Nekhaienko M. Clinico-pathogenetic reasoning of differentiated therapy of chronic gastroduodenitis in adolescents.

In this dissertation, the data of retrospective study are given clinical-paraclinical features of the course of chronical gastroduodenitis at children depending on age, gender and the length of illness. In the period of 10 years was detected: an increase of a number of adolescents at 3,8 times and at 1,9 times of gastric hypoacidity at them; growth of erosion form of CDG’s level at adolescents with the increase of the duration of disease. 164 adolescents at age of 15 – 17 with CDG were thoroughly examined, which were divided into 4 representative groups; 1 – 22 ill with helicobacteriosis without any signs of chronical candidiasis of digestive tract (CC DT); 2 – 32 infected H.p. with CC; 3 – 78 patients without H.p. at the presence of CC; 4 – 32 adolescents, not infected H.p. and without any signs of CC DT. The most prognostically significant factors of risk of course of gastric hypoacidity and numerous erosions gastroduodenal zone at adolescents with CDG were defined and accordant mathematic methods of calculation were developed. The feasibility of a cytological study of mucous membrane (MM) oral cavity (OC) and brush-cytology of stomach for verification of CC DT diagnosis. The endoscopic features of CDG at adolescents with associative infection are spread erosions MM of a stomach (MMS) and duodenum (DD). Morphological features of CDG at the presence of helicobacteriosis and its’ association with candidis is the destruction of superficial epithelium and expressive diffuse leukocyte-macrophage infiltration of its own plate (OP) with a maximum amount of macrophages (CD68) on the background of inflammation mainly of 3rd degree. At associative inflammation – with a formation lymphoid follicles and massive infiltration CD68 of deeper layers MMS, hyperplasia and «mucoadisation» of superficial glands with the 3rd degree of inflammation and a large number of candids. At CC DT – diffusive macrophage-eosinophilic infiltration OP CD68 at superficial glands MMS with the 2nd degree of inflammation, hyperplasia of upper and deeper glands with a great number of candids. With the absence of infection – not diffusive infiltration of OP alone with CD68 with the 1st level of inflammation without any changes at glands. For the first time the data of molecular features of influence of infected factors at reparation processes MMS at adolescents with CDG – significant activity of marker of proliferation Ki-67 at diffusive infiltration OP and upper glands at helicobacteriosis ; at associative infection – maximum at lymphoid follicles and superficial glands; with the presence of HK – significant activity of Ki-67 at the diffusive infiltration of OP, superficial and deeper glands, but at not infected patients – the minimal activity of marker at superficial epithelium. For the first time the particularities of molecular mechanisms of not specific protection MMS at CDG at adolescents with helicobacteriosis – maximal expression TLR4 on epithelium of superficial glands and macrophages of own plate, high expression TLR2 at upper epithelium; at associative infection – high level of expression TLR4 at superficial epithelium, epithelium of superficial glands, macrophages and lymphocytes of diffusive infiltrate OP at macrophages of lymphoid follicles at the background of maximum expression TLR2 of the same localization; with the presence of CC DG – moderate expression TLR4 at superficial epithelium and epithelium of upper glands at maximal expression TLR2 at the same location and eosinophils; with the absence of infection – the minimal expression of the both receptors on isolated macrophages of OP. Based on the research data scientifically substantiated, developed and approved the programme of complex differentiated therapy at adolescents with CDG including adjuvant oderators (probiotic spore-forming antibiotic resistant strains Bacillus clausii at helycobacteriosis, with the presence of associative infection H.p. and candids and at CC DT – therapeutic yeast (Sacharomyces boulardi), which due to results of clinical dynamic. Microbiological, micrological data, endoscopic and morphological characteristics of inflammation and reparation processes, expression of TLR2 and TLR4 and indicators of eradication provokers was at 1,55-1,83 times more effective in caparison with basis therapy accordingly to the group division.