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New Mechanisms of a Chronic Gastroduodenitis Pathogenesis in Children of a Preschool Age (Immunologic Aspects)
Aim of work is elaboration of the different etiology chronic gastroduodenitis diagnosis and treatment new criteria in children of a preschool age on a basis of its clinicomorphological and immunologic peculiarity study.
Materials and Methods. The clinical observations and laboratory and instrumental investigations are made in 106 children at the age of 4—7 years (52 boys and 54 girls) with a chronic gastroduodenitis (ChGD) with detection of the cytokine IL-β, FNO-α and IL-4 content in a gastric juice portion on an empty stomach.
Results of investigation. A ChGD, associated with H. pylori, is characterized by a high rate (100%; p=0.0389) of a painful abdominal syndrome, a combined lesion of the stomach anthral department and duodenal bulb (94%; p=0.0138) with nodular changes in a gastroduodenal mucous membrane in half of the patients (p=0.0076) and a diffusive inflammation in the stomach prevailing (89%; p=0.0018). A ChGD at the background of alimentary allergy, independently from H. pylori, is characterized by intensive painful syndrome (60%; p=0.0210), an isolated duodenitis in a third of patients, the erosive (32%; p=0.0480) and subatrophic (25%; p=0.0348) changes in a gastroduodenal mucous membrane, a prevailing of the gastritis superficial forms (67%; p=0.0035).
It is established, that a ChGD in children of a preschool age is accompanied by the IL-1β, FTN-α and IL-4 concentration increase in a gastric juice portion on an empty stomach. A degree of the IL-1β increase, observed in a majority of patients (86%), is connected with a period of disease (γ=0.36; p=0.0101). A FTN-α level is increased in a half of children (51%) and correlates with expression (γ=0.50; p=0.0049) and activity of inflammation (γ=0.46; p=0.0345) in the stomach mucous membrane. A cytokine profile of a gastric juice at a ChGD, associated with H. pylori, is characterized by the IL-1β and FTN-α increase, and the IL-1β and IL-4 concentration increase at a ChGD at the background of alimentary allergy.
The revealed peculiarities of a gastric juice cytokine profile at a ChGD, depending on etiologic factor of disease, reflect not only a character of the cytokine relationships with the secretory immunity values, the markers of allergy and alimentary sensibilization, but a priority direction of a local immune response in the stomach mucous membrane: a Th1-type at a HB-associated gastritis, a Th2-type at an alimentary allergy, and can serve as additional diagnostic criteria and be a basis for differential approach to treatment of children.
