Gastrointestinal disorders in children: causes, symptoms and treatment. Infant digestive system. The most important causes of gastrointestinal disorders

The digestive or gastrointestinal tract is one of the most important in the human body. He is responsible for the processing and extraction of valuable substances from food, transferring them to the blood and lymph. Thanks to this, the vital activity of the body is ensured. The gastrointestinal tract includes 30 organs, including oral cavity and teeth salivary glands, esophagus, liver, stomach, pancreas, intestines, etc.

The digestive tract should work as a well-coordinated, single mechanism. If at least one organ fails, this affects the activity of the entire system. A disorder of assimilation nutrients affects the general well-being. It is especially important to avoid problems with children's body. This may affect the future of the child.

How to avoid diseases, cope with the first symptoms, tells the heading "GIT".

Features of digestion in children

The gastrointestinal tract of a child is different from that of an adult. One of the features is that up to 10 years of age, the stomach is involved in the absorption process, while in adults the process occurs in the small intestine. That is why some foods, such as mushrooms, are taboo for kids.

Other distinguishing features of the pediatric GI tract include:

  • More delicate, but less elastic mucous membranes, their abundant blood supply.
  • The paucity and underdevelopment of the glands, and therefore less gastric juice. Because of this, bactericidal properties are reduced, susceptibility to pathogens of gastrointestinal infections is high.
  • Other enzyme composition.

Diseases of the digestive system in children

In children are more likely to diagnose such diseases of the gastrointestinal tract:

  • Diarrhea, or diarrhoea. The reasons may be different - a transfer to artificial milk formulas, a change in diet or diet, infections and inflammatory processes in the intestinal part of the tract.
  • (if emptying does not occur for more than 2 days). Constipation occurs due to improper structure of the organ, taking certain medications or changing the diet.
  • - acute and chronic. In the first case, roughage, unripe fruits, or food contaminated with bacteria are most likely to blame. The chronic form is caused by violations of the diet, the bacterium Helicobacter pylori, etc. Chronic gastritis fit with inflammatory processes in other organs - duodenum, pancreas.
  • Ulcer of the stomach and duodenum. In most cases, the pathology is caused by a hereditary factor. Among adverse factors called hyperexcitability. nervous system.
  • Hepatitis - chronic and acute. The disease occurs due to viral, due to the action of poisons. Hepatitis B can be avoided by vaccination, which is included in the vaccination schedule.
  • , or inflammation of the pancreas.
  • , which reduces the content beneficial microflora intestines. Occurs after transferred infections, antibiotic treatment, malnutrition, etc.
  • Spicy .

All ailments are accompanied by approximately the same symptoms - heartburn, nausea, vomiting, impaired stool,. Gastroenterologists note two peaks of incidence - 5–6 years and 9–11 years.

Causes of diseases

In addition to the reasons already mentioned above, they contribute to the development of pathologies:

  • an increase in the proportion of foods with artificial preservatives, dyes in the diet, a reduction in fiber, carbonated and cold drinks;
  • growing propensity to;
  • disorders of the nervous system - neuroses, neurocirculatory dysfunctions;
  • genetic factor;
  • unfavorable state of the environment.

Pediatric gastroenterologists are sounding the alarm: the incidence of the gastrointestinal tract is growing. Therefore, it is important for parents to be informed in this matter. From the materials of the heading "GIT" you will learn:

  • what symptoms indicate the disease;
  • what risk factors exist;
  • in what cases urgent medical assistance is needed;
  • about the methods of treatment, including the means traditional medicine.

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List of gastrointestinal diseases in children

The formation of the work of the gastrointestinal tract () occurs in the first year of a child's life. It is during this period that almost all babies suffer from functional disorders associated with the immaturity of the digestive system. Such disorders bring a lot of experiences, but usually when the child reaches 3 months of age, they disappear.

There are also birth defects gastrointestinal systems that require surgical intervention. It is important to notice suspicious symptoms in time, and contact a specialist.

In this article, we will consider the main diseases of the gastrointestinal tract of a child that any young mother may encounter.

stomach cramps

The most common problem is stomach cramps and excess gases. This disorder is completely natural process due to insufficient maturity of the microflora of the stomach. There are many reasons that provoke this phenomenon from the outside. So, if the mother is not breastfeeding, the mixture may not suit the baby. Breastfeeding also plays an important role. Excessive swallowing of air provokes gas formation, causing discomfort to the baby.

Colic goes away on its own as soon as the baby's digestive system gets a little stronger. A properly organized feeding process, the diet of a nursing mother, massage, dry heat, and the use of symbiotics will help speed up and facilitate this process.

Vomit

A fairly common symptom that can indicate a number of diseases, but can also be a physiological process.

If vomiting is frequent, “fountain”, while pallor is observed skin child, the temperature rises - this is a reason to see a doctor. These symptoms appear when viral diseases, intestinal infections, injuries of the abdominal organs.

Single vomiting after eating may be the result of overfeeding. It should be remembered that immediately after feeding the child can not be laid.

regurgitation

The physiological process due to the capture of large volumes of air during feeding, as well as the anatomical and physiological characteristics of the child's stomach. Doesn't cause spitting up autonomic disorders and changes in the child's mood. To solve the problem, it is necessary to reconsider the tactics of feeding, to exclude overfeeding.

If regurgitation is accompanied by vomiting, and the child is not gaining weight well, this may be a reason to contact a specialist.

Violation of the patency of the gastrointestinal tract

Due to the insufficient development of the child's digestive tract (esophagus, intestines, etc.). The process of food processing slows down, the stool becomes irregular, which leads to pain, gas, bloating, and other troubles.

Cardiospasm. An anomaly of the esophagus, characterized by the presence of spasms at the site of its transition to the stomach. In children, it is manifested by vomiting, "pressure" during meals.

Pylorospasm. Disorder of the pyloric part of the stomach. Characterized by vomiting "fountain", frequent regurgitation, disorders of the nervous system of the baby.

These diseases in without fail require careful diagnosis (including radiography). In case of violation of the work of organs, but the physiological norm, conservative treatment is prescribed.

Congenital obstruction of the digestive tract

It is characterized by a violation of the passage of food through the digestive tract due to the presence of malformations of their location. After a thorough diagnosis, urgent surgical intervention. For example, with intestinal obstruction, feces cannot pass naturally thereby releasing toxins into the blood. This condition is dangerous for the life of the baby.

Main symptoms this disease are problems with stool, vomiting, pale color baby's skin.

Dysbacteriosis - a state of deficiency in the intestines of beneficial microflora. It is characterized by acute intestinal disorders, bloating, loose stools, poor weight gain. Treatment includes the introduction into the child's diet of mixtures with beneficial bacteria(when it is impossible breastfeeding). Special drugs are prescribed to suppress the growth of opportunistic microorganisms, with a further population of the intestinal microflora with bacteriophages.

Alimentary dyspepsia - indigestion due to malnutrition. Overfeeding, non-compliance with the rules for preparing and storing mixtures, a quick transition to artificial nutrition, improper selection of a mixture - all these factors cause dyspeptic disorders.

Prevention of diseases of the digestive tract in newborns

It is necessary to monitor the condition of the child, and not to miss important symptoms. Whenever possible, the mother should breastfeed her baby. Milk contains all the necessary elements for the population of the child's sterile intestines with beneficial bacteria. This is an excellent prevention of dysbacteriosis and intestinal infections, which can be easily "caught" even in the hospital.

A young mother must comply correct mode feeding a child. It is easy for mothers who are breastfeeding to observe it - the child himself will give up the breast when he is full. Mothers of formula-fed babies should remember that it is better to underfeed than to overfeed. Overeating will not bring the baby any benefit, but it will add problems. Also, do not supplement a child under the age of 6 months with sweet tea or juice. Artificial babies can be given some water in between feedings. Babies don't need anything other than breast milk.


FUNCTIONAL DISORDERS

GASTROINTESTINAL TRACT IN CHILDREN

OMSK - 2010

The textbook "Functional disorders of the gastrointestinal tract in children", intended for students of the pediatric faculty, is published by decision of the Central Medical Committee of the Omsk State Medical Academy and the educational and methodological association for medical and pharmaceutical education of Russian universities.

Reviewers: Doctor of Medical Sciences, Professor Yu.G. MUKHINA

MD M.A. LIVZAN

Potrokhova E.A., Sobotyuk N.V. Functional disorders of the gastrointestinal tract in children: tutorial/E.A. Potrokhova, N.V. Sobotyuk // Omsk, 2009 - 105 p.

The manual outlines modern ideas about functional disorders of the gastrointestinal tract in children. Classifications are given, clinical and diagnostic issues are highlighted, the main groups of drugs used in the treatment of this pathology are presented.

1. INTRODUCTION…………………………………………………………………….4

2. ANATOMICAL AND PHYSIOLOGICAL FEATURES OF THE GASTROINTESTINAL TRACT IN CHILDREN…………………5

3. FUNCTIONAL DISORDERS OF THE GASTROINTESTINAL TRACT IN CHILDREN…………………………………….. 11

3.1 Background……………………………………………….…11

3.2 Epidemiology…………………………………………………...12

3.3 Etiology and pathogenesis……………………………………….….13

3.4 Classification……………………………………….………….19

3.5 Diagnosis…………………………………………………………21

3.6 Treatment………………………………………………………………28

3.6.1 Correction of neuropsychiatric disorders………………………………………………………28

3.6.2 Diet therapy………………………………..…………32

3.6.3 Drug therapy…………………………...37

4. PRIVATE PATHOLOGY…………………………………………………………………………65

4.1. Infantile regurgitation………………………………..…65

4.2 Rumination syndrome……………………………………….66

4.3 Syndrome of cyclic vomiting………………………………..…67

4.4 Infant colic…………………………………………...70

4.5 Functional diarrhea………………………………………..72

4.6 Infantile difficulty defecation (dyschezia)…………75

4.7 Functional constipation……………………………………………75

4.8 Aerophagia……………………………………………………………78

4.9 Functional dyspepsia……………………………………79

4.10 Irritable bowel syndrome………………………...83

4.11 Abdominal migraine…………………………………………87

4.12 Functional abdominal pain……………………...88

4.13 Functional fecal incontinence…………………………..91

5. DISPENSARY SUPERVISION OF CHILDREN WITH FUNCTIONAL DISORDERS OF THE GASTROINTESTINAL TRACT………………………………………………………………………………………………………………………………………………………………………………………………………………………………….…95

6. TESTS…………………………………………………...97

7. SITUATIONAL TASKS……………………………….…………98

8. REFERENCES……………………………………………….103

INTRODUCTION

In recent years, in general, there has been an increase in the number of diseases of the gastrointestinal tract: in 1999, diseases of the digestive system in children amounted to 450 cases per 10,000 children, and in 2003 - 525, in adolescents, respectively - 402 and 412. the most common diseases of childhood, ranking second in frequency. When studying the structure of morbidity, it is noted that the first place is occupied by functional disorders of the gastrointestinal tract.

Problem functional diseases of the gastrointestinal tract is becoming increasingly important, due to the widespread prevalence of this pathology and the numerous problems associated with it. Every second inhabitant of our planet has such disorders as functional dyspepsia, biliary tract dysfunction, irritable bowel syndrome, which significantly impair the quality of life, limit social and labor activity. Worldwide, hundreds of millions of dollars are annually spent on the diagnosis and treatment of functional disorders of the gastrointestinal tract. At the same time, many doctors still treat this pathology as insignificant and not requiring treatment.

Diagnosis of functional disorders often causes significant difficulties for practitioners, leading to a large number of unnecessary examinations, and most importantly, to irrational therapy. In this case, one often has to deal not so much with ignorance of the problem as with its misunderstanding. In terms of terminology, it is necessary to differentiate between functional disorders and dysfunctions, two consonant, but somewhat different concepts that are closely related to each other. Violation of the function of one or another organ can be associated with any reason, including its organic damage. Functional impairment, in this light, can be seen as special case dysfunction of an organ that is not associated with its organic damage.

Deepening the doctor's knowledge on the problem of functional pathology of the gastrointestinal tract in childhood and adolescence, timely and high-quality preventive and dispensary observation, treatment using modern schemes, the shift in the focus of care for gastroenterological patients to outpatient services is one of the conditions for the prevention of organic diseases of the gastrointestinal tract in subsequent age periods.

ANATOMICAL AND PHYSIOLOGICAL FEATURES OF THE GASTROINTESTINAL TRACT IN CHILDREN

The formation of the digestive organs begins from the 3rd-4th week of the embryonic period, when the primary intestine is formed from the endodermal plate. At the front end of it, a mouth opening appears on the 4th week, and a little later, at the opposite end, anus. The intestine quickly lengthens, and from the 5th week of the embryonic period, the intestinal tube is delimited into two sections, which are the basis for the formation of the small and large intestines. During this period, the stomach begins to stand out - as an extension of the primary intestine. At the same time, the formation of the mucous, muscular and serous membranes of the gastrointestinal tract takes place, in which blood and lymphatic vessels, nerve plexuses, endocrine cells.

The embryo before implantation in the uterine wall is fed by reserves in the cytoplasm of the egg. The embryo feeds on the secrets of the uterine mucosa and the material of the yolk sac (histotrophic type of nutrition). Since the formation of the placenta, hemotrophic (transplacental) nutrition, provided by the transport of nutrients from the mother's blood to the fetus through the placenta, is of primary importance. It plays a leading role until the birth of a child.

In the first weeks of pregnancy, the endocrine apparatus of the gastrointestinal tract is laid in the fetus and the production of regulatory peptides begins. In the process of intrauterine development, the number of endocrine cells increases, the content of regulatory peptides in them increases (gastrin, secretin, motilin, gastric inhibitory peptide, vasoactive intestinal peptide, enteroglucagon, somatostatin, neurotensin, etc.). At the same time, the reactivity of target organs with respect to regulatory peptides increases. In the prenatal period, peripheral and central mechanisms nervous regulation activity of the gastrointestinal tract.

In the fetus, the gastrointestinal tract begins to function already at the 16-20th week of intrauterine life. By this time, the swallowing reflex is expressed, in salivary glands amylase is found, in gastric - pepsinogen, in small intestine- secretin. A normal fetus swallows a large amount of amniotic fluid, the individual components of which are hydrolyzed in the intestine and absorbed. The undigested part of the contents of the stomach and intestines goes to the formation of meconium. From 4-5 months of intrauterine development, the activity of the digestive organs begins and, together with hemotrophic, amniotrophic nutrition occurs. The daily amount of liquid absorbed by the fetus in recent months pregnancy can reach more than 1 liter. The fetus absorbs amniotic fluid containing nutrients (proteins, amino acids, glucose, vitamins, hormones, salts, etc.) and hydrolyzing enzymes. Some enzymes enter the amniotic fluid from the fetus with saliva and urine, the second source is the placenta, the third source is the mother's body (enzymes through the placenta and, bypassing it, can enter the amniotic fluid from the blood of a pregnant woman).

Part of the nutrients are absorbed from the gastrointestinal tract without prior hydrolysis (glucose, amino acids, some dimers, oligomers and even polymers), since the intestinal tube of the fetus has a high permeability, fetal enterocytes are capable of pinocytosis. This is important to consider when organizing the nutrition of a pregnant woman in order to prevent allergic diseases. Some of the nutrients of the amniotic fluid are digested by its own enzymes, that is, the autolytic type of digestion plays an important role in the amniotic nutrition of the fetus. Amniotrophic nutrition of the type of own abdominal digestion can be carried out from the 2nd half of pregnancy, when pepsinogen and lipase are secreted by the cells of the stomach and pancreas of the fetus, although their level is low. Amniotrophic nutrition and the corresponding digestion are important not only for the supply of nutrients to the blood of the fetus, but also as a preparation of the digestive organs for lactotrophic nutrition.

In newborns and children in the first months of life, the oral cavity is relatively small, the tongue is large, the muscles of the mouth and cheeks are well developed, in the thickness of the cheeks there are fatty bodies (Bish's lumps), which are distinguished by significant elasticity due to the predominance of solid (saturated) fatty acids in them. These features provide full breast sucking. The mucous membrane of the oral cavity is tender, dryish, rich in blood vessels(easily hurt). The salivary glands are poorly developed, produce little saliva (submandibular, sublingual glands function to a greater extent in children infancy, in children after a year and adults - parotid). The salivary glands begin to function actively by the 3-4th month of life, but even at the age of 1 year, the volume of saliva (150 ml) is 1/10 of the amount in an adult. The enzymatic activity of saliva at an early age is 1/3-1/2 of its activity in adults, but it reaches the level of adults within 1-2 years. Although enzymatic activity saliva at an early age is low, its effect on milk contributes to its curdling in the stomach with the formation of small flakes, which facilitates the hydrolysis of casein. Hypersalivation at 3-4 months of age is due to teething, saliva may flow from the mouth due to the inability of children to swallow it. The reaction of saliva in children of the first year of life is neutral or slightly acidic - this can contribute to the development of thrush of the oral mucosa if it is not properly cared for. At an early age in saliva low content lysozyme, secretory immunoglobulin A, which determines its low bactericidal activity and the need for proper oral care.

Esophagus in children early age has a funnel shape. Its length in newborns is 10 cm, with age it increases, while the diameter of the esophagus becomes larger. The relatively short esophagus helps keep part of the stomach in chest cavity, and part - in the abdominal. There are 3 physiological constrictions in the esophagus: in the area of ​​​​contact of the esophagus with the posterior wall of the left ventricle (during esophagoscopy, when the endoscope passes through this section, various violations heart rate); when passing through the diaphragm; at the level of the tracheal bifurcation. The transition of the esophagus to the stomach in all periods of childhood is located at the level of the X and XI thoracic vertebrae.

The stomach in infants is located horizontally, its bottom and cardia are poorly developed, there is no tight coverage of the esophagus by the legs of the diaphragm, all these features, combined with increased intragastric pressure, explain the tendency of children of the first year of life to regurgitation and vomiting. As the child begins to walk, the axis of the stomach becomes more vertical, and by 7-11 years it is located in the same way as in an adult. The capacity of the stomach in a newborn is 30-35 ml, by the year it increases to 250-300 ml, by the age of 8 it reaches 1000 ml. The secretory apparatus of the stomach in children of the 1st year of life is underdeveloped, in the gastric mucosa they have 2.5 times fewer glands per kilogram of body weight compared to adults. Although the composition of gastric juice in children is the same as in adults (hydrochloric acid, lactic acid, pepsin, rennet, lipase), but the acidity and enzymatic activity are lower, which determines the low barrier function of the stomach and pH of gastric juice (pH of gastric juice in the first 6-12 hours - 1.0-2.0 due to lactic acid, then very quickly within a few days rises to 6.0; by the end of the first week - pH 4.0-6.0; by the end of 1 year - pH 3.0-4.0; in adults, pH 1.5-2.2). The high pH of the stomach, on the one hand, preserves the integrity of anti-infective factors, including immunoglobulins, supplied with breast milk, on the other hand, leads to insufficient breakdown of proteins in the stomach by pepsin (the required pH for pepsin activity is 1-1.5), so proteins they are cleaved mainly by cathepsins and gastrixin produced by the gastric mucosa, their optimum action is at pH 4-5. Lipase of the stomach (produced by the pyloric part of the stomach, the optimum activity at pH - 4.0-8.0) breaks down in an acidic environment, together with lipase of human milk, up to half of the fats of human milk. These features must be taken into account when prescribing various types of nutrition to a child. With age, the secretory activity of the stomach increases. Motility of the stomach in children of the first months of life is slowed down, peristalsis is sluggish. The timing of the evacuation of food from the stomach depends on the nature of feeding. Women's milk lingers in the stomach for 2-3 hours, cow's - 3-4 hours, which indicates the difficulties of digesting the latter.

The intestines in children are relatively longer than in adults. Newborns do not have omental processes, ribbons colon hardly noticeable, gaustra absent up to 6 months. The caecum is mobile due to the long mesentery, the appendix, therefore, can be located in the right iliac region, shift into the small pelvis and the left half of the abdomen, which creates difficulties in diagnosing appendicitis in young children. The appendix is ​​shorter (4-5 cm in newborns, 9-12 cm in adults), has a large inlet diameter, is easily drained, therefore in young children, appendicitis rarely develops. Mesentery small intestine longer and more easily stretchable, which can lead to torsion, intussusception and other pathological processes. The weakness of the ileocecal valve also contributes to the occurrence of intussusception in young children. A feature of the intestines in children is better development circular muscles than longitudinal, which predisposes to intestinal spasms and intestinal colic. Weak development of small and big omentum leads to the fact that the infectious process in the abdominal cavity (appendicitis, etc.) is often complicated by the development of diffuse peritonitis. The ascending part of the colon in newborns is short, the descending part is slightly mobile. Sigmoid colon relatively long, it predisposes to constipation in children, especially if the mother's milk contains an increased amount of fat. The rectum in children in the first months of life is also relatively long, with weak fixation of the mucous and submucosal layers, and therefore, with tenesmus and persistent constipation, the mucous membrane may prolapse through the anus. The ampulla of the rectum is poorly differentiated, adipose tissue not developed, as a result of which the ampoule is poorly fixed. The anus in children is located more dorsally than in adults at a distance of 20 mm from the coccyx.

Digestion processes are intensively occurring in the intestine, represented by 3 types: extracellular (cavity), membrane (parietal) and intracellular. Extracellular (cavity) digestion is carried out in the intestinal cavity, where enzymes are secreted from large and small food glands; membrane (parietal) digestion is carried out in space by enterocyte enzymes themselves, as well as enzymes of pancreatic origin, absorbed by various layers of the glycocalyx; intracellular digestion is carried out in special vacuoles of the cytoplasm of the epithelium with the help of pinocytosis. Children in their first year of life have low activity cavity and high activity of membrane and intracellular processes of digestion.

The intestinal secretory apparatus is generally formed at the time of the birth of the child, the same enzymes are found in the intestinal juice as in adults (enterokinase, alkaline phosphatase, lipase, erypsin, amylase, maltase, lactase, nuclease, etc.), but their activity is low. Under the influence of intestinal enzymes, mainly the pancreas, there is a breakdown of proteins, fats and carbohydrates. However, the pH of duodenal juice in young children is slightly acidic or neutral, so the breakdown of protein by trypsin is limited (for trypsin, the optimal pH is alkaline). Especially intense is the process of digestion of fats due to the low activity of lipolytic enzymes. In children who are breastfed, lipids emulsified by bile are cleaved by 50% under the influence of maternal milk lipase. Digestion of carbohydrates occurs in the small intestine under the influence of pancreatic amylase and disaccharidases. intestinal juice. The processes of putrefaction in the intestines do not occur in healthy infants. The peculiarities of the structure of the intestinal wall and its large area determine in young children a higher absorption capacity than in adults and, at the same time, an insufficient barrier function due to the high permeability of the mucous membrane for toxins and microbes.

The motor function of the gastrointestinal tract in young children also has a number of features. The peristaltic wave of the esophagus and the mechanical irritation of its lower section with a food lump cause a reflex opening of the entrance to the stomach. Motility of the stomach consists of peristalsis (rhythmic waves of contraction from the cardiac section to the pylorus), peristoles (resistance exerted by the walls of the stomach to the tensile action of food) and fluctuations in the tone of the stomach wall, which appears 2-3 hours after eating. The motility of the small intestine includes a pendulum movement (rhythmic oscillations that mix intestinal contents with intestinal secretions and create favorable conditions for absorption), fluctuations in the tone of the intestinal wall and peristalsis (worm-like movements along the intestine, promoting the promotion of food). Pendulum and peristaltic movements are also noted in the large intestine, and antiperistalsis in the proximal sections, which contributes to the formation of fecal masses. The time of passage of food gruel through the intestines in children is shorter than in adults: in newborns - from 4 to 18 hours, in older ones - about a day. It should be noted that with artificial feeding, this period is extended. The act of defecation in infants occurs reflexively without the participation of a volitional moment, and only by the end of the first year of life does defecation become arbitrary.

For a newborn in the first 7 days after birth, physiological dyspepsia (physiological intestinal catarrh) is characteristic. The first act of defecation is characterized by the release of original feces, or meconium, in the form of a thick mass of dark olive color and odorless. In the future, as the intestines are populated with a variety of microflora, stools increase up to 5 times, the stools become watery, frothy with abundant wetting of diapers (transitional stools). By the 7th day, a normal microbial landscape is established and milk stools appear - mustard-like, doughy consistency with a sour smell from 1 to 4-5 times a day. At an older age, the chair becomes decorated, 1 time per day.

The intestines of a child in the first hours of life are free from bacteria. In the future, the gastrointestinal tract is populated by microflora, while 3 stages are distinguished: 1 - (aseptic) - lasts 10-20 hours from the moment of birth; 2 - (settlement) - 2-4 days; 3 - (stabilization) - 1-1.5 months. In the oral cavity of an infant, staphylococci, streptococci, pneumococci, Escherichia coli and some other bacteria can be found. E. coli, bifidobacteria, lactic acid bacilli, etc. appear in the feces. With artificial and mixed feeding, the phase of bacterial infection occurs faster.

Functions of microflora

Protective - a barrier against microbial contamination, reducing the permeability of the intestinal mucosa for macromolecules

Immune - stimulation of the maturation of the lymphoid apparatus of the intestine, maturation of phagocytes.

Metabolic

Synthesis of vitamins of group B, K

Exchange of iron, bile acids, participation in lipid and carbohydrate metabolism

Digestive breakdown of carbohydrates, enzyme synthesis, parietal digestion, absorption regulation, stimulation of gastrointestinal motility.

Gut bacteria contribute to the processes of enzymatic digestion of food. With natural feeding, bifidobacteria, lactic acid bacilli predominate, and in a smaller amount - Escherichia coli. With artificial and mixed feeding, due to the predominance of putrefaction processes in feces, there are a lot of E. coli, fermentative flora (bifidoflora, lactic acid bacilli) are present in smaller quantities.

The liver in children is relatively large, in newborns it is about 4% of body weight (in adults - 2% of body weight). In young children, bile formation is less intense than in older children. The bile of children is poor in bile acids, cholesterol, lecithin, salts and alkali, but rich in water, mucin, pigments and urea, and also contains more taurocholic than glycocholic acid. It is important to note that taurocholic acid is an antiseptic. Bile neutralizes the acidic food slurry, which makes possible the activity of pancreatic and intestinal secretions. In addition, bile activates pancreatic lipase, emulsifies fats, dissolves fatty acids, turning them into soaps, and enhances peristalsis of the large intestine.

Thus, the system of the digestive organs in children is distinguished by a number of anatomical and physiological features that affect the functional ability of these organs. In a child in the first year of life, the need for food is relatively greater than in older children. Although the child has all the necessary digestive enzymes, the functional capacity of the digestive organs is limited and can only be sufficient if the child receives physiological food, namely human milk. Even small deviations in the quantity and quality of food can cause digestive disorders in an infant (they are especially frequent in the 1st year of life) and ultimately lead to a lag in physical development.

Among the most common diseases of the gastrointestinal tract in infants are called astroesophageal reflux, dyspepsia, diarrhea and enterocolitis. Some of them are directly related to the imperfection of the digestive system, others are provoked by hereditary factors or intrauterine failures. But there are also diseases of the digestive system in young children (for example, dystrophy or paratrophy), which appear due to malnutrition.

Disease of the digestive system in young children

This is a fungal infection of the oral mucosa, often occurring in infants. The disease is registered in 4-5% of all newborns. The most susceptible to thrush are premature babies, newborns with a weakened immune system, infants who receive insufficient hygiene care, and babies who, for one reason or another, take antibiotics.

The cause of the disease. This disease of the digestive system in young children causes a fungus of the genus Candida. Frequent regurgitation provokes the development of the fungus.

Signs of the disease. White spots appear on the mucous membrane of the mouth and cheeks, resembling curdled milk. Sometimes these points merge with each other, forming a continuous film of white-gray color. With a massive lesion, these plaques spread to the mucous membrane of the esophagus, stomach and respiratory tract.

Treatment. In mild cases, irrigation of the mucous membrane with a 2% solution of sodium bicarbonate or a 10-20% solution of borax in glycerin is sufficient. It is possible to use 1-2% solutions of aniline dyes (methyl violet, gentian violet, methylene blue), a solution of nystatin in milk or water (500 thousand units / ml). The mucosa is treated every 3-4 hours, alternating the means used.

In severe cases, in addition to the local treatment of this gastrointestinal disease in young children, the child is given orally nystatin 75 thousand units / kg 3 times a day for 3-5 days or levorin 25 mg / kg 3-4 times a day during the same period.

Malformation of the gastrointestinal tract of newborns pyloric stenosis

pyloric stenosis- a malformation of the upper muscular sphincter of the stomach, associated with the excessive development of its muscles and narrowing of the entrance to the stomach. Boys get sick more often.

Causes of the disease. The disease occurs as a result of a violation of the innervation of the stomach.

Signs of the disease. The first signs of this gastrointestinal malformation in newborns appear on the 2nd-3rd week of life, rarely earlier. Occurs in a strong fountain 15-GO minutes after eating. Over time, the weight of the child drops sharply, up to dystrophy, anemia and dehydration develop. Little urine and feces are excreted, constipation appears.

The duration of the disease is from 4 weeks to 2-3 months.

For diagnostic purposes, ultrasound, fibrogastroscopy, X-ray gastrography are performed.

Treatment. Treatment is operative. In the postoperative period, dosed feeding is carried out with the addition of glucose and saline solutions.

Gastrointestinal disease in infants neonatal reflux

gastroesophageal reflux newborns is an involuntary throwing of gastric contents into the esophagus with an increase in the tone of the lower and middle esophageal sphincters.

Causes of the disease. This pathology of the gastrointestinal tract in newborns often occurs against the background of encephalopathy, congenital hernia esophagus, with constant overeating.

Signs of the disease. After feeding, the newborn spits up profusely, after which he vomits. The child is excited and restless.

Treatment. Switch to solid formula feeding vertical position. After eating, the child should be in an upright position for another 5-10 minutes. The last feeding is carried out 2-3 hours before bedtime. To treat this digestive problem in newborns, antacid preparations are prescribed: Almagel 0.5 teaspoon per meal before meals, Maalox 5 ml suspension per meal before meals.

Pathology of the gastrointestinal tract in newborns dyspepsia

Dyspepsia simple (functional dyspepsia)- functional disorders of the gastrointestinal tract, manifested by a violation of the function of digestion of food, without pronounced changes gastrointestinal tract.

Causes of the disease. The cause of this digestive disorder in young children is errors in the diet, overfeeding or underfeeding the baby.

Signs of the disease. Children have regurgitation. With the predominant involvement of the stomach in the process after feeding, ordinary vomiting occurs, with the predominant involvement of the intestine - in the form of chopped eggs. In the latter case, frequent stools up to 6-10 times a day are also characteristic. The child may experience painful colic, passing after the passage of gases.

Treatment. Treatment is based on the elimination of the causes that caused dyspepsia.

In a mild case, the currents skip 1-2 feedings, liquid is given instead (tea, rehydron, glucosolan, 5% glucose solution).

In the case of artificial feeding with this disease of the digestive system in young children, a water-tea diet is prescribed for 8-10 hours. The amount of liquid is calculated based on the weight of the child. Liquid is given in small portions. After a water-tea diet, the amount of food is distributed for feeding and is 1/3 of the total need per day. In the following days, 100-200 ml per day is added, by the 4th day gradually recovering to a normal volume. At loose stool smect is appointed.

Digestive disorders in young children: diarrhea and milk intolerance

Antibiotic-induced diarrhea- This is a digestive disorder in young children who take antibacterial drugs for a long time.

Signs of the disease. The disease is characterized by vomiting, lack of appetite, frequent copious watery stools with mucus.

Treatment. After antibiotics are discontinued, diarrhea is treated.

Intolerance to cow's milk proteins can occur at any age and occur after consumption of cow's milk-based products.

Causes of the disease. The child does not have an enzyme that breaks down milk proteins, or there is a very strong allergization of the body to milk components.

Signs of the disease. The disease begins from the first days of using cow's milk or mixtures prepared on its basis. The greater the volume of milk entering the body, the brighter the intolerance manifests itself. With this disease of the gastrointestinal tract, the newborn is restless, and since he experiences constant pain in the abdomen (colic), he screams loudly. flatulence, watery, foam stool with cloudy mucus. In severe cases, the baby vomits immediately after feeding. Bloating, various skin rashes are possible.

Children lose weight dramatically, their growth and development are delayed, neuropsychiatric disorders appear.

Treatment. Natural feeding is the best way to protect the child from this pathology, and in the absence of breast milk and the appearance of its intolerance, they switch to special mixtures such as NAN H.A. These are hypoallergenic formulas containing whey protein other than standard cow's milk protein.

NAN H.A 1 is prescribed in the first half of life, in the second half of the year NAN H.A 2 is shown, which differs more high content iron, zinc and iodine, meets all the needs of children from 6 months of age.

Digestive disorders in newborns: celiac disease in infants

celiac disease occurs as a result of a violation of the digestion of cereal protein - gluten.

Causes of the disease. Pathology is genetic in nature.

Signs of the disease. The disease is detected in the first two years of life when you start eating white wheat and black rye bread, as well as dishes made from wheat and rye flour (i.e. products containing rye, wheat, oats, barley).

Usually this violation of the gastrointestinal tract in newborns manifests itself with the introduction of complementary foods with cereals. The child develops vomiting, rumbling in the intestines, flatulence, the stomach increases. The stool brightens, becomes plentiful, frothy, sometimes fetid, which indicates a lack of absorption of fat. There is a halt in growth and weight, mental development slows down.

Treatment. The baby is assigned a gluten-free diet with the complete exclusion of products containing flour and grains cereal crops. Dishes containing flour, pastes, minced meat products, sausages, boiled sausages, sauces, cereal soups are prohibited. During a diet with this digestive problem in infants, buckwheat, rice, soy, vegetables, and fruits are allowed. In the diet, increase the amount of products containing milk, additionally give cottage cheese, cheese, eggs, fish, poultry meat. Of fats, corn is preferable, sunflower oil, from sweets - jam, compotes, jams, honey.

Violation of the gastrointestinal tract in newborns enterocolitis

Ulcerative necrotic enterocolitis occurs in children of the first year of life as an independent pathology or intestinal damage may accompany other ailments.

Causes of the disease. Most often, independent enterocolitis develops in children infected with one or another microorganism in the womb, secondarily the process develops against the background of dysbacteriosis, long-term use antibiotics, sepsis, etc.

Signs of the disease. There are no typical manifestations of the disease. The child becomes lethargic, eats poorly, after feeding he has constant regurgitation, vomiting often occurs, sometimes with an admixture of bile. With this indigestion in newborns, the stool is watery, the feces acquire a greenish tint. Over time, the abdomen swells, and the venous network becomes clearly visible on its skin.

If left untreated, the disease can lead to the death of the baby due to perforation of intestinal wall ulcers.

Treatment. The child is recommended to be fed only with mother's milk, if breastfeeding is not possible, it is transferred to acidic mixtures. Of the medications, lactobacterin or bifidumbacterin are used at 3-9 biodoses per day. If the baby is severely tormented by vomiting, the stomach is washed with a 2% solution of sodium bicarbonate before each feeding. Be sure to introduce vitamins B1, B6, B12, P, PP, C. On the area solar plexus do UHF.

Digestive problems in newborns: malnutrition disorders in infants

Chronic eating disorders are most common in young children and are characterized by:

  • underweight, lagging behind growth norms (hypotrophy);
  • a uniform lag in increasing body weight and height;
  • overweight and height, the predominance of body weight over height.

Dystrophy- This is a violation of the digestion of the baby, characterized by pathologically low body weight.

Causes of the disease. There are alimentary causes of the disease - qualitative and quantitative malnutrition, lack of vitamins. This indigestion in infants can occur with long-term infectious and non-infectious diseases, care defects, due to constitutional reasons, with prematurity.

With mixed and artificial feeding, especially with unadapted mixtures, quantitative malnutrition occurs, and the level of metabolism decreases.

Intrauterine malnutrition occurs as a result of impaired fetal development, slowing down its physical development.

Signs of the disease. With malnutrition I degree thinning fatty tissue in the groin, on the abdomen, under the armpits. Weight loss is 10-15%.

With malnutrition II degree subcutaneous fat disappears on the trunk, limbs, its amount on the face decreases. Weight loss is 20-30%.

With malnutrition III degree(atrophy) subcutaneous fat disappears on the face, weight loss is over 30%. The skin turns gray, the face takes on an senile expression with a reproachful look. Anxiety is replaced by apathy. The mucous membrane of the mouth turns red, the muscles lose their tone, the body temperature is below normal. The child's food endurance decreases, regurgitation, vomiting appear, the stool may be normal or constipation alternates with diarrhea.

With congenital (intrauterine) hypotrophy in newborns, there is a lack of mass; decrease in tissue elasticity; paleness and peeling of the skin; multiple functional disorders; long-term physiological jaundice.

Treatment. Treatment of malnutrition is carried out taking into account the causes that caused it, as well as the severity of the disease, the age of the child.

In a child with any degree of malnutrition, the daily amount of food should be equal to 1/5 of his body weight. At the beginning of treatment, 1/3 or 1/2 of the daily volume of food is prescribed. Within 5-10 days, the volume is adjusted to 1/5 of body weight. The best nutrition is mother's milk or adapted age formulas.

Nutrition up to the daily volume is supplemented with tea, vegetable broth, rehydron, oralit. The number of feedings is increased by one. A child during this period should receive 80-100 kcal per 1 kg of weight per day. This stage of diet therapy is called the minimum nutrition, when the volume of food is brought to 2/3 of the required, enlites, protein milk are added. When feeding with women's milk, low-fat cottage cheese is added, the amount of drink is reduced by the corresponding volume.

At the next stage of intermediate nutrition, an increase in the amount of proteins, fats and carbohydrates consumed is required; the daily allowance is made up of 2/3 of the main food and 1/3 of the corrective one. This period lasts up to 3 weeks.

The period of withdrawal from dystrophy is called optimal nutrition. The child is transferred to physiological nutrition age appropriate.

As a drug treatment, infusion therapy (albumin, etc.) is carried out, donor gamma globulin is introduced. Enzyme therapy is prescribed during the period of intermediate nutrition for 2-3 weeks (pancreatin, abomin, etc.). Held active treatment dysbacteriosis, complex vitamin preparations are shown.

In severe cases, anabolic hormones (nerobol, retabolil) are used in age doses.

Paratrophy is a digestive disorder in infants, characterized by overweight.

Causes of the disease. Excess body weight appears as a result of overfeeding or with excess protein or carbohydrate nutrition, as well as with excessive carbohydrate intake of a pregnant woman.

Signs of the disease. There are 3 degrees of paratrophy.

  • I degree - weight exceeds the age norm by 10-20%.
  • II degree - weight exceeds the age norm by 20-30%.
  • III degree - weight exceeds the age norm by 30-40%.

In any case, the disease is accompanied by a violation of protein, fat and carbohydrate metabolism.

Protein eating disorders occur when excessive introduction of cottage cheese into the baby's diet in the 2nd half of life, protein mixtures. The stool becomes dry, acquires White color contains large amounts of calcium. Gradually, the appetite decreases, the child begins to lose weight, anemia occurs.

With excessive carbohydrate nutrition with a lack of protein, excessive deposition of fat and water retention in the body occur. In this case, the elasticity of tissues usually decreases. The child looks obese. Indicators of physical development by weight are usually above average.

Treatment. With paratrophy in the first months of life, it is recommended to eliminate night feeding, streamline other meals. Children with carbohydrate overfeeding are limited easily digestible carbohydrates. For protein eating disorders, do not use mixtures enriched with protein. Feeding is given in the form vegetable puree, enzymes and vitamins B1, B2, B6, B12 are additionally used.

Control over height and weight indicators in children with dystrophies is carried out 1 time in 2 weeks, while nutrition is calculated.

Massage, gymnastics, long walks on fresh air.

In older children, the need for carbohydrates is met by vegetable dishes, fruits, vegetable oils, proteins and vitamins are additionally introduced into the diet.

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According to statistics, in recent times disorders and pathologies of the gastrointestinal tract occupy leading place among other diseases. Residents of big cities are especially susceptible to them. The reason for this is the wrong lifestyle and constant stress. Therefore, by the age of 30, every fourth person suffers from gastrointestinal diseases.

Characteristics of the digestive system

It's no secret to anyone that digestive tract plays a very important role in the life of the organism. With it, we get vitamins, trace elements, proteins, fats, carbohydrates, fiber and useful acids. Some of them serve as a building material for cells, provide us with energy. Other substances contribute to the smooth functioning of organs and systems. Therefore, diseases of the gastrointestinal tract can not only disrupt the normal rhythm of a person's life, affecting his health, but in some cases lead to death.

The gastrointestinal tract consists of the following components: oral cavity, pharynx, esophagus, stomach and intestines, which includes thin, thick and straight sections. The main functions of all these organs are: the breakdown of food, the removal of its residues from the body, the production of beneficial enzymes that contribute to proper digestion and absorption of the necessary substances. Without normal functioning Gastrointestinal tract a person feels discomfort, he has bad feeling, which, due to the lack of treatment, can become chronic.

Causes of diseases

There are a lot of them and most of them belong to wrong image life. The main causes of gastrointestinal diseases are as follows:

  1. Unbalanced diet: constant diets, overeating, unhealthy snacks and chewing on the go, regular visits to fast food establishments, lack of useful fiber, instead, the predominance of animal fats and indigestible carbohydrates in the diet.
  2. Ecology: poor quality of drinking water, presence of a large number nitrates and pesticides in vegetables; antibiotics and preservatives in meat products.

Sharp and chronic diseases The gastrointestinal tract has a number of signs that make it easy to determine if you have problems with this part of the body. These include the following symptoms:

  • Abdominal pain. With ulcers, it is sharp, with frequent localization, in the case of appendicitis and hernia - strong, pulsating, when a person has colic - cramping.
  • Heartburn. Painful sensations are characteristic for her with an ulcer, intensification - with a hernia.
  • Belching. Sour speaks of indigestion, with the smell of rotten eggs - about a pathological delay in food in the stomach and intestines.

Among the symptoms, vomiting and nausea are also distinguished, which are more characteristic of chronic diseases. For example, for gastritis. If the vomit contains bloody issues and clots, it may be an open ulcer or stomach cancer. If the patient regularly suffers from flatulence, he may be diagnosed with dysbacteriosis, secretory pancreatic insufficiency, complete or partial obstruction intestines.

Other signs

Diseases of the gastrointestinal tract also have less pronounced symptoms that indicate damage to the digestive system: bad smell from the mouth, a feeling of bitterness, the appearance of a white coating on the tongue, poor appetite (especially aversion to meat products), constant thirst, increased salivation, a sharp decline body weight, the development of anemia, pallor, dizziness, weakness, a feeling of heaviness in the abdomen, prolonged stool disorder (constipation or diarrhea), as well as the appearance of bloody discharge in the feces.

These symptoms in themselves are not dangerous, but can disrupt the normal rhythm of life, affect its quality, and also indicate the development of pathology. Therefore, the sooner you see a doctor, the faster and easier the treatment will be, the therapy will work effectively and the result will be complete healing. If the disease is not detected at an early stage and is not cured, it can provoke serious complications or it will regularly worsen until the end of life.

Major diseases

They are characteristic of a larger percentage of patients who seek medical help. Firstly, it is gastritis, the development of which provokes bacterium Helicobacter pylori, as well as inaccuracies in nutrition, the presence of bad habits and constant neuroses. With gastritis, the mucous membrane of the gastric walls suffers, because of which a person feels pain, suffers from indigestion. Secondly, it is an ulcer of the stomach and duodenum. For her, among other things, painful sensations are characteristic, and also heartburn, problems with the assimilation of food. An ulcer is formed when the organs of the gastrointestinal tract are damaged and the integrity of the tissues is violated, and this can lead to life-threatening complications.

The third most common disease of the gastrointestinal tract is colitis. Occurs under the influence pathogenic bacteria, on the background of infection. Localized in the intestinal mucosa and is inflammatory character. Nonspecific colitis causes ulcerative lesions that cause peritonitis, intestinal bleeding, malignancy, and obstruction.

Other diseases

Their list is huge. What diseases of the gastrointestinal tract are most common among patients? First of all, it is pancreatitis and dysbacteriosis. The first refers to inflammatory diseases of the pancreas, which is characterized by vomiting, nausea, indigestion and painful sensations. The second is the consequences of a change in the natural state of the intestinal microflora, as a result of which its full functioning is disrupted, problems arise with the digestibility of food, its normal excretion from the body.

The most common diseases of the gastrointestinal tract include such ailments: cholecystitis - inflammation gallbladder, which is accompanied by bitterness in the mouth, nausea, pain, problems with stools and dyspeptic symptoms, cirrhosis of the liver is a deadly disease in which large-scale damage to the cells of the organ occurs. Digestive diseases are also called hemorrhoids and appendicitis.

Clinical picture in children

Unfortunately, recently there has been an increase in cases of digestive pathologies in babies. Diseases of the gastrointestinal tract in children occur due to several factors: poor ecology, heredity and not proper nutrition. As for the latter, it manifests itself in the uncontrolled use by minors of carbonated drinks, fast food products, sweets that contain emulsifiers, dyes and preservatives. Doctors say that intestinal diseases in babies, they most often appear at the age of 5-6 and 9-11 years. Clinical picture while it looks like this: the baby has a stomach ache, he is sick or vomits, he complains of diarrhea or constipation.

Even babies are not immune from disease. Often they suffer from so-called colic. Reason - artificial feeding. Therefore, doctors do not get tired of insisting that breast milk - the best food for the smallest children. It not only has a beneficial effect on the stomach, but also helps to strengthen the immune system. The organism that receives enough natural vitamins, microelements and antibodies from mother's milk, can also provide decent resistance to various bacteria that cause diseases of the stomach.

Intestinal diseases in children

Acute intestinal diseases of children are classified as separate group diseases of the gastrointestinal tract. These are salmonellosis and dysentery, which cause intoxication, dehydration and various dyspeptic disorders. These symptoms are very dangerous and require immediate hospitalization. Interestingly, it is children who most often suffer from intestinal infections. This is due to the fact that babies defense mechanisms organisms are not yet perfect. The reasons are also ignoring sanitary standards by children and physiological features their gastrointestinal tract.

Acute infectious diseases The gastrointestinal tract can provoke a delay in physical development, "kill" the immune system and cause a number of serious complications and irreversible consequences. They are usually accompanied total absence appetite, fever, painful sensations in the abdomen, diarrhea, nausea and vomiting. The kid complains of weakness and fatigue, he is inhibited, lethargic. This child needs medical care: antibiotic therapy is prescribed by a pediatric gastroenterologist.

Treatment

First you need to contact a specialized doctor - a gastroenterologist. Only after passing the necessary tests and examinations, he will put accurate diagnosis. Treatment of diseases of the gastrointestinal tract, its duration and intensity will depend on the specific disease, the form and stage of its development, the degree of neglect, the general condition of the patient. Usually drug therapy is used, but in some cases surgical intervention is urgently required.

Tactics are selected individually. The following drugs are usually prescribed:

  • Antacids - neutralize stomach acid.
  • Alginates - normalize acidity.
  • Prokinetics - stimulate gastrointestinal motility.
  • Antispasmodics - relieve spasms of smooth muscles.
  • Antibiotics and probiotics.
  • Enterosorbents - against intoxication.
  • Antimicrobial agents.
  • Enzymatic digestive preparations, etc.

In combination with drug treatment traditional medicine is also used: infusions and decoctions medicinal plants. For example, immortelle, nettle, yarrow, lemon balm. They are very effective, but you can only take them under the supervision of your doctor.

Diet for diseases of the gastrointestinal tract

All diseases from this series are so different that specific recommendations can be given only after a detailed study of the diagnosis. The ration is subject to adjustment at each individual case. But there is also General requirements to the patient's diet. First, you need to eat often - 6 times a day. Portions should not be large, it is best if the dish is rare or crushed. So you will not overload the stomach and intestines. Secondly, the patient needs to drink 2 liters of water per day.

Diet for diseases of the gastrointestinal tract must be sparing. Preference should be given to soufflé, mashed potatoes, omelettes, low-fat fish and meat broths. Fried, smoked, canned, pickled, salted - under a strict ban. It is also necessary to abandon various sauces, semi-finished products, seasonings and spices. Vegetables that cause fermentation processes should also be excluded. These are all legumes, corn, peas, cabbage, turnips and radishes. Other vegetables must be thoroughly boiled or stewed. Food should be fresh and easy to digest. The more fiber in the diet and less refined food, the better the digestive tract will work.

Prevention

First of all - it's all the same balanced and proper nutrition. Prevention of diseases of the gastrointestinal tract includes such measures: compliance with the rules of sanitary cooking and personal hygiene. Thus, you protect yourself and your family from intestinal infections. Eat only healthy foods: vegetables, fruits, greens, low-fat dairy products, fish and meat. Try to in daily diet proteins, fats and carbohydrates were in the correct ratio.

Diseases of the gastrointestinal tract are very "like" passive people. Therefore, try to move more, play sports, spend a lot of time outdoors. An excellent option would be swimming, light running, aerobics and even walking. Give up bad habits - they provoke malfunctions in the intestines and stomach. Try to protect yourself from stress, do not be too nervous, take natural sedatives: valerian or motherwort. If the first alarming symptoms occur, immediately consult a doctor - this way you will avoid the progression of the disease and prevent its transition to chronic form and, of course, you will achieve a full recovery.

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