PRALAXAN RESEARCH AT THE PAG INSTITUTE

Performers: Head of the Department of Nutrition and Somatic Pathology of Early Childhood. MD O.G. Shadrin Senior. Scientist MD S.V. Dyukareva-Bezgroshovykh

1. Functional disorders of the gastrointestinal tract occupy one of the leading places in the structure of digestive tract pathology. The most common form of the disease in early childhood is functional constipation (56.5%), which is diagnosed with chronic delay in bowel emptying for more than 36 hours, which is accompanied by a violation of the act of defecation, the passage of a large amount of feces of increased density. One of the most common causes of constipation is impaired intestinal motility, more often an increase in non-propulsive and segmental movements, a decrease in propulsive activity with an increase in sphincter tone.

A special place in the development of functional constipation in young children is given to the nature of nutrition and the closely related qualitative and quantitative composition of the intestinal microflora. reach the colon, where they are utilized by the microflora. This leads to the growth of bifido and lacto bacteria, and the short-chain organic acids formed as a result of microbial metabolism are a component of the nutrition of colonocytes, ensuring normal colon function, including motor function. The first prebiotics in a child's life are lactose and galactooligosaccharides of breast milk. Lactose, consisting of galactose and glucose, unlike other prebiotics, is largely broken down by lactase in the small intestine, and only a small amount of it reaches the colon. However, even this small amount of lactose turns out to be important for the formation of the child's intestinal microflora, which utilizes it in full.

2. One of the main synthetic prebiotics used today in the clinic for the correction of functional constipation is lactulose. It is a non-adsorbed disaccharide that cannot be broken down by enzymes of the small intestine of mammals and is metabolized by bacteria to simple organic acids, which, in turn, bind ammonium, reduce the formation of toxic substances containing nitrogen in the proximal parts of the intestine. As a result, the intestinal contents are acidified and the osmotic pressure increases. The latter contributes to an increase in the inflow of fluid and the volume of feces, changing its consistency to a looser one. several hours.

• The prebiotic effect of lactulose contributes to the restoration of the normal composition of the intestinal microflora in at least 79% of patients, which makes this drug unique in its kind.

• Lactulose creates unacceptable intestinal conditions for a number of pathogenic microorganisms, in particular. in patients with chronic salmonellosis and overgrowth of C10stridium.

• Lactulose has been used to treat constipation in adults for 40 years. During this period of time, no suggestive or obvious evidence has been found that the drug has a mutagenic, genotoxic or teratogenic effect on the human body.

• Studies conducted on animals have also not revealed a teratogenic effect of lactulose or a toxic effect on reproductive functions, and no dangerous effects have been observed even when using very high doses.

• Numerous comparative studies of lactulose with other laxatives have shown its high effectiveness. Due to its side effects, most strong laxatives are not used in pediatric practice, lactulose is one of the rare exceptions in this series.

• The dose of the drug for the treatment of constipation is selected individually and depends on many factors, in particular. the age of the child. Lactulose is usually prescribed once a day in the morning. The starting dose may be minimal, followed, if necessary, by an increase to an effective amount, which for young children may range from 2.5 to 10 ml. The duration of use of the drug is not limited, since there is no addiction to it.

The appearance on the market of the domestic drug Prelaksan, containing 50 g of lactulose in 100 ml of syrup in a convenient dosage form for a child - in the form of syrup, is undoubtedly a positive fact.

The typical regimen for taking Prelaksan in children is the same as for other lactulose drugs and consists of the following stages:

• starting the intake and selecting the dose within 1-7 days, taking the drug in a constant dose for 1-2 weeks and gradually canceling the drug within 1 week.

• If necessary, taking the drug may be a restoration of the previous or lower dose.

• The appearance of constipation after the end of the course may indicate an insufficient duration of treatment, as a result of which the intestinal microflora did not normalize, or an unresolved cause of constipation. In the latter situation, the diagnostic search should be continued or combination therapy should be prescribed.

Taking into account the above, the aim of the work was to study the clinical efficacy and tolerability of the drug Prelaksan in children aged 1 to 3 years with functional constipation.

30 children were under observation: 16 girls, 14 boys.

In 12 of them, the disease began at 10-13 months,

in 18 children - it has been ongoing for the past year. vegetative dysfunction, 19 children received prolonged antibiotic therapy.

It is known that psychogenic constipation is also common in young children, caused by certain stressful situations, which are subsequently fixed by conditioned reflexes. Such stresses for a child can be a change of residence, family problems, conflicts and many other simplified, from the adult's point of view, situations.

Almost all children examined had errors in nutrition: early artificial feeding (21 children), prolonged use of products in the form of finely dispersed purees, not pieces, insufficient amount of fiber, raw vegetables and fruits, juices, fermented milk products.

Among the concomitant diseases, it is necessary to point out:

• atopic dermatitis in 9 children,

• laboratory-confirmed intestinal dysbacteriosis – in 28 children,

• grade 1 anemia in 6 children,

• polyhypovitaminosis – in 14,

• chronic tonsillitis – in 13 children,

• biliary dyskinesia in 23 children

• grade 1 hypotrophy – in 5 children.

The main clinical syndrome in all patients was intoxication and was expressed by appetite disturbance, lethargy or increased excitability, pallor of the skin.

Dyspeptic and dyskinetic syndromes in the form of belching, rumbling, bloating were noted in almost all examined.

Defecation, as a rule, occurred with support, was accompanied by pain syndrome, was often repeated, with the discharge of "sheep feces".

In 22 children, there was no independent defecation for 3-4 days, after which the parents resorted to a cleansing enema.

All patients received the drug against the background of a diet enriched with fiber and products that have a laxative effect.

The average daily dose of Prelaksan for the examined children was 3-5 ml.

For 7 children aged 3 years, due to the lack of a laxative effect during the first 5 days, the dose of the drug was doubled. After achieving positive dynamics, the amount of the drug was reduced to 5 ml in 5 children under observation.

In 2 children, taking the drug at a dose of 10 ml per day during the course of treatment did not lead to the expected results. There were no refusals to take the drug.

The effectiveness of the treatment was assessed by the dynamics of clinical symptoms of the disease (Table 1). Table 1. Dynamics of the main symptoms of the disease in children with functional constipation during treatment with the drug Prelaksan.

Positive clinical dynamics were noted in 28 children under observation, in 2 the expected clinical effect was not noted

Dyskinetic syndrome decreased:

in 5 children for 1 day,

in 13 children for 5 days,

in 10 children – for 10 days of taking the drug.

Dyspeptic syndrome persisted longer:

reduced after 5 days of treatment in 8 children

and for 10 days in 20 patients.

The dynamics of intoxication syndrome was absent for the first day, after 5 days it was positive in 5 children and for 10 days – in 21 children.

Thus, Prelaksan at a dose of 5 ml per day effectively stimulates intestinal motility in children 1 - 3 years of age with functional constipation, as evidenced by the normalization of bowel movements in 93.3% of patients.

The absence of side effects allows us to recommend its use in young children.

Sources:

Бельмерс.В., Хавкін A.I1. Гастроентерологія дитячого віку: практичний посібник з дитячих хвороб. - М., - 2003. - 359 с.

Бутарова ЛЯ., Калінін А.В. Значення лактулози у регуляції кишкової мікрофлори. //Клінічні перспективи гастроентерології, гепатології. - 2002. - .N2 6. - С. 21-26.

Лук'янова О.М., Шадрін О.Г., Шкiряк-Нижник З.О., Числовська Н.В.

7 Клiнiко-епiдемiологiчна характеристика синдрому подразненого кишечника у дітей молодшого ШКlЛьного BiKy: популяцiйнiдослiдження. //Педiатрiя та перинатологiя. - 2003. - .N '!! 4. - С.25-27.

Хавкін А.І. Функціональні порушення шлунково-кишкового тракту в дітей віком раннього віку. - М: Правда, 2000. - 72с.

Johnson S. Clostridial constipation's broad pathology.l Med/Hypotheses. 2001. - Vol.56 (4). - Р.532-536.

6. Поле. Хайман. Педіатричні функціональні шлунково-кишкові розлади. - Академія Professional Infonnation Services, Inc., США. - 1999.-Р. -234