The aim of the work was to increase the effectiveness of the treatment of Helicobacter pylori-associated duodenal ulcer (H.pylori-associated duodenal ulcer) in children by determining intestinal microbiocenosis disorders, establishing the pathogenetic role of defensins alpha 1-3, cathelicidin LL37, vitamin D and developing complex therapy. Two observation groups were created: the main group (122 people) - children with duodenal ulcers (DU) and the comparison group (83 people) - practically healthy children. The main group, depending on the positive or negative test for H.pylori infection, was divided into two subgroups (I - children with a positive test for H. pylori (n = 98) and II - children with a negative test for H.pylori (n = 24). Depending on the treatment scheme, children with H.pylori- associated DU were divided into three treatment groups: treatment group I (ITG, n = 33), which received protocol therapy, treatment group II (IITG, n = 32), which received protocol therapy and vitamin D, III treatment group (IIITG, n = 33), which received protocol and adjuvant therapy with the inclusion of vitamin D and synbiotics.
The inclusion of a synbiotic in the treatment scheme of IIITG children contributed to the normalization of the frequency of bowel movements in 87.9% of people, and on the 10th day - in 96.9 % of people, while in ITG children, the normalization of bowel movements on the 7th day was observed only in 62.8 % of people, and on the 10th day - in 81.2 % of people (χ2= 6.67, p<0.05). Against the background of therapy with the use of synbiotics, positive dynamics in the composition of the intestinal microbiome are observed in patients with H. pylori-associated DU: an increase in the number of patients with eubiosis by 21.2 % and a significant decrease in the number of patients with dysbiosis of II and III degree (by 30.3 % and 41.6 %, respectively). The length of stay in the hospital in IITG children decreased to 3.2 days, in IIITG children - by 6.7 days compared to ITG. Three months after hospital discharge, early relapses were observed in 9.9 % of IIITG children, 15.6 % of IITG children, and 36.4 % of ITG children. After 6 months, signs of exacerbation appeared in 27.2 % of children who received only standard therapy, in 9.3 % of people who, in addition to traditional treatment, took a vitamin D, and only in 6% of patients who received modified therapy that included the vitamin D and synbiotics (χ2= 6.99, p<0.05). After one year, the recurrence rate in ITG children was 36.4 %, in IITG children - 33.3 % (χ2= 1.67, p>0.05) and in IIITG - 15.5% (χ2= 7.67, p <0.05). The analysis of the results of the comprehensive treatment showed that the relative risk of disease recurrence decreased by 0.56 times [95% CI: 0.19 - 1.99], χ²=3.86, p<0.05 when the drug was included in the standard therapy scheme of vitamin D and by 0.64 times [95% CI: 0.22 – 2.34], χ²=7.69, <0.05 when including vitamin D and synbiotics in the treatment regimen. The state of intestinal microbiocenosis, indicators of antimicrobial peptides and vitamin D probably changed after the eradication of H.pylori, but did not reach the level of the corresponding values in healthy children, which indicates the need for pathogenetic treatment with the inclusion of vitamin D and synbiotics in the treatment regimen to restore intestinal microbiocenosis. Complex treatment provides more stable results of the disease treatment both in the early and late periods of observation of children, increases the result of the eradication of the H.pylori bacterium, promotes faster positive dynamics of the main clinical syndromes and biologically active substances (the active metabolite of vitamin D, DFA1-3, CL LL37), normalization of the functional state of the stomach and microbiocenosis of the intestinal cavity, which creates conditions for recovery and transition of the pathological process to an inactive state.
