vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v12i5.799vsp-281Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCEСОВРЕМЕННЫЕ ДАННЫЕ О ФУНКЦИОНАЛЬНЫХ НАРУШЕНИЯХ ЖЕЛУДОЧНО-КИШЕЧНОГО ТРАКТА У ДЕТЕЙCURRENT DATA ON GASTRO-INTESTINAL DYSFUNCTIONS IN CHILDRENГрибакинС. Г.GribakinS. G.

Gribakin Sergey Germanovich, Doctor of Medical Sciences, Professor, Scientific Consultant for FrieslandCampina

gribakin@anika-ru.ruГаранкинаТ. И.GarankinaT. I.gribakin@anika-ru.ruДавыдовскаяА. А.DavydovskayaA. A.gribakin@anika-ru.ru«Аника РУ» ООО, МоскваРоссия«Anika RU» Limited Liability Company, MoscowRussian Federation201319092013125Вопросы современной педиатрии6065Copyright © Грибакин С.Г., Гаранкина Т.И., Давыдовская А.А., 20132013Грибакин С.Г., Гаранкина Т.И., Давыдовская А.А.Gribakin S.G., Garankina T.I., Davydovskaya A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/281

Функциональные нарушения пищеварения часто встречаются у детей первого года жизни. Врачи-педиатры нередко рекомендуют сменить одну детскую молочную смесь на другую, что обычно не приводит к положительным результатам, а только усложняет ведение таких детей. В статье приводятся современные взгляды на причины, патофизиологические механизмы и принципы диетотерапии синдрома срыгиваний, функциональных запоров, кишечных колик и других функциональных нарушений желудочно-кишечного тракта у детей раннего возраста. Особенностью данной группы патологических состояний является то, что они реже встречаются в виде моносимптомов и значительно чаще — в различных сочетаниях. При функциональных нарушениях желудочно-кишечного тракта при обследовании не удается обнаружить ни морфологических изменений со стороны органов пищеварительной системы, ни нарушений ферментовыделительной функции. Вместе с тем минимальные пищеварительные дисфункции негативно отражаются на качестве жизни семьи, на темпах развития и нутритивном статусе ребенка. Диетологические мероприятия относятся к числу наиболее эффективных методов коррекции этих состояний.

Digestive dysfunctions are common in infants of the 1st year of life. Pediatricians often recommend shifting one milk formula to another, but usually it has no positive results, only complicating the managing of such patients. The article demonstrates the modern views on etiology, pathophysiological mechanisms and principles of dietary therapy of regurgitations, functional constipations, intestinal colic and other gastro-intestinal dysfunctions in infants. One of the special characteristics of these disorders is the fact that they rarely occur as isolated symptoms and much more often — in different combinations with each other. On clinical examination of children with functional disorders neither morphological changes in gastro-intestinal tract, nor disturbances in enzyme-secretory function are found. At the same time minimal digestive dysfunctions have negative effect on life quality of the family, development rate and nutritive status of the child. One of the most effective methods of correction of such conditions is dietary measures.

дети раннего возрастасрыгиванияфункциональные запорыкишечные коликибелки коровьего молокаinfantsregurgitationsfunctional constipationsintestinal coliccow milk proteinsReferencesFunktsional'nye Narusheniya Zheludochno-Kishechnogo Trakta u Detey Grudnogo Vozrasta i Ikh Dietologicheskaya Korrektsiya [Functional Disorders of the Gastrointestinal Tract in Infants and their Nutritional Correction]. In the book: Lechebnoe Pitanie Detey Pervogo Goda Zhizni [Therapeutic Nutrition of Infants]. Under the general editorship of A. A. Baranov, V. A. Tutelyan. Klinicheskie Rekomendatsii dlya Pediatrov [Clinical Guidelines for Pediatricians]. Moscow, Soyuz Pediatrov Rossii Publ., 2010. P. 51–64.Funktsional'nye Narusheniya Zheludochno-Kishechnogo Trakta u Detey Grudnogo Vozrasta i Ikh Dietologicheskaya Korrektsiya [Functional Disorders of the Gastrointestinal Tract in Infants and their Nutritional Correction]. In the book: Lechebnoe Pitanie Detey Pervogo Goda Zhizni [Therapeutic Nutrition of Infants]. Under the general editorship of A. A. Baranov, V. A. Tutelyan. Klinicheskie Rekomendatsii dlya Pediatrov [Clinical Guidelines for Pediatricians]. Moscow, Soyuz Pediatrov Rossii Publ., 2010. P. 51–64.Funktsional'nye Narusheniya Zheludochno-Kishechnogo Trakta u Detey Grudnogo Vozrasta i Ikh Dietologicheskaya Korrektsiya [Functional Disorders of the Gastrointestinal Tract in Infants and their Nutritional Correction]. In the book: Natsional'naya Programma Optimizatsii Vskarmlivaniya Detey Pervogo Goda Zhizni v Rossiyskoy Federatsii [National Program for Optimization of Infants Feeding in the Russian Federation]. Moscow, Soyuz Pediatrov Rossii Publ., 2010. P. 39–42.Funktsional'nye Narusheniya Zheludochno-Kishechnogo Trakta u Detey Grudnogo Vozrasta i Ikh Dietologicheskaya Korrektsiya [Functional Disorders of the Gastrointestinal Tract in Infants and their Nutritional Correction]. In the book: Natsional'naya Programma Optimizatsii Vskarmlivaniya Detey Pervogo Goda Zhizni v Rossiyskoy Federatsii [National Program for Optimization of Infants Feeding in the Russian Federation]. Moscow, Soyuz Pediatrov Rossii Publ., 2010. P. 39–42.Hyman H. E., Milla P. J., Benninga M. A., Davidson G. P., Fleisher D. F., Taminau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006; 130: 1519–1526.Hyman H. E., Milla P. J., Benninga M. A., Davidson G. P., Fleisher D. F., Taminau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006; 130: 1519–1526.Sherman P. M., Hassall E., Fagundes-Neto U., Cold B. D., Kato S., Kolezko S. A global evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am. J. Gastroenterol. 2009; 104: 1278–1295.Sherman P. M., Hassall E., Fagundes-Neto U., Cold B. D., Kato S., Kolezko S. A global evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am. J. Gastroenterol. 2009; 104: 1278–1295.Vandenplas Y., Rudolph C. D., Di Lorenzo C., Hassall E., Liptak G. Pediatric gastroesophageal reflux clinical practice guidelines. Joint recommendations of the North America Society for pediatric gastroenterology, hepatology and nutrition (NASPGHAN) and European Society for pediatric gastroenterology, hepatology and nutrition (ESPGHAN). J. Pediatr. Gastroenterol. Nutr. 2009; 49: 498–547.Vandenplas Y., Rudolph C. D., Di Lorenzo C., Hassall E., Liptak G. Pediatric gastroesophageal reflux clinical practice guidelines. Joint recommendations of the North America Society for pediatric gastroenterology, hepatology and nutrition (NASPGHAN) and European Society for pediatric gastroenterology, hepatology and nutrition (ESPGHAN). J. Pediatr. Gastroenterol. Nutr. 2009; 49: 498–547.Sindrom Rvoty i Srygivaniya u Detey. Posobie dlya Vrachey [Vomiting and Regurgitation Syndrome in Children. Manual for Physicians]. Edited by I. N. Zakharova, N. A. Korovina, M. I. Pykova et al. Moscow, 2009. 140 p.Sindrom Rvoty i Srygivaniya u Detey. Posobie dlya Vrachey [Vomiting and Regurgitation Syndrome in Children. Manual for Physicians]. Edited by I. N. Zakharova, N. A. Korovina, M. I. Pykova et al. Moscow, 2009. 140 p.Moon R. Y. Task force on sudden infant death syndrome, SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011; 128: 1030–1039.Moon R. Y. Task force on sudden infant death syndrome, SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011; 128: 1030–1039.Horvath A., Dziechciarz P., Szaewska H. The effect of thickenedfeed intervention on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized controlled trials. Pediatrics. 2008; 122: 1268–1277.Horvath A., Dziechciarz P., Szaewska H. The effect of thickenedfeed intervention on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized controlled trials. Pediatrics. 2008; 122: 1268–1277.Costalos C., Kapiki A., Apostolou M., Papathoma E. The effect of a prebiotic supplemented formula on growth and stool microbiology of term infants. Early Hum. Dev. 2008; 84: 45–49.Costalos C., Kapiki A., Apostolou M., Papathoma E. The effect of a prebiotic supplemented formula on growth and stool microbiology of term infants. Early Hum. Dev. 2008; 84: 45–49.Borovik T. E., Skvortsova V. A., Yatsyk G. V. et al. Funktsional'nye Narusheniya Zheludochno-Kishechnogo Trakta u Detey Grudnogo Vozrasta: Rol' Dietoterapii [Functional Disorders of the Gastrointestinal Tract In Infants: The Role of Diet Therapy]. Lechashchiy vrach [Doctor in Charge]. 2011; 6: 66–69.Borovik T. E., Skvortsova V. A., Yatsyk G. V. et al. Funktsional'nye Narusheniya Zheludochno-Kishechnogo Trakta u Detey Grudnogo Vozrasta: Rol' Dietoterapii [Functional Disorders of the Gastrointestinal Tract In Infants: The Role of Diet Therapy]. Lechashchiy vrach [Doctor in Charge]. 2011; 6: 66–69.Aggett P. G., Agostoni C., Goulet O., Hernell O., Kolezko B., Lafeber H. Antireflux or antiregurgitation milk products for infants and young children. A commentary by the ESPGHAN Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 2002; 34: 496–498.Aggett P. G., Agostoni C., Goulet O., Hernell O., Kolezko B., Lafeber H. Antireflux or antiregurgitation milk products for infants and young children. A commentary by the ESPGHAN Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 2002; 34: 496–498.American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000; 106: 346–349.American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000; 106: 346–349.Wessel M. A., Cobb J. C., Jackson E. B., Harris G. S. Paroxysmal fussing in infancy, sometimes called «colic». Pediatrics. 1954; 14: 421–435.Wessel M. A., Cobb J. C., Jackson E. B., Harris G. S. Paroxysmal fussing in infancy, sometimes called «colic». Pediatrics. 1954; 14: 421–435.Shergill-Bonner R. Infantil colic: practicalities of management, including dietary aspects. J. Fam. Health Care. 2010; 20: 206–209.Shergill-Bonner R. Infantil colic: practicalities of management, including dietary aspects. J. Fam. Health Care. 2010; 20: 206–209.Cohen-Silver J., Ratnapalan S. Management of infantile colic: a review. Clin. Pediatr. 2009; 48: 14–17.Cohen-Silver J., Ratnapalan S. Management of infantile colic: a review. Clin. Pediatr. 2009; 48: 14–17.Critch J. Infantil colic: is there a role for dietary intervention? Pediatr. Child. Health. 2011; 16: 47–49.Critch J. Infantil colic: is there a role for dietary intervention? Pediatr. Child. Health. 2011; 16: 47–49.Lucassen P. L., Assendelft W. J., Gubbels J. W., van Eijk J. T., Douwes A. C. Infantile colic: crying time reduction with a whey hydrolysate: A double-blind, randomized, placebo-controlled trial. Pediatrics. 2000; 106 (6): 1349–1354.Lucassen P. L., Assendelft W. J., Gubbels J. W., van Eijk J. T., Douwes A. C. Infantile colic: crying time reduction with a whey hydrolysate: A double-blind, randomized, placebo-controlled trial. Pediatrics. 2000; 106 (6): 1349–1354.Savino F., Palumeri E., Castagno E., Cresi F., Dalmasso P., Cavallo F., Oggero R. Reduction of crying episodes owing to infantile colic: A randomized controlled study on the efficacy of a new infant formula. Eur. J. Clin. Nutr. 2006; 60 (11): 1304–1310.Savino F., Palumeri E., Castagno E., Cresi F., Dalmasso P., Cavallo F., Oggero R. Reduction of crying episodes owing to infantile colic: A randomized controlled study on the efficacy of a new infant formula. Eur. J. Clin. Nutr. 2006; 60 (11): 1304–1310.Metcalf T. J., Irons T. G., Sher L. D., Young P. C. Simethicone in the treatment of infantile colic: a randomized, placebo-controlled multicenter study. Pediatrics. 1994; 94: 29–34.Metcalf T. J., Irons T. G., Sher L. D., Young P. C. Simethicone in the treatment of infantile colic: a randomized, placebo-controlled multicenter study. Pediatrics. 1994; 94: 29–34.Savino F., Cordisco I., Tarasco V. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, placebo controlled trial. Pediatrics. 2010; 126: 526–533.Savino F., Cordisco I., Tarasco V. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, placebo controlled trial. Pediatrics. 2010; 126: 526–533.Chen I. L., Gao W. Y., Johanson A. P., Niak A., Troiani J. Proton pump inhibitor use in infants: FDA reviewer experience. Gastroenterol. Nutr. 2012; 54: 8–14.Chen I. L., Gao W. Y., Johanson A. P., Niak A., Troiani J. Proton pump inhibitor use in infants: FDA reviewer experience. Gastroenterol. Nutr. 2012; 54: 8–14.Baildam E. M. Duration and pattern of crying in the first year of life. Dev. Med. Child. Neurol. 1995; 37: 345–353.Baildam E. M. Duration and pattern of crying in the first year of life. Dev. Med. Child. Neurol. 1995; 37: 345–353.St. James-Roberts I., Peachey E. Distinguishing infant prolonged crying from sleep-waking problems. Arch. Dis. Child. 2011; 96: 340–344.St. James-Roberts I., Peachey E. Distinguishing infant prolonged crying from sleep-waking problems. Arch. Dis. Child. 2011; 96: 340–344.Gormally S. Clinical clues to organic ethiologies in infants with colic. In: New evidence on unexplained early infant crying: its origins, nature and management. R. Barr, I. St. James-Roberts (eds.). Johnson& Johnson Pediatric Institute. 2001. P. 133–149.Gormally S. Clinical clues to organic ethiologies in infants with colic. In: New evidence on unexplained early infant crying: its origins, nature and management. R. Barr, I. St. James-Roberts (eds.). Johnson& Johnson Pediatric Institute. 2001. P. 133–149.Freedman S. B., Al-Harthy N., Thull-Freedman J. The crying infant: diagnostic testing and frequency of serious underlying disease. Pediatrics. 2009; 123: 841–848.Freedman S. B., Al-Harthy N., Thull-Freedman J. The crying infant: diagnostic testing and frequency of serious underlying disease. Pediatrics. 2009; 123: 841–848.Sorvacheva T. N., Pashkevich V. V., Kon’ I.Ya. Dietoterapiya Zaporov u Detey Pervogo Goda Zhizni [Diet Therapy of Constipation in Infants]. In the book: Rukovodstvo po Detskomu Pitaniyu [Guidelines for Child Nutrition]. Edited by V. A. Tutelyan, I.Ya. Kon’. Moscow, MIA Publ., 2009. P. 519–526.Sorvacheva T. N., Pashkevich V. V., Kon’ I.Ya. Dietoterapiya Zaporov u Detey Pervogo Goda Zhizni [Diet Therapy of Constipation in Infants]. In the book: Rukovodstvo po Detskomu Pitaniyu [Guidelines for Child Nutrition]. Edited by V. A. Tutelyan, I.Ya. Kon’. Moscow, MIA Publ., 2009. P. 519–526.Tunc V. T., Camurdan A. D., Illah M. N., Sahin F., Beyazova U. Factors associated with defecation patterns in 0–24 month-old children. Eur. J. Pediatr. 2008; 167: 1357–1362.Tunc V. T., Camurdan A. D., Illah M. N., Sahin F., Beyazova U. Factors associated with defecation patterns in 0–24 month-old children. Eur. J. Pediatr. 2008; 167: 1357–1362.Biggs W. S., Dery W. H. Evaluation and treatment of constipation in infants and children. Am. Fam. Phys. 2006; 73: 469–477.Biggs W. S., Dery W. H. Evaluation and treatment of constipation in infants and children. Am. Fam. Phys. 2006; 73: 469–477.Eigenmann P. A., Zamora S. A., Belli D. C. Cow, s milk and chronic constipation in children. N. Engl. J. Med. 1999; 340: 891.Eigenmann P. A., Zamora S. A., Belli D. C. Cow, s milk and chronic constipation in children. N. Engl. J. Med. 1999; 340: 891.Anokhin V. A., Khasanova E. E., Urmancheeva Yu. R. et al. Otsenka Klinicheskoy Effektivnosti Smesi Frisovom v Pitanii Detey s Disbakteriozom Kishechnika Razlichnoy Stepeni i Minimal'nymi Pishchevaritel'nymi Disfunktsiyami [Evaluation of the Clinical Effectiveness of the Frisovom Mixture in Nutrition of Children with Varying Degrees of Intestinal Dysbiosis and Minimal Digestive Dysfunctions]. Voprosy sovremennoy pediatrii [Current Pediatrics]. 2005; 3: 75–79.Anokhin V. A., Khasanova E. E., Urmancheeva Yu. R. et al. Otsenka Klinicheskoy Effektivnosti Smesi Frisovom v Pitanii Detey s Disbakteriozom Kishechnika Razlichnoy Stepeni i Minimal'nymi Pishchevaritel'nymi Disfunktsiyami [Evaluation of the Clinical Effectiveness of the Frisovom Mixture in Nutrition of Children with Varying Degrees of Intestinal Dysbiosis and Minimal Digestive Dysfunctions]. Voprosy sovremennoy pediatrii [Current Pediatrics]. 2005; 3: 75–79.Yolkina T. N., Kondyurina E. G., Surovikina E. A., Gribanova O. A. Otsenka Effektivnosti Antireflyuksnoy Smesi s Prebiotikami dlya Korrektsii Funktsional'nykh Rasstroystv Pishchevareniya u Detey Pervykh Mesyatsev Zhizni [Evaluating the Effectiveness of Antireflux Mixtures with Prebiotics for the Correction of Digestive System Functional Disorders in Infants]. Voprosy detskoy dietologii [Problems of Pediatric Nutritiology]. 2011; 6: 53–57.Yolkina T. N., Kondyurina E. G., Surovikina E. A., Gribanova O. A. Otsenka Effektivnosti Antireflyuksnoy Smesi s Prebiotikami dlya Korrektsii Funktsional'nykh Rasstroystv Pishchevareniya u Detey Pervykh Mesyatsev Zhizni [Evaluating the Effectiveness of Antireflux Mixtures with Prebiotics for the Correction of Digestive System Functional Disorders in Infants]. Voprosy detskoy dietologii [Problems of Pediatric Nutritiology]. 2011; 6: 53–57.Sackesen C., Assaad A., Baena-Cagnali C., Ebisawa M., Fiocchi A., Heine R. G. Cow, s milk allergy as a global challenge. Curr. Opin. Allergy Clin. Immunol. 2011; 11: 243–248.Sackesen C., Assaad A., Baena-Cagnali C., Ebisawa M., Fiocchi A., Heine R. G. Cow, s milk allergy as a global challenge. Curr. Opin. Allergy Clin. Immunol. 2011; 11: 243–248.Fiocchi A., Schunemann H. J., Brozek J., Restani R. et al. Diagnosis and rationale for action against cow, s milk allergy. A summary report. J. Allergy Clin. Immunol. 2010; 51: 599–607.Fiocchi A., Schunemann H. J., Brozek J., Restani R. et al. Diagnosis and rationale for action against cow, s milk allergy. A summary report. J. Allergy Clin. Immunol. 2010; 51: 599–607.Henriksen C., Eggesbo M., Halvorsen R., Botten G. Nutrient intake among two-years old children on cow, s milk restricted diets. Pediat. Clin. North Am. 2009; 56: 1085–1103.Henriksen C., Eggesbo M., Halvorsen R., Botten G. Nutrient intake among two-years old children on cow, s milk restricted diets. Pediat. Clin. North Am. 2009; 56: 1085–1103.Boyce J. A., Assaad A., Burks A. W., Jones S. A. et al. Guidelines for the diagnosis and management of food allergy in United States. Report of NIAID-sponsored expert panel. J. Allergy Clin. Immunol. 2010; 126 (6): 1–58.Boyce J. A., Assaad A., Burks A. W., Jones S. A. et al. Guidelines for the diagnosis and management of food allergy in United States. Report of NIAID-sponsored expert panel. J. Allergy Clin. Immunol. 2010; 126 (6): 1–58.Skripak J. M., Matsui E. C., Mudd K. The natutal history of IgEmediated cow, s milk protein allergy in infants. Arch. Dis. Child. 2007; 92: 902–908.Skripak J. M., Matsui E. C., Mudd K. The natutal history of IgEmediated cow, s milk protein allergy in infants. Arch. Dis. Child. 2007; 92: 902–908.Vandenplas Y., De Greef E., Devreker T., Hauser B. Soy infant formulas: is it that bad? Acta. Paediatr. 2011; 100: 162–166.Vandenplas Y., De Greef E., Devreker T., Hauser B. Soy infant formulas: is it that bad? Acta. Paediatr. 2011; 100: 162–166.Bhatia J., Greer F. American Academy of Pediatrics Committee on Nutrition. Use of soy protein-based formulas in infant feeding. Pediatrics. 2008; 121: 1062–1068.Bhatia J., Greer F. American Academy of Pediatrics Committee on Nutrition. Use of soy protein-based formulas in infant feeding. Pediatrics. 2008; 121: 1062–1068.Klemola T., Vanto T., Juntunen-Backman K. Allergy to soy formula and to extensively hydrolysed whey formula in infants with cow’s milk allergy: a prospective randomized study with a follow-up to the age of 2 years. J. Pediatr. 2002; 140: 219–224.Klemola T., Vanto T., Juntunen-Backman K. Allergy to soy formula and to extensively hydrolysed whey formula in infants with cow’s milk allergy: a prospective randomized study with a follow-up to the age of 2 years. J. Pediatr. 2002; 140: 219–224.

The authors declare that there are no conflicts of interest present.