's milk protein and caseins. Molecular-genetic analysis of С > Т polymorphism at position 13910 of lactase gene (LСT) demonstrated that C/C-13910 genotype was observed in 44.7 % of children, С/Т-13910 heterozygous genotype was found in 36.2 %, and 19.1 % of children had Т/Т-13910 genotype; these were interpreted in conjunction with other clinical criteria for verification of secondary lactase deficiency diagnosis.
Assessment of children over time during their treatment showed that combined therapy using lactase preparation and probiotics contributed to relief of clinical symptoms. All patients had their fecal pH increased (> 5.5), whereas the majority of children demonstrated improvement yet on days 2-3 (i.e., decrease in pain syndrome, flatulency, and stool frequency; restoration of normal stool consistency). Based on the obtained data, we proposed a practical algorithm for verification and monitoring of children with gastrointestinal disorders.
婴儿中最常见的疾病属于儿科和胃肠病学领域，包括功能性胃肠疾病、食物过敏和食物不耐受。首先，这些症状可能掩盖乳糖酶缺乏、牛奶蛋白过敏、嗜酸性胃肠炎、过敏性直肠结肠炎、特应性皮炎的胃肠道表现、胃肠道和胆道的功能性紊乱等。我们研究的目的是制定一种针对胃肠道疾病婴儿的监测算法，并研究益生菌和酶替代疗法的疗效。材料与方法：对47名年龄在1至3岁、有胃肠道和特应性皮炎症状的儿童进行了临床和实验室检查。
进一步检查分析揭示了胃肠道疾病的病因，并做出了以下诊断：15名儿童（32%）患有继发性乳糖酶缺乏，9名儿童（19%）对牛奶蛋白和酪蛋白敏感。乳糖酶基因（LCT）第13910位C>T多态性的分子遗传学分析表明，44.7%的儿童为C/C-13910基因型，36.2%为C/T-13910杂合基因型，19.1%的儿童为T/T-13910基因型；这些结果结合其他临床标准用于验证继发性乳糖酶缺乏的诊断。
对儿童治疗期间的长期评估表明，使用乳糖酶制剂和益生菌的联合治疗有助于缓解临床症状。所有患者的粪便pH值均升高（>5.5），而大多数儿童在第2至3天症状就有所改善（即疼痛综合征、肠胃胀气和排便频率降低；恢复正常大便稠度）。基于所获得的数据，我们提出了一种用于验证和监测胃肠道疾病儿童的实用算法。
