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THE PROBLEM OF INTESTINAL DYSBACTERIOSIS IN THE
ASPECT OF PEDIATRICS
N.D. Yadgarova1
In our work, the problems of intestinal dysbacteriosis in the aspect of pediatrics are noted, based on literary data.
Key words: aspects, analysis, stomach, intestines, complications.
The problem of intestinal dysbacteriosis continues to be relevant and significant for practicing physicians of various specialties.
Despite the large number of studies in the field of etiology, epidemiology, diagnosis of intestinal dysbacteriosis, many of its pathogenetic aspects remain insufficiently covered. In the works of some authors of the near abroad, data are given on the close relationship between immunity and the state of intestinal microbiocenosis.
In a broader sense, intestinal dysbacteriosis is a manifestation of a general disturbance in the state of the microflora in the whole organism - dysbiocenosis, i.e. violations are present in all biocenoses of the body, and not only in the intestines. The close correlation of dysbacteriosis of the skin, pharynx, genitourinary tract and dysbiotic disorders in the intestine has been convincingly shown. Intestinal dysbacteriosis is not an independent disease, but a microbiological condition that leads to a disruption in the functioning of the microflora and the appearance of certain symptoms associated with pathological conditions.
Numerous literature data indicate that under physiological conditions, the intestinal microflora plays a regulatory role, ensures the maturation of the immune system and its balanced functioning in later life. In a situation of instability of the biocenosis of the gastrointestinal tract, prerequisites are created for the intensity of the processes of the immune response, overcoming the threshold of tolerance, and the formation of immune dysfunction.
According to the authors of the literature, the imbalance of the immune system and intestinal microflora in children is quite common and remains an important, complex and not completely solved problem. The formation of immunological competence at an early age has large individual differences not only in the intensity of the immune response, but also in the timing of its appearance. These differences are due to numerous factors.
The main ones are: the ecological environment of the child, the immunological relationship between the organism of the mother and the fetus, the physiological maturity of the child at the time of birth, the state of maternal immunity, the method of feeding, diseases suffered during the neonatal period and in the first year of life, the nature and intensity of early and artificial antigenic stimulation.
During intrauterine development, the fetus is sterile. During the passage of the birth canal, the colonization of the gastrointestinal tract and skin of the child with the microflora of the vagina and skin of the mother begins. The formation of the microflora of a newborn child is determined by the state of the microflora of the intestines and vagina of the mother, the timing of the first breastfeeding and the type of feeding, the state of health of the newborn, environmental conditions. The state of the microflora of the intestines and the mother's vagina.
There is a hypothesis of immunological tolerance to normal microflora, according to which, in the prenatal period, fragments of representatives of the normal intestinal microflora of the mother, similar to the structures of macroorganism cells, come to the fetus, and immunolog-ical tolerance is formed to these microorganisms (under physiological conditions - bifidobacteria and lactobacilli). That is why IgA antibodies to these microorganisms are not produced throughout life.
In case of violation of the biocenosis of the intestine and / or vagina (bacterial vaginosis, vulvovaginal candidiasis) in the mother, dysbacteriosis naturally develops in the child. The timing of the first attachment to the breast and the type of feeding. With late breastfeeding (after 2 hours of life) and artificial feeding, microbial colonization of the intestine is disrupted, the formation of normal microflora slows down, opportunistic microorganisms predominate. Bifidus factor - oligosaccharides, as well as a number of other components of breast milk - stimulates the growth of bifidobacteria.
1Yadgarova Norbibi Dzhaparovna - Senior Lecturer, Department of propaedeutics of children's diseases, Tashkent Pediatric Medical Institute.
The second critical moment after the neonatal period, which has an exceptional effect on bacterial colonization of the intestine, is weaning. At this time, significant qualitative and quantitative changes occur in the composition of the microflora (an increase in the proportion of E. coli), which is accompanied by a change in the stool (acquires a typical adult character).
Health status of the newborn. Bifidobacteria are among the most capricious in terms of microorganism growth conditions. Violations in the normal ratio of amino acids, fatty acids, vitamins in the intestine that occur during parenteral nutrition in premature infants, with ischemia of the intestinal wall in various diseases, neonatal maladjustment syndrome lead to dysbacterio-sis.
Environmental conditions (degree of contamination of personnel, care items). It is shown that if the child is in the maternity hospital for more than 5 days, the normal microflora is naturally replaced by opportunistic microorganisms.
Unlike older children and adults, in whom dysbacteriosis is always secondary and its main causes are antibiotic therapy and chronic diseases of the gastrointestinal tract, in newborns and infants, the development of dysbacteriosis can be primary and is due to factors such as intestinal dysbacteriosis, bacterial vaginosis in a pregnant woman and lactating mother, late breastfeeding, early artificial or mixed feeding, perinatal pathology, species microbial landscape and the degree of contamination of the environment.
Thus, the etiology of dysbacteriosis depends on age. In a newborn, the process of colonization of the gastrointestinal tract has a clinical expression in the form of a transient physiological catarrh of the intestine, which in its development goes through 3 stages, coinciding with the stages of colonization of the gastrointestinal tract. The first stage (conditionally sterile) corresponds to the separation of the original stool - meconium (1-2 days). The second stage (increasing infection) is manifested by a transitional stool containing mucus, greens, undigested lumps, leukocytes.
At this stage, there is a colonization by various microorganisms presented in the birth canal of the mother and the environment of the child. The next stage is called transformation, when microorganisms representing the protective microflora (bifidobacteria and lactobacilli), due to antagonistic activity, displace representatives of another, mainly opportunistic, microflora. The transformation stage is marked by the appearance of a "mature" stool - yellow, with a sour smell, creamy consistency (in breastfed children)
According to classical ideas, the second stage lasts until the end of the first week.
Currently, more and more clinical and microbiological data are accumulating on a much longer duration of this stage, often opportunistic microorganisms in the feces of children with corresponding clinical manifestations are found in the first 4-6 months of life. In these cases, we can talk about a delay in the formation of a normal intestinal biocenosis.
The range of causes that cause dysbacteriosis is quite wide. The causes of intestinal dysbacteriosis can be divided into exogenous and endogenous, in accordance with them, variants of dysbacteriosis of various etiologies are distinguished. Factors contributing to the development of dysbacteriosis either directly affect the microflora or create "uncomfortable" conditions in the gastrointestinal tract for the existence of normal microflora, which are determined by the nature of nutrition and metabolism, the state of oxygenation and hemodynamics in the intestinal wall, intestinal motility.
Drug dysbacteriosis is caused primarily by antibacterial drugs. Some antibiotics (ampicil-lin, carbenicillin, aminoglycosides, tetracyclines, chloramphenicol, lincomycin) cause significant disturbances in the composition of the microflora, while other antibacterial drugs (sulfonamides, phenoxymethylpenicillin, macrolides, quinolines) have a moderate effect. Taking into account the parietal localization of the main protective intestinal microflora, it is clear why parenteral administration of antibacterial drugs leads to more pronounced changes in the composition of the microflora compared to oral administration.
In addition to antibiotics, the development of dysbacteriosis also leads to the intake of a number of other drugs that disrupt gastrointestinal motility, regeneration of the epithelium, or the formation of mucus. These include narcological and local anesthetics, emetics, enveloping, laxatives, expectorants, choleretic agents, adsorbents, psychotropic drugs (phenothiazine derivatives), heavy metal salts, antihistamines and non-steroidal anti-inflammatory drugs, cytostatics, hormonal contraceptives.
Alimentary dysbacteriosis occurs when non-traditional food products or non-physiological forms of nutrition are consumed (for example, a deficiency of dietary fiber, vitamins, protein, an excess of canned refined foods, one-sided nutrition, prolonged parenteral nutrition, starvation, the use of dyes and preservatives). Postoperative dysbacteriosis occurs as a result of operations on the gastrointestinal tract (resection, stoma, etc.) and any mechanical impact that violates the integrity of the biofilm.
Post-infectious dysbacteriosis develops after bacterial and viral infections. The most pronounced changes in the intestinal biocenosis cause intestinal infections, helminthiases, hepatitis, giardiasis, but even a banal acute respiratory disease can cause dysbiotic disorders.
Stress dysbacteriosis occurs after physical or emotional stress. Post-radiation dysbacteriosis is caused by exposure to ionizing radiation.
Toxic dysbacteriosis is caused by environmental toxins, xenobiotics (domestic and industrial pollutants). Functional dysbacteriosis occurs due to reduced secretion of hydrochloric acid in the stomach, insufficiency of the exocrine function of the pancreas, liver, intestinal dyskinesia. Under these conditions, the mechanisms that under normal conditions prevent the overgrowth of bacteria in the small intestine are disrupted.
Nutritional dysbacteriosis develops with dyspepsia, diarrhea, and the syndrome of impaired intestinal absorption (malabsorption). Inflammatory dysbacteriosis accompanies inflammatory diseases of the gastrointestinal tract (gastroenterocolitis, including allergic ones, Crohn's disease, ulcerative colitis), while a violation of causal relationships is possible. Immunodeficiency dysbacteriosis occurs in some patients with a deficiency of specific and nonspecific protective factors (primary and secondary immunodeficiency states, including iatrogenic, for example, due to long-term use of immunosuppressants).
In a number of children, intestinal dysbacteriosis may have a polyetiological character. So, according to our data, in the study of biocenosis of the terminal intestine of 80 children of the first two years of life with bronchopulmonary dysplasia, intestinal dysbacteriosis, detected in most patients (93.75%), was of mixed genesis (prematurity, genital infections of mothers, early artificial feeding, intensive and aggressive antibiotic therapy in the neonatal period and thereafter).
In recent years, more and more attention is paid to the immune mechanisms of the development of intestinal dysbacteriosis. It has been established that the intestinal flora takes part in the formation of the immune system, and the latter can influence the composition of the microflora.
There are few publications in the literature on clinical and immunological examination of children with frequent respiratory diseases. A number of researchers point to a violation of the processes of interferon formation (IFN) in this group of patients.
The individual ability to synthesize IFN is genetically determined, and resistance to viral infections largely depends on the production of IFN even before infection.
Respiratory diseases occupy a leading place in the structure of morbidity in children. First of all, this concerns the group of frequently ill children, in which the risk of developing respiratory infections and their complicated forms is highest. About 80% of children turn to an immunologist for recurrent respiratory diseases.
The researchers noted that when analyzing the factors contributing to the occurrence of frequent respiratory diseases in the examined children, they found that in terms of frequency of psychosocial factors, unfavorable material and living conditions (26%), a low level of sanitary culture of parents (21%), with less frequent incomplete family composition (9%) and the degree of attention to the child (17%). The results of the authors' analysis of biomedical factors showed a high frequency of perinatal lesions of the central nervous system (55%), unfavorable course of pregnancy (32%), pathology of labor (23%
Less commonly noted factors such as irrational feeding, low or high birth weight, prematurity. A combination of psychosocial and biomedical factors contributing to recurrent respiratory morbidity was observed in 74% of children.
Analyzing the formation of morbidity in children of the first year of life, it was found that there is a dependence of morbidity on the period of occurrence of the first disease in children and living conditions.
Among the children examined by them, by the end of the first year of life, 86% of children had been ill with one or another disease, the first diseases in 47.7% of children were respiratory diseases.
Thus, summing up the literature review, we can say that the prevention of dysbacteriosis in children includes the prevention and treatment of intestinal dysbacteriosis and bacterial vaginosis in a pregnant woman, measures aimed at the normal formation of microflora in a newborn (early attachment to the breast, joint stay of mother and child, breastfeeding, with artificial feeding - mixtures with prebiotics), prophylactic administration of prebiotics (for newborns, at the stage of weaning, after taking antibiotics), functional nutrition.
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© N.D. Yadgarova, 2023.
