Gastroenterology is better than a hospital for children. Gastroenterology Department

General gastroenterology , as a science, was formed at the beginning of the nineteenth century. She studied the structure and diseases of the gastrointestinal tract and organs directly involved in digestion. Among them are the stomach, liver, bile and bile ducts, and pancreas. However, in Lately Diseases of the gastroenterological direction have become significantly younger; they began to occur more often in young people. Although at all times, diseases of this kind were common in all age categories. Stomach and intestinal disorders are observed in both infants and the elderly. But today our conversation will only be about pediatric gastroenterology . This is a relatively new direction.

What does a pediatric gastroenterologist do?

It is not uncommon for children to have digestive problems: infants, preschoolers and teenagers. This is partly due to poor nutrition, poor lifestyle, and the use of products containing many harmful additives: preservatives, dyes, stabilizers, emulsifiers and other “identical to natural” flavors. The main problem is that children are much more likely to have problems with the digestive organs and gastrointestinal tract. But not all parents understand that visit to a pediatric gastroenterologist mandatory even in a relatively prosperous state of affairs. After all, children do not always pay attention to specific ailments, and cannot always clearly and understandably explain to their parents what is bothering them. Work specifics pediatric gastroenterologist is to be sensitive and careful attention to the children. Great importance in their work, she has the ability to establish friendly contact with a small patient, instill in him trust and a sense of security. After all, almost all children, when they see a white coat and feel the specific smell of the office, begin to be capricious and refuse to be examined. The next feature of the work pediatric gastroenterologist is the fact that the structure and functioning of children’s organs responsible for digestion are somewhat different from those of adults digestive system. These differences are especially evident in the first year of life. The difference can be seen in everything: in anatomical location and the structure of organs, their sizes. The ability of children's organs to produce the appropriate enzymes in children is completely atypical. Therefore, diagnosis and treatment and prevention of diseases gastrointestinal tract and organs of the digestive system in children requires specific knowledge and a special approach.

Features of the child's body

First of all, in addition to knowledge about the peculiarities of the functioning of children's organs, every qualified gastroenterologist must take into account age characteristics. Each age category has its own specifics. And this greatly influences making the correct diagnosis and prescribing the correct treatment. After all, it is no secret to anyone that children different ages react differently to the same medications. Children younger age and infants more often suffer from “functional” disorders of the digestive system:

• indigestion;
• dyspepsia;
• bloating;
• lactose deficiency;
• regurgitation syndrome;
• dysbacteriosis;
• gastroduodenitis;
• enterocolitis;
• functional constipation.

The older a child gets, his chance of getting rid of problems with the intestines and stomach increases; he seems to outgrow childhood diseases. This feature is due to the regenerative-restorative feature of the child’s body. We adults can only dream about this. However, for this it is important that parents remember that they need to create the necessary conditions, in order for it to successfully outgrow digestive problems. And ideally, this process should take place under the constant supervision of a qualified pediatric gastroenterologist . Similar diseases by special order pediatrician are examined using hardware diagnostic methods and appropriate lab tests.

What diagnostic methods does a pediatric gastroenterologist use?

Diagnostic methods:

Problems with the gastrointestinal tract in children should not be left without proper attention. The predisposition of the child’s body to such diseases is laid down during pregnancy, and at this time the formation of the future person’s own biocenosis occurs, their own immunity begins to form and defense mechanisms. Therefore, if the expectant mother’s pregnancy proceeds normally, then you can be sure that the child will not have problems with the intestines and stomach.

Causes of diseases

The main reasons for the formation of problems with the gastrointestinal tract in children and infants are the following points.

All these problems directly affect the formation of the child’s gastrointestinal tract, the development of pathology of the digestive organs and the entire body as a whole. However, such problems are not limited to the reasons described. No less impact on the gastrointestinal tract and digestive system is exerted by various stressful situations. Especially if you can’t avoid them. long time. Adolescents are susceptible to such disorders, and during the period when they are about to visit kindergarten or schools. If the gastrointestinal tract does not work normally, then, as a rule, the body does not receive large amounts of what it needs for growth and proper development nutrients. In this case, the child lags behind his healthier peers in growth, physical and mental development.

Indications for visit and symptoms

About the fact that one should not ignore a child’s complaints about bad feeling, mentioned above. But I would like to dwell in more detail on the symptoms and signs of gastric and intestinal disorders, so that parents immediately take appropriate measures if they are detected. So, if you notice that your child has:

Then you in mandatory need to meet a good one pediatric gastroenterologist . Take care of yourself and your children. Don’t be lazy to contact a specialist for help!

As part of the reform of Moscow healthcare, on the basis of the gastroenterology department of the Morozov Children's Hospital, the city Center for Children's Gastroenterology was organized, the objectives of which are:

• provision of specialized, high-tech assistance for children and adolescents with gastroenterological diseases: inflammatory diseases intestines - Crohn's disease, ulcerative colitis; short bowel syndrome, stoma, etc.;
• improving the system of medical care for children;
• coordination of activities of institutions at different levels;
• introduction of new effective diagnostic, surgical and therapeutic techniques;
• providing rehabilitation and social adaptation children with gastroenterological pathology;
• Information support.

Morozovskaya Children's City Clinical Hospital is responsible for drug provision And correct use in children with IBD, the high-tech, effective and expensive drug Remicade (infliximab). The Center issues prescriptions, and also creates special conditions for the correct and safe administration of the drug (anti-cytokine therapy). The immunological status of patients with IBD is monitored in accordance with developed modern treatment standards. The Center provides advisory services - diagnostic work on questions complex therapy severe inflammatory bowel diseases resistant to standard therapy in children.

The center provides medical care children and adolescents with diseases leading to the formation of a stoma.
The Center conducts:

• medical consultation;
• individual selection modern means stoma care;
• issuing preferential prescriptions for ostomy care products;
• training the patient and his relatives in the use of recommended stoma care products.

Medical staff of the Center for Pediatric Gastroenterology:

Skvortsova Tamara Andreevna - head of the Center for Pediatric Gastroenterology and the Center for IBD, Morozovskaya Children's City Clinical Hospital, Doctor of Medical Sciences, gastroenterologist, chief freelance pediatric gastroenterologist in Moscow
Glazunova Lyudmila Vladislavovna – pediatrician, gastroenterologist, deputy head of the gastroenterological service of the Morozov Children’s Hospital
Mukhina Tatyana Fedorovna – pediatrician, gastroenterologist of the highest category
Olga Aleksandrovna Goryacheva – pediatrician, gastroenterologist, candidate of medical sciences
Sarycheva Alexandra Andreevna – pediatrician, gastroenterologist

This is a specialist who diagnoses, treats and prevents pathologies of the digestive tract in children. Diseases of the digestive system are among the most common today. Their reasons are varied: starting with unbalanced diet and ending with stress, and children's body least protected from these factors. That is why consultation with a pediatric gastroenterologist is necessary in case of any problems related to the digestive system.

If you are looking for a pediatric gastroenterologist in Moscow, contact the CELT multidisciplinary clinic. We employ leading domestic specialists who have extensive experience and have all the means to determine the cause of the disease, make a correct diagnosis and prescribe effective treatment.

Why should you contact a pediatric gastroenterologist?

A good pediatric gastroenterologist is necessary for many young patients with digestive problems. It's no secret that childhood has its own anatomical and physiological characteristics. This rule also applies to the gastrointestinal tract. Therefore, the need to consult a child with a pediatric specialist is obvious.

When is it necessary to contact a pediatric gastroenterologist?

Whole line clinical manifestations should be a reason to visit a pediatric gastroenterologist:

• painful sensations in the stomach of varying intensity, of different nature and any localization;
• nausea and vomiting;
• heartburn and belching;
• loss of appetite;
• bad smell from mouth;
• bowel dysfunction: constipation, diarrhea;
• flatulence, increased gas formation in the abdomen

Urgent consultation is also required by suspicion of bleeding from the gastrointestinal tract, which manifests itself in the form of vomiting mixed with blood, black stools, and stools mixed with blood. Such situations are rare, but should be regarded as life-threatening and therefore immediately supervised in inpatient conditions!

During the appointment

During the consultation, a pediatric gastroenterologist conducts initial examination and listens to complaints that exist. It is very good if parents bring with them the data of everyone diagnostic studies, if any have been carried out before, as well as previous expert opinions. This will save both time and money. In order to make a diagnosis, pediatric gastroenterologists at the CELT clinic carry out comprehensive examination, which is prescribed based on a specific clinical situation and may include the following:

• ultrasound examination abdominal cavity;
• x-ray examination;
• endoscopic examination(gastroscopy);
• blood, urine, stool tests.

If the situation requires it, a pediatric gastroenterologist can join forces with other pediatric specialists (neurologist, surgeon, endocrinologist, otolaryngologist, dentist, pediatrician) to jointly evaluate the results obtained diagnostic examination and compilation individual program treatment.

Multidisciplinary clinic CELT: we will take care of your baby's health!

Every mother knows how unpleasant digestive problems can sometimes be for a baby. Unfortunately, it is not always possible to solve them on your own. And it’s not worth risking the child’s health. A pediatric gastroenterologist deals with such issues. His responsibilities include treating all organs of the digestive system, as well as preventing diseases of the gastrointestinal tract.

What does the doctor do?

Pediatric gastroenterologist deals with the treatment of gastritis, ulcers, colitis, hepatitis and many other diseases. It is worth contacting this specialist as early as possible, before the disease has just begun to develop and does not cause complications (for example, gastritis that is not treated in time can easily become an ulcer over time).

It is important for a doctor not only to diagnose the disease, but also to find out its causes: hereditary predisposition, poor nutrition, viral disease etc. This significantly affects treatment tactics. A pediatric gastroenterologist refers a small patient to a series of examinations, which include: various tests, ultrasound, FGDS (if necessary), talks with the baby’s parents and, based on this, selects therapy.

When should you contact a specialist?

It is difficult not to notice digestive problems in a child. Be sure to make an appointment with a pediatric gastroenterologist if your baby is concerned about:

• persistent diarrhea or diarrhea;
• nausea, vomiting;
• loss of appetite;
• constant abdominal pain;
• specific odor from the mouth.

How to become a pediatric gastroenterologist?

If you decide to get such a complex but useful specialty, then there is a long and difficult path ahead. You need to get your degree first medical education and become a certified pediatrician. Pediatric programs are available in all medical universities Moscow. By tradition, the First Moscow State Medical University named after. THEM. Sechenov, Russian National Research Medical University named after. N.I. Pirogov, as well as the Faculty of Fundamental Medicine of Moscow State University. M.V. Lomonosov. In the future, you need to complete a residency in the area of ​​interest to you. Throughout medical practice necessary constant increase qualifications, exchange of experience with colleagues. The Scientific Research Clinical Institute of Pediatrics can help with this. acad. Yu.E. Voltishcheva.

Famous Moscow specialists

Gastroenterology is a relatively young branch of medicine, because it began to develop approximately in the second half of the 19th century. For a long time diseases of children were not considered separately and were rather managed by surgery. Only towards the end of the last century did pediatric gastroenterologists begin to appear. In 1982, on the initiative of M.B. Kuberger, research on this topic began at the Moscow Research Institute of Pediatrics and Pediatric Surgery, and already in 2000 a specialized hospital appeared. The development of pediatric gastroenterology in Moscow is also associated with the names of A.A. Cheburkina, A.I. Khavkina, A.A. Korsunsky and others.

A gastroenterologist deals with problems with the esophagus, stomach, intestines, pancreas, gall bladder, bile ducts, liver, duodenum. The following diseases are treated by specialists:

• Gastritis
• Gastroduodenitis
• Stomach ulcer
• Ulcer duodenum
• Allergic diseases (food allergy)
• Giardiasis intestines
• Pancreatitis
• Cholecystitis
• Colitis
• Constipation
• Hepatitis
• Diarrhea
• Dysbacteriosis
• Flatulence
• Colitis
• Esophagitis
• Diseases of the biliary system and gallbladder

A high-class pediatric gastroenterologist will definitely inquire about the details of the child’s lifestyle and nutrition, discuss the exact diet with the parents, find out everything about the state of the baby’s digestive system, and prescribe necessary tests and research and will make an expert opinion based on the complete picture.

Gastroenterological diagnostic methods

In our clinic we use following methods gastroenterological diagnostics:

Functionaldiagnostics:

13-C urease breath test

• Primary non-invasive diagnosis of H. pylori infection in the gastrointestinal tract in diseases of the stomach and duodenum
• Presence of acid-related and H. pylori-associated diseases in the family (among those living together)
• Monitoring the effectiveness of eradication therapy
• Screening examinations for hereditary burden of diseases of the gastrointestinal tract
• Patient's oncological alertness
• Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs)

Endoscopy- this is a group of methods that allow you to visually assess the condition internal organs in real time, as well as, if necessary, carry out a number of additional diagnostic and therapeutic manipulations, is united by a single concept "endoscopy"(from Latin endos - inside, scopia - to examine). Endoscopic studies divided depending on the organs studied:

• Esophagogastroduodenoscopy(EGD) - examination of the esophagus, stomach and duodenum. Sometimes carried out in combination with jejunoscopy- inspection of the initial departments small intestine
• Rectosigmoscopy- direct and sigmoid colon
• Colonoscopy- examination of the colon and final sections ileum

Esophagogastroduodenoscopy

The main indications for this method endoscopic examination are:

• Detection of defects and developmental anomalies in the baby, suspicion of internal bleeding
• In infants and early age- suspicion of congenital and acquired malformations of organs: underdevelopment or absence of an organ or part of an organ, abnormal communications between various organs, abnormal narrowings (for example, of the esophagus, the junction of the stomach with the intestines), which can be manifested by frequent persistent regurgitation of the baby, breathing problems, poor weight gain, etc.
• In older children, inflammatory diseases come first (gastroduodenitis - inflammation of the mucous membrane of the stomach, duodenum, etc.) and various disorders digestive organs, manifested in most cases by abdominal pain of various types, as well as nausea, vomiting, belching, heartburn, etc. Often chronic disorders digestive problems in children are directly related to Helicobacter pylori infection (bacteria that play a leading role in the development chronic gastritis, duodenal ulcers). During endoscopy, signs of the presence of this infection in the stomach can be detected, and a biopsy (taking a sample) of the gastric mucosa allows for rapid diagnosis of the disease
• There are often cases when a child, out of curiosity, puts in his mouth and swallows various objects (coins, buttons, small parts of toys, batteries, pins, etc.). In most cases, removal of foreign bodies from the gastrointestinal tract is only possible using endoscopic techniques

Esophagogastroduodenoscopy is performed on an empty stomach using small-diameter flexible endoscopes specially adapted for children. Before the test, the child should not take food or liquid for 5-6 hours. The psychological preparation of the child before the study is of great importance. The pediatric gastroenterologist who prescribed endoscopy, as well as the child’s parents, must explain in an accessible form that the study is painless, although it may cause some complications. discomfort. The procedure itself takes on average 1-2 minutes. The child is placed on the treatment table on his left side, the rules of behavior during the procedure are explained (the child is advised to breathe calmly and evenly, not to swallow so that saliva drips onto the towel, emphasis is placed on the painlessness of the procedure). After psychological preparation, children quite easily agree to endoscopy and tolerate it well. Nurse gives the child a special mouthpiece that protects the endoscope from the child’s teeth and holds it during the entire examination. Anesthesia, both local and general, is performed in rare cases for special indications - when the child’s reaction to the procedure is extremely inadequate. After the examination, you can immediately feed the child and give him water. In case it was carried out local anesthesia, eating should be delayed for 30-40 minutes. The study is usually well tolerated by children, most of them agree to repeat the procedure if necessary.

Colonoscopy

The examination of the colon and terminal ileum in children, unlike adults, is carried out under general anesthesia. The preparation for it is carried out by the staff of the department in which the child is lying. Psychological preparation boils down to the fact that the baby is explained that during the study he will sleep and will not feel anything. Indications for colonoscopy are:

• Blood in the stool
• Suspicion of bleeding
• Foreign bodies
• Structural anomalies
• Clarification of the level and nature of inflammation
• Collection of material for biopsy
• Diagnosis and removal of polyps

The study prescribed by a pediatric gastroenterologist lasts from 15 to 40 minutes. A condition for success is good bowel preparation with enemas or medications, which is carried out by medical professionals.

Ultrasonography abdominal organs

This method is one of the few instrumental studies which can be performed without any fear on patients of any age, even children!

The capabilities of modern equipment have brought ultrasound diagnostics on high level and allow you to accurately assess the condition of the child’s body.

Ultrasound waves reflecting from organs make it possible to provide accurate information about the size and density of organs, structure, and wall thickness. Ultrasound diagnostics has been used in the practice of pediatricians and pediatric gastroenterologists for more than 20 years and is a safe examination even for children. Method ultrasound examination based on the ability of different fabrics human body transmit vibrations of supersonic waves differently. Special equipment directs high-frequency radiation into the cavity of the patient being examined. sound wave, when reflected from the organ under study, creating an echo that is captured by the scanning sensor. After special processing, the organ being examined is reflected on the device’s monitor in the form of a graphic image.

With the help of ultrasound it is possible without damaging the integrity skin study the features of the anatomical structure and functional activity digestive organs. This method diagnostics is the most effective, painless and safe. Ultrasound of the abdominal organs for children is actively used in neonatology, surgery, oncology, gastroenterology and endocrinology:

• To determine the size, shape and location of any of the abdominal organs
• Studying the homogeneity and structure of their tissues
• Identification of existing developmental anomalies, injuries, inflammatory processes and tumor-like formations

Indications and contraindications for performing ultrasound

First of all, ultrasound scanning is an examination that, in order to mandatory medical examination carried out to children at the prescribed time. In newborn infants, a diagnostic procedure is prescribed to exclude birth defects digestive tract that require emergency surgical intervention:

• Atresia bile ducts
• Congenital pyloric stenosis or hepatitis
• Damage to parenchymal tissue of organs
• Reactive pancreatitis

During schooling and especially during adolescence, gastroenterologists prescribe ultrasound to diagnose cholecystitis, biliary tract dysfunction, cholelithiasis, pancreatitis. An examination of internal organs is necessary in emergency situations- if you suspect injury, abscess, appendicitis.

There are many indications for prescribing ultrasound:

• Discomfort and painful sensations in the abdominal area
• Nausea
• Heaviness and tension in the right hypochondrium
• Frequent vomiting
• Halitosis (bad breath)
• Bitter taste in mouth
• Sour belching
• Flatulence
• Stool disorders
• Yellowness of the sclera and skin
• Sudden change in body weight
• Skin rashes

Rules for preparing for the procedure

Ultrasound examination does not cause any discomfort or fear in children. However, it is necessary to prepare for it in advance and not feed the baby on the eve of the procedure. The fasting period should be: for an infant - 3 hours, for a baby up to three years of age - 4 hours, for a child over three years old - 6 hours. Important condition information content diagnostic procedure- absence of gas accumulation in the abdominal cavity.

Therefore, to enhance the visualization of the organs being examined, preliminary preparation is required:

• A nursing mother should avoid eating foods that contribute to the formation of gases in the intestines - legumes, raw vegetables, black bread, confectionery, pastry, juices, milk.
• A young child does not need to be given juices or fruit or vegetable purees.
• Older children must follow a special diet for three days that excludes flatulence and constipation. The diet should include lean meat (boiled, baked or steamed), boiled eggs, porridge, cheese

Radialdiagnostics

CT ( CT scan), MRI (magnetic resonance imaging), ultrasound of the abdominal organs are often used to study the pancreas, bile ducts, liver, and mesenteric lymph nodes.

Children's gastroenterological CHECK-UP

Our clinic provides a unique opportunity to conduct pediatric gastroenterological CHECK-UP.

This is a comprehensive program medical research, which includes a basic conversation with a pediatric gastroenterologist (conducted to collect differential diagnosis, introducing the doctor to the medical history, preparing an examination program). Then the necessary laboratory research. The doctor sums up the results, explains the results of the examinations, gives medication recommendations and talks about lifestyle, nutrition, diet, and then issues a final written conclusion.

IN comprehensive program diagnostics includes an appointment with a specialist, as well as:

• Ultrasound of the abdominal organs (liver, gallbladder, pancreas, spleen)
• General analysis urine
• Clinical analysis blood
• Coprogram
• Determination of the presence of Giardia Lamblia antigens in feces (rapid method)
• Enterobiasis test

Immunoserology (blood from a vein):

• Antibodies to Toxocara Ig G
• Antibodies to amoebas Ig G (Entamoeba hystolitica)
• Antibodies to Toxoplasma gondii Ig G
• Determination of antibodies to Trichinella spp
• Determination of class G antibodies (Ig G) to Ascaris Lumbricoides
• Comprehensive examination of stool for eggs, helminth larvae, protozoa

Celiac disease - This hereditary disease, which occurs in children due to intolerance to gluten contained in some grains (such as wheat, rye, oats, barley). The body does not absorb this protein from many foods (baked goods, cereals, sausages, sweets). Irritation of the intestinal mucosa leads to diarrhea, symptoms of intoxication and exhaustion of the body. As a result, the development of children is disrupted, they suffer physically, and deviations in the functioning of the nervous system occur.

The peculiarity is that most often the disease does not manifest itself immediately after birth, but later, when children begin to be given, in addition to breast milk, additional food. Cereals and infant formula contain gluten; in addition, it may be present in the form of additives in other products. baby food. When the first signs of pathology appear, even experienced pediatric gastroenterologists do not immediately make the correct diagnosis, since similar manifestations also occur with dyspepsia. However, for celiac disease, conventional medications do not help improve digestion.

Unlike others intestinal diseases, celiac disease is incurable. There are periods of exacerbation and remission (temporary relief of symptoms). You can save a child from suffering only by completely eliminating foods containing harmful protein from his diet. This stops the impact of toxins formed during the breakdown of gluten, and the condition of the intestines and the entire body is completely restored.

Examinations:

• Family history collection, anthropomery
• ZI of the abdominal organs
• Blood test for antibodies to endomysium, tissue translutaminase, and gliadin
• Coprogram
• Endoscopy with histological examination of a biopsy specimen of the small intestinal mucosa