Irritable bowel syndrome in children. teaching aid

Irritable bowel syndrome (IBS) is a functional disease of the digestive system, which is accompanied by a number of motor and evacuation abnormalities.

The pathology has pronounced symptoms, manifested in the form pain, flatulence, alternating constipation and diarrhea. The disease can occur at any age, but children are at particular risk. With absence timely therapy Irritable bowel syndrome can cause other diseases gastro- intestinal tract. Prognosis directly depends on the stage of the disease and the adequacy of treatment.

1. Causes of occurrence

Many factors can trigger irritable bowel syndrome in a child. In most cases, the cause of the disease is errors in nutrition and pathology of the digestive system. IBS can be inherited. In some cases, the causes of the pathology remain unclear.

For example, if a child has an altered intestinal pain threshold, then the risk of irritable bowel syndrome will be maximum.

Causes of IBS:

The result of a violation of the pain sensitivity threshold of the gastrointestinal tract is a change in the level of enkephalins. These substances are proteins with a morphine-like effect. They affect certain groups of receptors and provoke acceleration of peristalsis (the process is accompanied by severe pain). Symptoms can be aggravated by accompanying hormonal imbalances.

At-risk groups

The risk group for IBS includes children with a hereditary predisposition to diseases of the digestive system, as well as lability nervous system.

Plays an important role in preventing irritable bowel syndrome proper feeding the baby from the first days of life and attentive attention to the state of his health. Children exposed to inadequate care are more likely to suffer from gastrointestinal disorders (for example, children from disadvantaged families).

Other risk groups:

children starting to attend kindergartens and schools (changes in diet and diet);
babies who switch to artificial feeding early;
identical twins (in fraternal twins, IBS is diagnosed less frequently).

2. Classification

IBS is divided into several categories depending on the symptoms that occur. Irritable bowel syndrome can occur with, be mixed or unclassified type. In the first case, solid feces predominate in the stool (bowel emptying is difficult), in the second - liquid ones. At mixed type are replaced.

Unclassified IBS is difficult to classify into any group due to the presence of mixed symptoms.

Code in ICD-10

According to ICD-10, irritable bowel syndrome is assigned code K 58. Pathology with predominance is marked with code K 58.0, with a predominance of symptoms - K 58.9.

3. Symptoms

The main symptoms of irritable bowel syndrome in children are sharp ones, which decrease or disappear after bowel movements, and alternation with. The general condition of the child depends on the form of IBS. In some cases, the main symptoms may be accompanied by external intestinal manifestations in the form of insomnia, excessive sweating, rapid heartbeat or respiratory dysfunction.

Symptoms of IBS depending on the form of pathology:

with irritable bowel syndrome, the child has no stool at night, defecation occurs mainly in the morning (liquid stool, the process of bowel movement is carried out several times in a row after a short period of time, in the right iliac region spastic pain of varying intensity may occur);
when predominant, the process of bowel movement does not occur regularly, the stool may change its consistency (defecation is carried out several times a week, constipation may occur after constipation, it can be permanent or periodic);
with unclassified IBS, the symptoms alternate (the child exhibits all the signs of pathology, including pain, external intestinal manifestations and general weakness of the body);
Regardless of the form of IBS, a child may experience symptoms such as, the presence of, attacks or, excessive anxiety or irritability.

4. Diagnostics

The process of diagnosing IBS is difficult in children younger than age category. In babies, irritable bowel syndrome is often mistaken for infant colic. The diagnosis can only be confirmed comprehensive examination, in which a pediatrician, gastroenterologist, endocrinologist, proctologist and coloproctologist should take part.

If IBS is suspected, the child is prescribed a specific list of tests and procedures.

The following methods are used to diagnose IBS:

biochemical and clinical analysis blood;
stool occult blood test;
bacterial culture of stool on the intestinal group;
fecal analysis for helminths;
examination for dysbacteriosis;
ultrasonography of the large intestine;
Ultrasound of organs abdominal cavity;
irrigography;
endoscopic examination;
X-ray of the stomach.

5. Complications and consequences

With absence adequate therapy IBS can become chronic pathology. With regular use there is a risk of developing other serious illnesses digestive system. Some of the complications will significantly reduce the child's quality of life and will require constant use of certain medications.

Possible consequences of IBS:

dehydration (with uncontrolled use laxatives);
gastric bleeding and necrosis of the mucous membranes of the digestive system;
abnormalities in kidney function;
disorders of the cardiovascular system;
chronic pathologies of the digestive tract;
psychical deviations.

6. Treatment of irritable bowel syndrome in children

The treatment regimen for IBS in children is based on individual clinical picture child's condition. IN mandatory dietary correction and symptomatic treatment are carried out.

If a child is diagnosed with hypermotor dysfunction of the digestive system, then electrical stimulation of the abdominal area, massage of the anterior abdominal wall or paraffin applications.

Medication

One of the main methods of treating IBS in children is drug therapy. The list of prescribed drugs depends on the form of the pathology and the general condition of the child. It is not recommended to create a therapy schedule on your own. Otherwise, the risk of complications increases.

Treatment should include not only medications that relieve symptoms of IBS, but also restorative medications to improve the functioning of the gastrointestinal tract.

Examples of drugs for the treatment of IBS:

Dietary supplements and herbs

Biological active additives to food help improve the functioning of the digestive system, but replace them with medications It’s not possible for IBS. Such funds can be used to prevent abnormalities in the gastrointestinal tract. For irritable bowel syndrome, dietary supplements Narine or are very effective.

These products contain probiotics and prebiotics. A similar rule applies to herbal medicine.

Herbs to improve the digestion process:

mint;
aloe;
chamomile;
fennel;
nettle;
valerian;
sage;
ginger;
cinnamon.

Traditional medicine

Alternative medicine prescriptions for IBS are used as an adjunct to primary therapy. When selecting such funds, it is important to consider individual characteristics the child’s body (for some components, children may experience allergic reaction). If you use folk remedies as a replacement for drug therapy, a temporary improvement in the functioning of the digestive system may give way to serious complications.

Examples of folk remedies:

infusion of pomegranate peels(the recipe is used as a fixing agent for pomegranate peels, pour boiling water over them, leave for 30 minutes, it is recommended to take the product one tablespoon before each meal);
tea based on mint (mint leaves are poured with boiling water, infused for 10 minutes, the product should be taken in small portions throughout the day, honey can be added to improve the taste of the drink);
apples (the child needs to eat one medium-sized fruit daily; apples improve the digestion process and contain many elements useful for the gastrointestinal tract).

Diet

A mandatory step in the treatment of IBS is diet. Changing the diet will help not only normalize the functioning of the digestive system, but also speed up the child’s tendency to recovery.

Meals should be eaten in small portions (5-6 times a day in small portions). Products must undergo full heat treatment.

Fried and fatty foods, chocolate, muffins, cocoa and strong tea should be excluded from the diet of a child with IBS;
Do not consume carbonated drinks and foods that increase gas formation (for example, White cabbage or legumes);
During therapy, whole milk products are excluded from the child’s diet ( fermented milk products not only allowed, but also recommended for use);
pickles, canned food, marinades, spices and seasonings must be excluded from the diet;
improves the functioning of the digestive system congee or porridge;
meat for baby food selected from low-fat varieties(children can only consume such products in boiled form);
the menu should include jelly based on berries, semolina, soups, black currants and blueberries;
when the menu must include vegetables and fruits rich in dietary fiber.

To accelerate the recovery trend in IBS, parents need to follow a number of important rules. Experts recommend keeping a special “food diary”, in which the reactions of the baby’s digestive system to food are recorded. certain products and his diet.

If IBS symptoms return, the doctor will be able to draw up as much information as possible by reviewing the records. effective course therapy.

providing the child with daily walks fresh air and sufficient physical activity;
control of diet and proper menu planning;
compliance with the therapy schedule and all doctor’s recommendations;
creating a favorable atmosphere with the exception of stressful situations.

7. Psychotherapy

With IBS, children may experience abnormalities in the nervous system. To treat mental disorders, special therapy is prescribed. In some cases, a child may need the help of a psychologist (with anxious and suspicious moods, depression, phobias, irritability or impulsive behavior). The duration of therapy depends on the general state of the baby’s psyche and the reasons that provoked IBS.

Psychotherapy includes the following techniques:

Gestalt therapy;
training in conflict-free communication;
relaxation techniques;
interpersonal therapy;
Ericksonian hypnosis.

8. Forecast

Favorable prognosis for IBS is only possible with timely diagnosis and adequate treatment of the pathology. Following your doctor's recommendations greatly reduces the risk of complications. If therapy is carried out incorrectly or is absent, then the consequence of irritable bowel syndrome can be dangerous conditions- or dehydration. As they progress, the child’s life will be threatened.

9. Preventive measures

If your child develops symptoms of IBS, you should consult a doctor and undergo an examination. Ignoring or as well as them untimely treatment may have a negative impact on general condition health and cause serious complications. Control of a baby’s diet should be carried out from the first days of his life. Experts recommend prolonging breastfeeding as much as possible.

Preventive measures:

providing the child with proper and good nutrition(foods should be rich in vitamins);
prevention of traumatic factors (the child should grow up in a prosperous atmosphere);
Complementary feeding of babies should be carried out in accordance with age;
All diseases in a child must be treated fully and in a timely manner.

10. Conclusions

irritable bowel syndrome is a functional pathology of the digestive system (the disease manifests itself in the form of motor-evacuation abnormalities);
IBS may be accompanied by, or alternating different types deviations in the process of bowel movement;
In children, IBS is often combined with psychological factors(stress leads to pathology, and the consequences of the syndrome can be phobias and serious disorders of the psycho-emotional state);
treatment of pathology includes drug therapy, herbal medicine, diet therapy, psychotherapy and implementation of special clinical recommendations;
Without adequate treatment IBS can cause critical dehydration in a child (such conditions pose a threat to life).

Engaged in the prevention, diagnosis and treatment of diseases of the stomach, esophagus and 12 duodenum, diseases of the pancreas and liver of alcoholic etiology. Treats intestinal dysbiosis and constipation.

IN Lately patients who come with complaints of abdominal pain are increasingly seen in the note left by the doctor in medical card, an incomprehensible abbreviation - Irritable Bowel Syndrome (IBS). The therapist for a short time Of course, there is no time to explain in detail what kind of illness this is.

Meanwhile, in the treatment of irritable bowel syndrome, as IBS stands for, no matter what medications the doctor prescribes, the main thing that the patient should know is that recovery largely depends not on the medications, but on his lifestyle.

Irritable bowel syndrome is a specific condition that is manifested by functional disorders in the intestines, in which it is possible.

The disease occurs more often in women, lasting about three days for three months in a row throughout the year.

Start treatment by changing your lifestyle. The daily routine includes morning exercises, daily long walks, jogging, cycling, swimming, hardening, and massage.

Normalize your diet and rhythm. Do not overeat under any circumstances, eat little by little at regular intervals.

If IBS manifests itself as diarrhea, limit your consumption of vegetables, especially beets, carrots, celery root, and onions. Avoid apples and plums.

If you have constipation, reduce the menu of fried and baked foods, fatty meats, do not snack on sandwiches, and do not drink strong tea.

In case of gas formation, legumes, corn, white cabbage, nuts, grapes, carbonated drinks and baked goods are prohibited.

If you are prone to constipation, an hour to an hour and a half before meals, 2-3 times a day, drink a glass of chilled mineral water such as “Smirnovskaya”, “Slavyanovskaya”, “Batalinskaya” or “Essentuki” No. 17.

If diarrhea predominates, drink mineral water such as “Borjomi”, “Narzan” or “Essentuki” No. 4 - 1-1.5 glasses warm without gas an hour before meals 2-3 times a day.

In a traumatic situation, after consulting a neuropsychiatrist, take cuts or amitriptyline.

If the disease is accompanied by diarrhea, smecta or loperamide When constipation predominates - guttalax or weakened.

Pain and spasms will be relieved no-shpa or duspatalin. At for bloating, take espumisan or carbolene, and for intestinal dysbiosis hilak forte or lactulose.

Enzyme preparations pancreatin or pancrea-oflat will relieve flatulence, eliminate disturbances in the digestive processes.

Let me note that when treating irritable bowel syndrome, it is not so important what medications the doctor prescribes. Here is the case when recovery largely depends on the patient himself, who must normalize the diet and rhythm of nutrition, lead healthy image life, learn to control your emotions.

Supplement your drug treatment with recipes from the arsenal of traditional medicine. However, first try to do without medications altogether - take them off unpleasant symptoms IBS in some cases can be treated with herbal medicine.

Peppermint oil

- 3-5 drops on a piece of sugar, sucked before bed, will not only calm the nerves, but also relieve intestinal spasms.

At diarrhea crushed will help - 1 tbsp. Eat a spoonful in the morning on an empty stomach or before bed.

Blueberry infusion

Pour 2 teaspoons of raw material into a glass of water, keep in a water bath for 15 minutes, cool for 1 hour. Drink 0.5 glasses 2-3 times a day.

Please note that treatment of IBS with diet and folk remedies should be used only after consultation and examination by a specialist.

Now I'll stop at water procedures and exercise - this is a good help for irritable bowel syndrome.

Take warm (37-38 degrees) general or sitz baths. They perfectly relieve intestinal spasms without any medications. Baths with sea salt are especially good.

Pour 1.5-2 kg of salt with hot water, then fill the bath to the top warm water. The procedure time is 15-20 minutes.

You can take a bath with pine concentrate or alternate with sea salt. Such procedures also wonderfully calm the nervous system.

If taking a bath is problematic for any reason, apply a wet wrap at night. Wet a towel with warm water and apply it to your stomach.

Along with baths, simple exercises for the abdominal and pelvic floor muscles improve intestinal function and normalize the neuropsychological state.

If you have a lazy intestine, do a “bicycle”; if you have hyperkinesia, do relaxation exercises. Also perform abdominal breathing, bending and turning the torso to the sides, flexing and extending the hip joints with rotation of the hips.

Perform this kind of gymnastics rhythmically, without tension or with slight strengthening, at an average pace, every day for 10 minutes, maybe longer, but without excessive zeal.

Master the now so popular Nordic walking. Or just try to walk more and, if possible, go swimming. Leisurely walks in the fresh air and reasonable physical activity will also help keep emotions under control.

Get up in the morning 10-15 minutes earlier than usual - this will allow you to take your children to school, your husband to work, and get ready calmly without fuss and hassle. Control yourself, don’t be dissatisfied with others, show condescension. When you feel stress coming on, try to breathe slowly and deeply.

While working, take short breaks, do not stay in one position for a long time, and, if possible, do simple warm-up exercises. On weekends, do not only do your accumulated household chores, but also find hours for active, varied recreation. Consume.

Abdominal pain, changes in stool, flatulence are symptoms that may indicate this in children. This is a multifunctional disorder, in which for at least 12 weeks the patient experiences abdominal pain for at least 12 weeks, which significantly decreases or disappears after defecation, accompanied by a change in stool frequency and stool structure.

Causes

This is a disease gastrointestinal system, characterized by the presence of abdominal pain, which is significantly reduced by defecation. The main factors contributing to the onset of the disease have not been fully studied. There are many reasons why irritable bowel syndrome occurs in children:

hereditary predisposition to the development of the disease;
dysbacteriosis;
transferred company viral infections;
unbalanced diet;
helminthic infestations;
intestinal infections;
the presence of an unfavorable psycho-emotional climate in the family;
visceral hypersensitivity;
stagnation of food in the intestinal walls;
binge eating;
insufficient fiber intake;
presence of brain damage during labor activity;
absence breastfeeding;
use of antibiotics;
anatomical and physiological characteristics structure of the organs of the abdominal system.

The danger of this disorder lies in the development of mental and emotional disturbances, and sometimes the stress itself provokes the appearance functional diseases gastrointestinal system.

Symptoms

Clinical symptoms diseases are characterized by their diversity and speed of development clinical manifestations. The disorder is characterized by the absence of complications even if certain therapeutic effects. Signs of the syndrome increase when the urge to have a bowel movement occurs; after the end of bowel movement, all symptoms disappear. The main symptoms of irritable bowel syndrome in children:

Abdominal pain. It has temporary nature and occurs when it is necessary to have a bowel movement.
Violation of the act of defecation. There is a threefold increase in stool frequency, as well as the presence of incomplete emptying. Some patients experience constipation. Bowel disorders and an increase in the intensity of going to the toilet may also occur.
Flatulence. Stagnation of food and its accumulation in anatomical cavity intestines causes an increase in gas formation. Symptoms of this disorder include bloating and a feeling of discomfort and heaviness.
Syndrome chronic fatigue.
Dizziness.
Paresthesia. They are one of the types of sensitivity disorders, characterized by the spontaneous appearance of a burning sensation or a sensation of goosebumps. This reaction occurs when the child feels the need to defecate. This reaction indicates the emergence of psychological discomfort and fear.
Increased frequency of urination.
Migraine.
The appearance of behavioral and psycho-emotional disorders.
Mucus discharge and change in stool consistency. Often observed in infants who are not fed mother's milk, but mixtures. Excessive mucus secretion helps facilitate the act of bowel movement.
The appearance of false urges.
Colic. Painful and sharp pains localized in the abdominal area. As a rule, the appearance of this symptom indicates an unbalanced diet and a lack of systematization. It is also necessary to ensure sufficient consumption drinking water to speed up digestion and reduce the intensity of colic.

If you notice any signs of illness, you should visit medical institution for detailed differential diagnosis child's condition. An examination of the baby must be carried out by a gastroenterologist with the appropriate patents for medical practice.

How to diagnose and treat IBS in children?

Necessary activities

To the list of necessary diagnostic measures the following should be included:

as the basis for a detailed diagnosis, blood tests (general clinical and biochemistry) are required;
analysis feces necessary to confirm or exclude the presence of dysbacteriosis, hidden blood in feces, helminths;
examination of the abdominal cavity using ultrasound and sonography of the colon;
endoscopic examination (colonoscopy, sigmoidoscopy, FGDS) will allow you to study the condition of the intestinal walls, detect visual pathological changes, and also, if necessary, take material for a biopsy;
fluoroscopy can provide information about chronic diseases Gastrointestinal tract;
Anorectal manometry is necessary to assess intestinal motor function.

If any pathologies are detected, the child being examined needs additional consultation with specialized pediatric specialists, such as:

proctologist;
gastroenterologist;
neurologist;
psychiatrist.

Thus, diagnosis using the above methods consists in excluding pathological changes and other diagnoses.

Drug treatment

Drug treatment Irritable bowel syndrome in a 6-year-old child (or any other age) is aimed at suppressing unpleasant manifestations, which are extremely varied. For this reason, treatment involves different categories of substances. Their use should be under the strict supervision of the attending physician.

Dietary supplements and herbs

To cure the disease, numerous herbs that have a pharmaceutical effect, as well as drugs made from them, are used. They can help with increased gas formation, reduce abdominal pain, remove inflammation in the intestinal tract, and are used for constipation and diarrhea. This also includes dietary supplements containing probiotics, such as “Narine”, “Bifiform”, etc. But there is no evidence that their use is effective for such pathology.

Antispasmodic substances

With the syndrome inflamed bowel, doctors strongly recommend paying attention to the following drugs. They relieve pain and relieve some of the symptoms:

"No-Shpa";
"Buskopan";
"Dicetel";
"Duspatalin";
"Niaspam" and others.

These medications minimize pain by eliminating spasms of the intestinal tract. The structure of most of them includes peppermint oil, which occasionally causes a burning sensation on the skin or heartburn. Medicines are prohibited for use during pregnancy.

Regulating the functioning of the gastrointestinal tract

Pharmaceuticals, which normalize the functioning of the gastrointestinal tract, are prescribed depending on the type of IBS. To treat irritable bowel syndrome with constipation, the doctor prescribes laxatives. They increase the amount of fluid in the stool, making it softer. During the period of use you should consume great amount water. Likely Negative consequences, such as bloating or flatulence.

Anti-diarrheal substances - Imodium and Loperamide - help improve the situation of the patient with diarrhea syndrome. They compact the excrement, allowing it to reach the required size and increase the transit time through the gastrointestinal tract. In most cases, patients notice a favorable result, but abdominal cramps, bloating and lethargy are not excluded. Contraindications are similar to those for laxatives.

Antidepressants

This category of medications changes the psycho-emotional state of the patient. In case there is diarrhea and abdominal pain without signs deep depression, the doctor prescribes medications from the category of tricyclic antidepressants:

"Amitriptyline";
"Imipramine."

As a secondary result, lethargy and dry mouth occur, but after 10 days of use they disappear. For irritable bowel syndrome with constipation, manifested by depression and abdominal pain, selective serotonin contra-uptake inhibitors - Fluoxetine and Citalopram - are used. But if the patient has diarrhea, the situation will only worsen. There may be a temporary decrease in visual acuity and dizziness. Regardless of the type of antidepressants, they must be used strictly following the dose and dosage interval.

Psychotherapy

Many people are interested in how irritable bowel syndrome in children can be treated. Clinical guidelines discussed above, but you can use another method - psychotherapy. Cognitive behavioral treatment provides optimal results. There are several goals in psychotherapeutic work with a patient.

The first goal is to eliminate the fear of waiting for the next seizure and change the “avoidant” behavior. Here, the period of studying self-control during an exacerbation begins is very important; techniques are used that help reduce the degree of tension and fear. These are specialized concentration and breathing procedures. Improving self-control makes it possible to more regulate behavior and increase the comfort zone when moving in your own life. And as a result, the reflexes of the intestinal tract, which lie in the reinforcement mechanism of IBS, are weakened.

In addition, attention is paid to developing distinctive features personality, because similar states are characteristic of emotionally unstable and restless individuals who have “learned” to limit their stress inside the body. Research and mental processing of current pressing problems, past catastrophes in life, expectations of upcoming failures and the impending meaninglessness of existence are being conducted. This kind of systematic approach to the issue, if a person is suffering from irritable bowel syndrome, makes it possible to cope more reliably and with a stable result for the future.

Diet

Consumption large quantity food can cause stomach cramps and diarrhea, so you need to eat small portions or eat less, but increase the number of meals. Also, while eating, it is necessary to ensure that the child does not rush and chews the food thoroughly. First of all, you need to give preference to fiber products. Fiber has a number of useful properties: relieves cramps, improves digestion and makes the baby’s stool softer, which makes bowel movements easier. For irritable bowel syndrome in children, Komarovsky, a well-known doctor, also recommends turning to diet.

There are two types of fiber:

Soluble fiber - beans, fruits, oatmeal.
Insoluble fiber- whole grains and vegetables.

Research shows that soluble fiber is more effective in relieving IBS symptoms. To determine the required amount of fiber for a child per day, nutritionists recommend using the “age plus 5 grams” rule.

For example, a seven-year-old child should get 7 plus 5, which is twelve grams of fiber per day. In some cases, fiber may cause increased gas formation and lead to an exacerbation of IBS symptoms, so the amount of fiber per day may vary for different children.

You should also avoid foods that contain the protein gluten. Foods that contain gluten include most cereals, grains and pasta.

More and more often, doctors advise trying special diet, known as FODMAP. This diet allows you to reduce the consumption of foods containing difficult-to-digest carbohydrates. FODMAP carbohydrates are poorly and incompletely absorbed in the intestines and cause distress.

These products include:

apples, apricots, blackberries, cherries, mangoes, nectarines, pears, plums and watermelon, or juice containing any of these fruits and berries;
canned fruits and dried fruits;
asparagus, beans, cabbage, cauliflower, garlic, lentils, mushrooms, onions, peas;
milk, cheese, yogurt, ice cream, cottage cheese and other dairy products;
wheat and rye-based products;
honey and food high content fructose;
candies, chewing gum and anything else created using artificial sweeteners.

These diet principles have conflicting points, so it is important to remember that each child has his own individual characteristics. Therefore, it is important to seek help from a medical facility.

MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RF

Department of Pediatrics

Educational and methodological manual

for students of pediatric faculties, interns, residents and pediatricians.

Irritable bowel syndrome in children

Irritable bowel syndrome (IBS), classified as a functional disease of the gastrointestinal tract, is usually considered as a biopsychosocial disease that can affect the emotional and mental state of the patient, his social activity, professional activities and family relationships. This pathology does not pose a danger to human life, but significantly limits his creative freedom.

This explains the great attention to IBS, a diagnosis that is increasingly appearing in medical practice, including pediatrics.

IBS is one of the common diseases of the adult population. According to medical statistics, from 40% to 70% of patients visiting a gastroenterologist have IBS with a female to male ratio of 2-4:1 with a peak of the disease at 40 years of age. In the domestic literature, reports on IBS in children are mainly of a general educational nature and are based on a small number of observations, which does not allow us to judge the real frequency of its occurrence.

The term “irritable bowel syndrome” was first coined by Peters and Bargen in 1944. In 1988, at the International Workshop in Rome (Rome Criteria I), a definition of IBS was developed as a complex of functional disorders lasting over 3 months, the main clinical symptoms of which are abdominal pain (usually decreasing after defecation), accompanied by flatulence, rumbling, a feeling of incomplete bowel movement or an imperative urge to defecate, as well as disturbances of its function: constipation, diarrhea or their alternation .

In 1993, during the 10th revision of the International Classification of Diseases and Causes of Death, the World Health Organization officially introduced the diagnosis "irritable bowel syndrome".

However, to date, the diagnosis of IBS has been interpreted ambiguously in both domestic and foreign literature, especially in pediatric literature. Some authors consider it inappropriate to talk about IBS as an independent nosological form, since the concept of “syndrome,” in their opinion, includes not one, but several diseases. Other authors reject the functional nature of the disorders present in this case [Sheptulin A.A., 2001]. Nevertheless, most experts classify IBS as an intestinal functional disorder.

The term “functional disorders of the gastrointestinal tract” implies the absence of organic disorders in the presence of some deviations in the functioning of this system (sensitivity and motor skills) [Mukhina Yu.G. et al., 2003].

Diagnosis of functional disorders, including IBS, often causes significant difficulties in practitioners, on the one hand, due to insufficient laboratory and instrumental equipment of medical institutions, and on the other, due to ignorance or, most likely, misunderstanding of this problem. This situation leads to a large number of various diagnostic studies, making this syndrome rather a diagnosis of exclusion and often entails the prescription of irrational therapy.

What is meant by the term IBS in modern gastroenterology?

The latest refined definition of irritable bowel syndrome was adopted in 2000 in Rome at the International Meeting of Experts on Functional Gastrointestinal Disorders and was called the “Rome Criteria”:

Irritable bowel syndrome– a complex of functional disorders lasting over 3 months, including the following persistent or recurrent symptoms:

Pain or discomfort in the abdomen that decreases after bowel movements;

Changes in stool frequency;

Change in stool consistency.

The etiology and pathogenesis of IBS remains poorly understood.

The fact that symptoms of IBS are more common in monozygotic twins than in dizygotic twins may indicate a certain role of hereditary predisposition to the development of the disease.

Great importance is attached to psycho-emotional stress. Psychological studies of adult patients with IBS have not confirmed any special personality profile in them, however, the tendency of these patients to depression and panic has been noted, 30-40% of them associate the onset of the disease with one or another stressful situation.

Decreased rectal pain threshold or more intense rectal pain when normal threshold its perception (visceral hypersensitivity).

Abnormal intestinal motility is a violation of the myoelectric activity of the muscle fibers of the colon (the response to cholecystokinin and rectal balloon administration is changed), however, these changes are not specific and are observed in patients with organic diseases intestines. There are suggestions that visceral hypersensitivity and abnormal motility begin to manifest themselves under the influence of a number of factors: intestinal infection, physical trauma, antibiotic therapy, stress, etc. Factors that irritate intestinal receptors, contributing to the formation of IBS, include: lactose and other sugars, fatty acids with short chain, food allergens, excessive bacterial growth, dysbacteriosis, etc.

Features of the regime and nature of nutrition. Normal propulsive intestinal motility presupposes the presence of the required volume of intestinal contents that excite the receptors of the intestinal wall, the presence of ballast substances in it that retain water, adsorb toxins and stimulate motility.

Past acute intestinal and viral infections, amoebiasis, giardiasis, etc.

Antibiotic therapy.

Gynecological and endocrine diseases.

Clinical manifestations of IBS are varied:

Stomach ache;

Stool less than 3 times a week;

Stool more often than 3 times a day;

Hard consistency of feces (“sheep” or “bean-shaped”);

Thin, mushy, or watery stool;

Tension during defecation;

Urgent urge to defecate (inability to delay bowel movements);

Feeling of incomplete bowel movement;

Discharge of mucus during bowel movements;

Feeling of fullness, bloating, or transfusion in the abdomen.

The presence of 2 or more of the above signs for at least 25% of the patient’s observation period gives grounds to talk about IBS.

The leading clinical symptom of IBS is abdominal pain, varied in nature (dull, sharp, spasmodic) and duration (from several minutes to several hours). However, they are all united by an essential fact - a decrease in their intensity or complete disappearance after defecation.

As presented above, changes in the frequency and nature of stool in IBS are also varied and worry more parents than children themselves.

Depending on which symptom is leading in the clinical picture of the disease, it is customary to distinguish: IBS with a predominance of abdominal pain, constipation or diarrhea.

In addition to gastroenterological complaints, children with IBS have vegetative disorders of various types, and some of them have serious mental disorders, up to depression. These patients are characterized by: impulsive behavior, anxiety, suspiciousness, increased irritability, phobic disorders, introversion, which increases as the disease progresses. Possible complaints of autonomic disorders: fatigue, weakness, headaches, anorexia, paresthesia, insomnia, palpitations, dizziness, sweating, feeling of lack of air, chest pain, increased urination, etc.

Persons with this type of personality focus their attention on intestinal symptoms, and even a favorable prognosis of IBS in these patients can cause a feeling of internal dissatisfaction, exacerbating neurotic disorders, which can, in turn, cause an exacerbation of the syndrome.

Patients with IBS are characterized by a reduced threshold for the response of sensitive gastrointestinal receptors, in particular, they have a significantly increased sensitivity to colon distension. At the same time, the reaction to intestinal distension during balloonography does not correlate with changes in mental status. Motor activity of the intestine is not interconnected with tolerance to intestinal distension with a balloon, but to a greater extent correlates with the neuropsychic characteristics of the patient and determines the type of IBS. On this basis, it has been suggested that altered receptor sensitivity may be the cause of pain during bowel distension in patients with IBS.

Based on the results of balloonography, the so-called “sensitive” type of rectum was identified. “Sensitive” rectum was detected significantly more often in patients with a predominance of diarrhea than in patients with a predominance of constipation. In patients with IBS, there is a marked decrease in the sensitivity threshold of the colon to balloon distension, colon irrigation with saline solutions, bile and fatty acids. Consequently, nonspecific colonic irritability is characteristic of these patients. At the same time, it is important that during sleep, the sensitivity of the colon in patients with IBS is normalized. Patients with IBS respond more to stimulation of colonic motility with cholecystokinin and fatty foods, especially patients with diarrhea. Disorders of small intestinal motility are also observed in these patients, and during the waking period, disappearing during sleep.

These data indicate the leading role of the central nervous system in the development of IBS. At the same time, the mechanism of pain in disorders of the motor function of the colon remains unknown.

The clinical picture of IBS is characterized by abdominal pain, usually localized in the area of the projection of the descending and sigmoid colons. Children most often localize them in the umbilical region. Pain usually occurs over a long period of time (see Rome II criteria for IBS definition), is periodic in nature, and varies in frequency, duration and intensity. They can be both dull and acute, associated or not associated with food, but, as a rule, with psycho-emotional factors. Symptoms of IBS disappear during sleep but reappear while awake.

It should be noted that trigger factors in the development of IBS in children most often are: previous intestinal and viral infections (enterovirus and rotavirus); stressful situations (separation of children early age with parents, starting to attend kindergarten or school, a conflict situation in the family or educational institution and etc.); antibiotic therapy; change of drinking water, diet and diet.

When diagnosing IBS, patients must undergo a set of laboratory and instrumental studies:

Clinical and biochemical analysis blood;

Stool analysis for:

hidden blood

presence of bacteria intestinal group(Shigella, Salmonella, Yersinia, etc.),

dysbacteriosis,

loss of fat and carbohydrates in feces;

Ultrasound of the abdominal organs;

Sigmoidoscopy with biopsy of the rectal mucosa;

Colonoscopy with targeted biopsy;

Endoscopy with biopsy for suspected celiac disease or Whipple's disease;

Irrigoscopy;

X-ray examination of the gastrointestinal tract with barium;

Electromyography and manometry of the rectum;

Consultations with specialists: neurologist, psychiatrist, gynecologist, endocrinologist, etc.

In the diagnosis of functional intestinal diseases, including IBS, the study of fecal transit through the colon is of great importance. For this purpose they are used various methods research – radiotelemetric, radiological, radionuclide. To study the motor function of the colon, enterocoloscintigraphy and scintidedefectography, and computerized manometry are used. However, these methods are not widely available in practice.

Currently, in the diagnosis of IBS, ultrasound examination of the colon in children has increasingly become used, which makes it possible to determine the size of the lumen of the colon, the thickness and layer-by-layer structure of the wall, the severity of folding of the mucous membrane, disruption of the haustra, the location and condition of the zones of unstable sphincters, and indirectly assess the condition of the wall colon, as well as nearby organs and structures of the small pelvis.

IBS stands in the structure of non-ulcer diseases of the colon on the verge of functional and organic pathology. It has been suggested that some patients with IBS may develop recurrent bacterial segmental colitis. At endoscopic examination in patients with IBS, no changes may be detected; sometimes there is slight swelling and hyperemia of the colon mucosa with mucus deposits, thickened and rough folds. Ultrastructural changes in the colon mucosa

may indicate degeneration of individual epithelial cells, moderate fibrosis in the stroma, and a predominance of bacterial cells over epithelial ones.

The scope of research in each specific case is determined individually, taking into account medical history, which makes it possible to exclude organic (structural) and biochemical disorders in the patient.

Particular attention should be paid to a number of symptoms that are called “anxiety symptoms” in the scientific literature in the diagnosis of IBS. This is an unexplained decrease in body weight, the manifestation of symptoms of the disease at night, fever in combination with hepato- and / or splenomegaly, changes in laboratory parameters (anemia, increase in ESR, blood in the stool, etc.), colon cancer in close relatives.

The presence of at least one of the above symptoms requires further, more thorough examination to exclude inflammatory (specific or nonspecific) intestinal diseases, as well as a tumor process.

Treatment IBS includes a number of sequential positions and largely depends on the leading symptom of the disease (abdominal pain, flatulence, diarrhea, constipation).

for diarrhea - table No. 3b, c

for constipation - table No. 3.

For abdominal pain - antispasmodics:

Selective anticholinergics (Buscopan, etc.)

Dicetel

Spasmomen and others.

For flatulence:

Espumisan

Meteospasmil

- Unienzyme with MPS

For diarrhea:

Imodium

Intestinal antiseptics:

Intetrix

Furazolidone

Ercefuril

With an increase in stool frequency, enterosorbents:

Polyphepan (Entegnin)

Phytotherapy

For constipation:

Wheat bran

Functional food products

Prebiotics

For all forms of IBS, “informational influence on the patient” is necessary (explanatory conversations, normalization of lifestyle, resolution conflict situations etc.) and dietary recommendations.

Diet therapy has important in the treatment of IBS.

Patients with IBS are recommended to eat regularly, in small portions with the exclusion or reduction of the proportion of animal fats, citrus fruits, chocolate, peas, beans, lentils, cabbage, whole milk, black bread, carbonated drinks, kvass, grapes, raisins. In this case, it is recommended to take unrefined products containing a sufficient amount of ballast substances in the diet (bread made from flour coarse, with the addition of bran, fresh and boiled vegetables, fruits, also taking into account their tolerance, oatmeal, buckwheat, barley).

In the presence of pain and flatulence, it becomes necessary to prescribe antispasmodics. More often used in children with IBS Buscopan in solution (1-2 teaspoons 2-3 times a day) or rectal suppositories(1-3 times a day), and for children over 6 years old, 1-2 tablets 3 times a day.

For flatulence, medications are prescribed that reduce gas formation in the intestines by weakening the surface tension of gas bubbles, leading to their rupture and thereby preventing stretching of the intestinal wall and, accordingly, the development of pain. Such a drug is simethicone (espumisan). Espumisan used in young children 1 teaspoon 3-5 times a day, in older children 1-2 capsules 3-5 times a day. Sub simplex is prescribed 15 drops - infants, 20 drops - for preschool children, 20-30 drops - for school-age children 3-5 times a day.

In older children, preference is given to Meteospasmilu – combination drug, which contains alverine and simethicone, 1 capsule 2-3 times a day before meals. Alverine is a myotropic antispasmodic, the action of which is not accompanied by an atropine-like effect. Alverine regulates gastrointestinal motility through neurogenic and myogenic control of intestinal wall contractility. Simethicone is a hydrophobic polymer substance with low surface tension that reduces gas formation in the intestines and covers the walls of the gastrointestinal tract with a protective film. Simethicone is also included in the multienzyme (fungal diastase, papain) combination drug Unienzyme with MPS , which can be prescribed to children over 5 years of age (1 tablet 1-2 times a day) both to reduce flatulence and to prevent it.

With pronounced pain syndrome used in children over 12 years of age Dicetel(pinaverine bromide) 50-100 mg 3 times a day - a Ca-channel blocker that has an antispasmodic effect; Spasmoman(otilonium bromide), which has an antispastic effect on the smooth muscles of the digestive tract (from 12 years old, 1 tablet 2-3 times a day).

When treating children with predominant diarrhea, it is prescribed Imodium(loperamide), which reduces the tone and motility of intestinal smooth muscles, being an agonist of M-opiate receptors, suppresses fast, propulsive contractions of the intestines. Antidiarrheal drug Neointestopan Due to its astringent and enveloping effect, it eliminates spasms of smooth muscles.

Correction of existing disorders of intestinal microbiocenosis is carried out. For bacterial contamination in the small intestine, antiseptics are prescribed: Intetrix, Furazolidone, Ercefuril and etc.; enterosorbents: Smecta, Polyphepan,Neointestopan and etc.

Physiotherapeutic procedures for hypermotor dyskinesia of the gastrointestinal tract can include paraffin, ozokerite or mud applications on the stomach, electrophoresis of papaverine, platiphylline, novocaine on the stomach; SMT (I and IV types of work, 3 minutes each, modulation depth 25-50%, modulation frequency 100 Hz); physical therapy, reflexology, drinking warm low-mineralized mineral waters, and for hypomotor dyskinesia - electrical stimulation and darsonvalization of the abdominal area; SMT (II type of work, modulation depth 100%, modulation frequency 30 Hz), electrophoresis or SMT-phoresis of proserine, physical therapy, reflexology, intake of moderately and highly mineralized mineral waters.

With constipation, the efforts of doctors to achieve bowel regularity can be significant. Appointed:

Food bran;

Functional food products;

Laxatives (preferably herbal);

Prebiotics (Normaze, Duphalac, Hilak-forte, etc.);

Probiotics;

Physiotherapy, physical therapy.

Thus, the diagnosis of IBS is increasingly appearing in the nomenclature of gastroenterological diseases, both in adults and in children, and is beginning to gradually replace such diagnoses as “chronic colitis”, “chronic enteritis”, “chronic enterocolitis”. The debate continues about whether IBS is a functional disease, since dystrophic changes are detected in the mucous membrane of a number of patients against the background of impaired barrier and absorption functions.

Further efforts are required to study this pathology, which will allow us to develop a consistent view of the nature of IBS, clarify differential diagnostic criteria and treatment tactics.

Irritable bowel syndrome in a child is a disorder of the digestive system, which manifests itself in upset stools and severe abdominal pain.

This disease is in no way associated with the inflammatory process or organic changes in the tissues of the small and large intestine.

Why does IBS occur in children?

IBS in children does not appear as a result of a biochemical or structural disorder in the digestive tract.

This disease occurs due to poor nutrition, heredity, failure of the intestines to perform motor functions, psycho-emotional state or reaction to the inflammatory process.

The fact that irritable bowel syndrome is transmitted at the genetic level is confirmed by numbers. In 33% of children with this disease, immediate relatives also previously suffered from it.

It has long been a proven fact that a third of children experience symptoms of IBS due to psychological trauma.

Quite often, a child’s intestinal problem is associated with an infectious disease he has suffered.

Symptoms of IBS also appear against the background inflammatory processes in the body, severe stretching of the smooth muscles of the digestive organ or its increased sensitivity to irritants.

These may include large amounts of food and expansion of the walls of the colon due to gases, causing painful sensations in a stomach.

A child's intestines may not function well if there is a lack of dietary fiber in the food they eat.

Irritable bowel syndrome is a phenomenon familiar to children suffering from dysbiosis and physical inactivity.

Often constipation, abdominal pain and other symptoms of IBS make themselves felt due to inelasticity or spasticity of the intestine.

According to the observations of doctors, the appearance of irritable bowel syndrome in children is caused by a group of brain diseases and the early transfer of infants to feeding with special nutritional formulas.

The disease can also occur in a child who suffered from chronic malnutrition (hypotrophy) at the age of 1 year. The appearance of IBS is provoked by rotavirus infection, giardiasis and poor nutrition.

It is not known exactly how often irritable bowel syndrome occurs in children. However, it was found that more than half of children who feel pain in the abdominal area complain of IBS symptoms.

The syndrome affects about 25% of adults who suffered from the disease in childhood. Therefore, the problem of IBS in children is taken very seriously, and pediatricians and pediatric gastroenterologists closely monitor this.

How does the disease manifest itself?

The symptoms of irritable bowel syndrome are varied, so during a conversation with the patient, the doctor asks about many things.

Some signs of this disease occur only against the background of a psychoemotional disorder. At night, a child suffering from IBS does not experience stomach problems.

The disease does not tend to progress. The health condition worsens only before bowel movement, and then returns to normal.

The syndrome is mainly manifested by abdominal pain or significant discomfort. A sick child often has to endure these symptoms for more than 3 months, since parents often do not pay attention to them due to the fact that they disappear after defecation.

Painful sensations are usually accompanied by a change in stool frequency. A child can go to the toilet several times a day or only 2-3 times a week.

Irritable bowel syndrome is characterized by symptoms such as a rumbling stomach and a feeling that it is full.

Suffering from this disease, a child may feel that his intestines have not completely emptied.

The act of defecation with such a disease is always difficult, and a large amount of mucus comes out of the rectum. The urge to go to the toilet due to the syndrome becomes imperative.

Parents of a child should sound the alarm if symptoms become more pronounced at night, and the child begins to rapidly and unreasonably lose weight.

Another reason to take urgent measures are non-disappearing and severe pain in a stomach.

Irritable bowel syndrome can be very dangerous for a child if his immediate family has colon cancer.

Digestive dysfunction can cause serious problems when it occurs along with fever, anemia, leukocytosis, or hepatomegaly (enlarged liver).

But, as a rule, IBS does not cause any particular harm to the health of children, although it may to some extent impair their quality of life.

And yet, if the disease is ignored, there is a possibility of organic disorders digestive tract.

Depending on which symptoms are most pronounced, the syndrome is divided into the following types:

IBS, which is mostly manifested by constipation, is a disease in which in 25% of bowel movements the intestines are emptied with hard stool;
IBS, mainly expressed as diarrhea, is a disease characterized by the fact that more than 25% of bowel movements are watery or pasty;
mixed IBS, which is distinguished by the fact that the patient’s stool has either a watery or hard consistency;
unclassified syndrome is a disease that is not similar in symptoms to any of the listed types.

What should I do to heal?

Treatment for an illness that causes poor intestinal function should be comprehensive, that is, including not only taking medications, but also physical exercise, as well as the help of a psychotherapist.

It is very important that the child gets rid of pain and the cause of its occurrence, so the doctor prescribes myotropic antispasmodics.

Small children under 2 years old are supposed to take Papaverine 5 mg. A child 3–6 years old can be given tablets of the same drug, but 10 mg each.

Buscopan or a drug from the group of m-cholinergic receptor blockers is another means by which a child is treated for a syndrome in which the intestines do not work properly.

Children 6 years of age and older should take this medication 2 tablets 3 times a day. In addition to Buscopan, Mebeverine and Retard will help eliminate spasms. But they need to be used correctly: as the condition improves, reduce the dosage.

To slow down the motility of an unhealthy digestive organ, it is necessary to supplement treatment with adsorbents.

It is better to give the child “Smecta”, and “Imodium” should be used only if irritable bowel syndrome is manifested by persistent diarrhea and severe pain.

In order to eliminate these symptoms, treatment with Imodium should be carried out strictly according to the instructions.

When a child is bothered by constipation, he should be given Duphalac. Any other laxative may not provide any benefit.

If irritable bowel syndrome occurs as a result of infectious disease, then the doctor advises parents to give their children prebiotics and probiotics.

One of these drugs, Enterol, is effective against diarrhea and removes toxins from the body well.

It happens that the unpleasant symptoms of the syndrome are a consequence of a stressful situation.

In this case, treatment is also carried out using neutrotopic drugs that reduce irritability and anxiety. These drugs include Phenazepam, Sibazon and Lorazepam.

The doctor decides how to take any of these drugs. For example, treatment of adolescents involves taking 0.25 mg of the drug 3 times a day.

Treatment with herbal remedies will give a positive result in eliminating the symptoms of IBS. Children can be given Novo-Passit, which contains extracts of hawthorn fruits, black elderberry flowers and valerian rhizomes.

Doctors prescribe it from the age of 12 and tell people to take one tablet in the morning, afternoon and evening. For improvement mental state For younger children, Persen containing lemon balm extracts and peppermint.

If, in addition to other symptoms, flatulence is also a concern, then treatment is recommended to be supplemented with the drug Espumisan.

It prevents the formation of large amounts of gas in the intestines and breaks the bubbles that have already appeared, protecting the walls of the colon from excessive stretching.

IBS is a condition most often caused by poor diet, although there can be many other causes.

The syndrome manifests itself quite painfully, and therefore requires treatment to be timely and effective.

Medicines against constipation and other symptoms of the disease should be given to a child only after consultation with a doctor.