Дисфункция сфинктера Одди выявлена в 1/2 случаев у детей с повторяющимися эпизодами болей в животе в течение последних 3 мес перед обращением к врачу, в 1/3 (38,7%) случаев они сопровождались нарушениями моторики верхних отделов пищеварительного тракта в виде дуодено-гастрального рефлюкса. Характерными клиническими проявлениям для дисфункции сфинктера Одди являются болевой синдром и синдром диспепсии с преобладанием симптомов кишечной диспепсии (метеоризм, урчание в животе), обусловленные развитием вторичной билиарной и панкреатической недостаточности. Применение в качестве патогенетической терапии ферментных препаратов поджелудочной железы в виде мини-таблеток способствовало эффективной коррекции вторичной панкреатической недостаточности и восстановлению функциональной активности поджелудочной железы.
Ключевые слова: функциональные нарушения поджелудочной железы, дисфункция сфинктера Одди.
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Dysfunction of sphincter Oddi was found in one half cases in children with recurrent abdominal pain during the last 3 months before going to the doctor and in one third cases (38.7%) was accompanied by motility disturbance of upper part of gastrointestinal tract as duodeno-gastric reflux. Typical clinical manifestations for dysfunction of sphincter Oddi were pain syndrome and dyspeptic syndrome with the prevalence of intestinal dyspepsia symptoms (bloating, rumbling in the abdomen) due to the development of secondary biliary and pancreatic insufficiency. Using of pancreatic enzymes in the form of minitablets as pathogenetical treatment promoted effective correction of secondary pancreatic insufficiency and restored functional activity of the pancreas.
Key words: functional disorders of the pancreas, dysfunction of sphincter Oddy.
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22. Laugier R. Dynamic endoscopic manometry of the response to secretin in patients with chronic pancreatitis. Endoscopy 1994; 26: 222–7.
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1. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology 2006; 130: 1377–90.
2. Rimarchuk G.V., Shchepliagina L.A. Zabolevaniia podzheludochnoi zhelezy. V kn.: Detskaia gastroenterologiia. Pod red. A.A.Baranova, E.V.Klimanskoi, G.V.Rimarchuk. M., 2002; s. 390–423. [in Russian]
3. Behar J, Corazziari E, Guelrud M et al. Functional gallbladder and sphincter Oddy disorders. Gastroenterology 2006; 130: 1498–509.
4. Cohen S, Bacon BR, Berlin JA et al. National Institutes of Health State-of-the Science Conference Statement; ERCP for diagnosis and therapy. GIE 2002; 56: 803–9.
5. Volkova M.P., Stetskaia N.A. Vzgliad pediatrov na funktsional'nye zabolevaniia organov pishchevareniia. 2013. http://ptcevolution.me/vzglyad-pediatrov-na-funkcionalnye-zabolevaniya-organov-pishhevareniya/ [in Russian]
6. Rajindrajith S, Devanarayana NM. Functional gastrointestinal diseases in children: Stepping out of the box. Sri Lanka J Child Health 2013; 42: 65–9.
7. Toouli J, Roberts-Thomson IC, Dent J, Lee J. Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis. Br J Surg 1985; 72: 859–63.
8. Varadarajulu S, Hawes R. Key issues in sphincter of Oddi dysfunction. Gastrointest Endosc Clin N Am 2003; 13: 671–94.
9. Bolezni podzheludochnoi zhelezy u detei. Pod red. S.V.Bel'mera, A.Iu.Razumovskogo, E.A.Kornienko, V.F.Privorotskogo. M.: Medpraktika-M, 2015. [in Russian]
10. Evans PR, Bak Y-T, Dowsett JF et al. Small bowel dysmotility in patients with post-cholecystectomy sphincter of Oddi dysfunction. Dig Dis Sci 1997; 42: 1507–12.
11. Corazziari ES, Cotton PB. Gallbladder and sphincter of Oddy disorders. Am J Gastroenterol 2010; 105: 764–9.
12. Desautels SG, Slivka A, Hutson WR et al. Postcholecystectomy pain syndrome: pathophysiology of abdominal pain in sphincter of Oddi type III. Gastroenterology 1999; 116: 900–5.
13. Petersen BT. An evidence-based review of sphincter of Oddi dysfunction: part I, presentations with "objective" biliary findings (types I and II). Gastrointest Endosc 2004; 59: 525–34.
14. Hogan WJ, Geenen JE, Dodds WJ. Dysmotility disturbances of the biliary tract: classification, diagnosis, and treatment. Semin Liver Dis 1987; 7: 302–10.
15. Geenen JE, Hogan WJ, Dodds WJ et al. The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 1989; 320: 82–7.
16. Semenova O.V. Diagnostika biliarnoi disfunktsii u detei. Okhrana materinstva i detstva. 2005; 1 (6): 27–31. [in Russian]
17. Toouli J, Di Francesco V, Saccone G et al. Division of the sphincter of Oddi for treatment of dysfunction associated with recurrent pancreatitis. Br J Surg 1996; 83: 1205–10.
18. Sherman S, Lehman GA. Sphincter of Oddi dysfunction: diagnosis and treatment. JOP 2001; 2: 382–400.
19. Fazel A, Geenen JE, MoezArdalan K, Catalano MF. Intrapancreatic ductal pressure in sphincter of Oddi dysfunction. Pancreas 2005; 30: 359–61.
20. Eversman D, Fogel EL, Rusche M et al. Frequency of abnormal pancreatic and biliary sphincter manometry compared with clinical suspicion of sphincter of Oddi dysfunction. Gastrointest Endosc 1999; 50: 637–41.
21. Guelrud M, Morera C, Rodriguez M et al. Sphincter of Oddi dysfunction in children with recurrent pancreatitis and anomalous pancreaticobiliary union: an etiologic concept. Gastrointest Endosc 1999; 50: 194–9.
22. Laugier R. Dynamic endoscopic manometry of the response to secretin in patients with chronic pancreatitis. Endoscopy 1994; 26: 222–7.
23. Vestergaard H, Kruse A, Rokkjaer M et al. Endoscopic manometry of the sphincter of Oddi and the pancreatic and biliary ducts in patients with chronic pancreatitis. Scand J Gastroenterol 1994; 29: 188–92.
24. Tarnasky PR, Hoffman B, Aabakken L et al. Sphincter of Oddi dysfunction is associated with chronic pancreatitis. Am J Gastroenterol 1997; 92: 1125–9.
Авторы
М.М.Гурова1, А.И.Кириенко2
1 ФГАОУ ВО Белгородский государственный национальный исследовательский университет. 308015, Россия, Белгород, ул. Победы, д. 85;
2 ОГБУЗ Городская детская больница г. Белгорода. 308014, Россия, Белгород, ул. Садовая, д. 1а
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M.M.Gurova1, A.I.Kirienko2
1 Belgorod State National Research University. 308015, Russian Federation, Belgorod, ul. Pobedy, d. 85;
2 Belgorod City Children Hospital. 308014, Russian Federation, Belgorod, ul. Sadovaia, d. 1a