Zhuravl'ova I. Clinical significance of bile microflora and intestines biocenosis at children's chronic cholecystitis.

Object of the research: Chronic cholecystitis. Purpose of the research: To improve the efficacy of diagnosis and treatment for chronic cholecystitis in children based on the study of bile microflora and intestinal biocenosis. Methods of the research: Clinical, bacteriological, instrumental, statistical. Practical significance of the obtained findings: A method of early diagnosis of hepatobiliary system diseases, chronic cholecystitis in particular, in children using bacteriological study of the feces for dysbacteriosis. When the number of clostridia exceeds 104 CFU/g, hepatobiliary disorders requiring further more profound study are diagnosed. The necessity of bacteriological study of the feces for dysbacteriosis at least 2 times a year was substantiated. Clinical efficacy of Enterol-250 was shown its expediency in complex therapy for chronic cholecystitis was demonstrated. Novelty: For the first time, simultaneous study of bacterial microflora of the bile and intestine biocenosis in patients with chronic cholecystitis was done. This allowed expanding the ideas about the etiology and mechanisms of infection. The parameters of bile infestation and their frequency were determined. It was shown that at present the leading role is played by Candida (81,25%) fungi, which are characterized by morphophysiological changes in the cells with increase in their aggression. Clinical significance of dysbiotic disorders in the large intestine in patients with chronic cholecystitis was determined. Depending on the changes in the large intestine microflora, 3 degrees of dysbiotic disorders whose severity increases with the degree were distinguished. Correlation of Candida (C.albicans и C.cruzei) in the feces and presence of these microorganisms in the bile was found in patients with chronic cholecystitis. It was shown that high level of feces infestation with spore-forming anaerobic bacteria (clostridia) - 104 CFU/g - was present in patients with chronic cholecystitis. These data were used to work out a new method of earlydiagnosis of hepatobiliary diseases with the use of bacteriological investigation of the feces (positive decision on application № 2004020791 dated 04.02.2004). A method of correction of dysbiotic disturbances in children with chronic cholecystitis was substantiated. Degree of introduction: The obtained findings were introduced into the work of pediatric gastroenterology and nutrition department of Kharkiv Medical Academy for Post-graduate Training, pediatrics department of Ternopil State Medical University. The findings of the research were introduced to the work of Children's Hospital No. 19 (Kharkiv), No. 24 (Kharkiv), Prikarpattia joint stock society "Ukrprofzdravnitsa". Sphere of application: medicine, gastroenterology.