Irritable bowel syndrome (IBS) is one of the most widespread disorders of gut-brain interaction in children, which lead to a decrease in the quality of life of patients, impairment of their mental health, social functioning, etc. This results in frequent requests for medical care, which creates a serious burden on the health care system. Numerous potential risk factors for the development of IBS are reported in the literature, but their interdependence, especially in children, remains unclear. Due to the high prevalence of IBS among children in Ukraine, there is currently a need to improve the existing methods of diagnosis and treatment of the disorder.
The aim of the dissertation was to increase the effectiveness of diagnosis and treatment of IBS in children based on the study of clinical significance of biological, psychoemotional, psychosocial factors in the occurrence and course of this disorder, taking into account its heterogeneity.
We have examined 54 children with IBS aged 6 to 12, 28 boys (51.9%) and 26 girls (48.1%). The average duration of the disorder at the time of the diagnosis amounted to 2.2 ± 1.1 years. 24 children (44.5%) had constipation-predominant IBS, 12 (22.2%) had diarrhea-predominant IBS, while 18 patients (33.3%) had IBS with alternating constipation and diarrhea. A trigger factor in the occurrence of the disorder was also taken into account, in particular stress (stress-associated IBS in 46.3% of patients), previous intestinal infection and/or antibacterial therapy (post-infectious IBS in 53.7% of subjects).
The control group consisted of 50 patients of the traumatology department of the Lviv Regional State Clinical Hospital, who were of similar age (46.7% boys and 53.3% girls, who were diagnosed with a mild injury that did not require surgical treatment (S50, S52.2, S52.3, S80, S60, S82.0, S82.2).
The following methods were used in the dissertation: molecular-genetic research, enzyme immunoassay to determine the concentration of fecal calprotectin, measurement of heart rate variability using cardiointervalography, determination of the level of trait anxiety and somatization, genealogical research (family history) and analytical-statistical methods.
At the first stage of the study, the role of individual biological (val158met polymorphism of the catechol-O-methyltransferase (COMT) gene, parameters of heart rate variability (HRV)), psychoemotional (level of trait anxiety and somatization) and psychosocial (perinatal, psychosomatic disorders of infants and microsocial) risk and protection factors in the occurrence of IBS in children were studied.
At the second stage of the dissertation research, the study of interrelationships between different levels, i.e., biological, psychoemotional and psychosocial risk and protection factors in the occurrence of IBS was carried out.
At the third stage of the dissertation research, a regression model of the probability of IBS occurrence in a child was developed based on the biopsychosocial approach, which includes the 11 most important somatic, psychoemotional, and psychosocial risk and protection factors. The accuracy of the developed model amounted to 92.3%, specificity – 94.0%, sensitivity – 90.7%. Importantly, most of these factors, with the exception of the functional val158met polymorphism of the COMT gene, are available for determination already at the primary level of medical care. Therefore, the prognostic model proposed by us can be used for the early diagnosis of IBS, as well as for the prevention of the disorder in the future.
The results of the dissertation have been implemented in the practical activities of 7 children’s medical and preventive institutions in Lviv and Lviv region. 13 scientific works have been published on the topic of the dissertation, including 8 articles, 7 of which are in journals indexed in the international scientific-metric databases Scopus and Web of Science.
