Dzhagiashvili O. Age characteristics of syntropic pathology with functional disorders of the digestive system in children

The thesis is devoted to the improvement of diagnosis and prediction of the course of functional disorders of the digestive organs (FDDO) in children by defining the role of collagenopathy and the intestinal microbiota in syntropia pathogenesis. A high level of syntropic disorders with FDDO is shown. The structure of syntropic pathology is represented by a combination of irritable bowel syndrome with functional disorders of the biliary tract and functional dyspepsia in children of the older age group, with functional disorders of the pancreas in children of the middle age group and with cyclic vomiting syndrome in children of the younger group. It is established that abdominal syndrome is the leading sign in children with syntropic FDDO. Using a multivariate logistic regression, a mathematical model was created to quantify the most significant signs, namely, the duration of the disease, the intensity of abdominal pain, localization, temperature response, peritoneal irritation, which allows optimizing the differential diagnosis between FDDO and surgical pathology at the stage of primary care. It was revealed that children with FDDO have a high prevalence (55.1 %) of phenotypic manifestations of connective tissue dysplasia (CTD), the degree of which increases with the age of patients. The importance of the CTD role in the development of syntropic FDDO was proved by the identification of COL3A1 rs1800255 genetic polymorphism with the prevalence of G/A genotype, which 3.6 folds (95 % CI 1.4÷9.4) increased the risk of syntropic disorders. The pathogenetic importance of disorders of the intestinal enterotype Prevotella in children with syntropic FDDO was determined, which was characterized by the absence of representatives of Prevotella сopri in half of the patients and a decrease in their quantity in 42.0 % of the examined children. The de-escalation of P. copri increases 4 folds the chance of syntropy detection (OR 3.9; CI 1.3÷12.0). The data obtained are evidence of deeper changes in the intestinal microbiota with syntropic FDDO in children, which must be considered when developing therapeutic recommendations.