Sokolnyk
S.V.,
Sorokman T.V.,
Palavar L.G.
Bukovinian state medical university
STRUCTURE OF GASTROENTEROLOGICAL PATHOLOGY OF CHILDREN WITH GOITER
The problem of deficiency iodine diseases comes into all more notice in
the whole world in connection from considerable prevalence and unfavorable
mediko- social consequences of
pathology, related to the deficit of iodine and is one of primary tasks of
health protection population on the whole and child in particular.
In clinical practice plenty enough of information is accumulated that
deficit of thyroidin hormones be what degree negatively influences on child's
organism, is the factor of high risk of violation of growth and development for
children, forming of chronic pathology and growth of socially meaningful
illnesses. On a background iodine insufficiency there are violations of neuro-psychological development of, which
have a wide spectrum - from the decline of intellect of easy degree to the
heavy forms of endemic cretinism. In the districts of iodine deficit found out
the low particle of schoolboys which have harmonious development of
personality, in third of children rejections are registered in sexual
development, and there are violations of indexes of reproductive health in the
halves of girls.
To examine prevalence and structure of gastroenterological
pathology of children with goiter.
The program of inspection foresaw the
statistical analysis of school age (500 persons) children’s case report with
pathology of gastrointestinal tract, with the selection of clinically
instrumental and laboratory researches.
Determination
of concentration of iodine in urine of children from the different climate-geographical
areas of Bukovina showed that in most children excretion of iodine with urine
is reduced. A median of ioduria in inspected population on the whole is 58,1 ±
3,2 mkg/l, for children Chernivtsi 69,8 ± 2,87 mkg/l, mountain area - 29,08 ±
2,14 mkg/l, flat area - 66,4 ± 3,22 mkg/l mkg/l.
General frequency of goiter for the children of Bukovina from data of
palpation research is 53,3% and as a result of US 30,08%, both for boys and the
goiter of I of degree prevails for girls, for certain
high-frequency of goiter and predominance of his heavy degrees it is registered
for the children of mountain area of dwelling.
The laboratory signs of subclinical hypothyroidism
were observed in 3,4% all population of the inspected children. 34,6% children
of basic group (with the different degrees of goiter) were characterized the
changes of indexes of thyroid type of, which go out outside age-old parameters,
18,8% have signs of subclinical hypothyroidism. Children from the mountain area
of dwelling had the most wide vibrations of maintenance of hormones of the
hypophysial-thyroid system.
It costs to notice that
as a result of research not a single child from the inspected group does not
use marine products, rich on maintenance of iodine, iodized salt is used only
by a 1 family from 50, but also they use and keep salt without the observance
of elementary hygienical requirements.
In the structure of gastroenterological pathology among children with
the goiter of 1-2 degrees first place has chronic gastroduodenitis - 86,6%.
Characteristic of this pathology is a decline of amount of hypertrophic gastroduodenitis with the displays of lymphofollicular
hyperplasia, increase of erosively
destructive affection of gullet, stomach and duodenum. The erosive - hemorrhagica affection of tunica mucosa is registered in 15,5%
schoolchildren. Primarily these kids are more frequently boys that live on endemic
territory (1-2 degrees of endemic goiter). The clinical picture of such patient
border is not determined between the periods of aggravation and remission,
there is no clear localization of pain that has stable character and does not
depend on the reception of meal. Classical basic therapy does not give a
positive clinical result and prolonged effect.
Morphologically superficial gastritis is confirmed in 34% of cases,
gastritis with the affection of glands without atrophy - in 28%, moderate
atrophy - in 18%, expressed atrophy - in 3,7%.
Pays attention on itself increase of frequency of gastric and duodenum
ulcers. Thus, if in 2000 year ulcer of stomach and duodenum registered in 4,6%
children, than in 2008 year - in 9,7%. In 88,7% of sick children with pathology
that is associated with Heliobacterium that it is confirmed with express method
and cytological
research.
Among concomitant pathology of this contingent of children the
pathological changes of liver (67,7%) of different level of affection prevailed
often in combination with affection of the bile-excreting system,
kidneys and intestine.
More than half of children had allergic affection: allergic dermatitis and food allergy.
Chronic gastroduodenal pathology had 60% of children with prolonged syndrome of “chronic
unspecific intoxication”. There are fewer occurrences of combined affection of
gastroduodenal zone with pathology of pancreas.
Analysing the results of laboratory examination was discovered that such
children had increased amylase in blood. At the same time ultrasonic research
of sign of
dyspacreatism was registered in 90% of children with gastroenteritis
pathology. We consider such state as reactive involvement of pancreas to the
pathological process in connection with the uneven arcade of bile in duodenum
because 87% of children were found with various deformations of gallbladder.
There was S-form deformation of gallbladder in third part of patients. A ponderable
part (35%) included various refluxes.
Thus, there is considerable growth of gastroenterological
pathology among school age children that live in the zone of endemic goiter.