21.10.2020

Treatment of biliary dyskinesia in children

The basis of biliary dyskinesia in children is a violation of the regulation of the sequential contraction and relaxation of the gallbladder and sphincters of the nervous and paracrine systems. As a result of the discoordination of the activity of the biliary system, the passage of bile into the intestine is disrupted, which is accompanied by a complex of clinical manifestations.

In infants, biliary dyskinesia, like other functional disorders of the gastrointestinal tract, is most often the result of perinatal CNS lesions (hypoxia, birth trauma, asphyxia, etc.). The development of biliary dyskinesia in children is promoted by anomalies of the bile ducts and excesses of the gallbladder, which impede the normal flow of bile; sphincter abnormalities; cytogenic or hepatogenic dyscholium.

In pediatrics, there is an association between the occurrence of biliary tract dyskinesia and the infectious diseases carried by the child – hepatitis A, salmonellosis, and dysentery. Chronic diseases (antritis, chronic tonsillitis, etc.), giardiasis, ascariasis, and neuro-arthritic diathesis play a certain role in a number of causes of biliary dyskinesia in children.

In older children, the role of vegetative-vascular dystonia, neurosis, psycho-emotional disorders, physical inactivity, nutritional errors in the development of biliary dyskinesia is increasing. Since the contraction and relaxation of the gallbladder occurs under the influence of peptide hormones (cholecystokinin, gastrin, secretin, glucagon, etc.), the impairment of their production during gastritis, gastroduodenitis, pancreatitis, enterocolitis can also cause biliary dyskinesia in children.

Classification of biliary dyskinesia in a child

Depending on the nature of the disorders, primary and secondary biliary dyskinesia in children is distinguished. Primary dysfunction is associated with a disorder of neurohumoral regulation; secondary arises as a viscero-visceral reflex and is a consequence of the pathology of the digestive system.

According to the international classification, two forms of dyskinetic disorders are distinguished: dyskinesia of the gallbladder and cystic duct and spasm of the sphincter of Oddi.

Given the nature of the impaired tonus and motility of the biliary tract and the clinical manifestations of dyskinesia in children, it can occur in hypertonic-hyperkinetic, hypotonic-hypokinetic, and mixed versions. In the hypermotor variant, the secretion of bile occurs quickly and often, which is accompanied by the spastic condition of the gallbladder and sphincters.

When hypomotor form muscles biliary tract relaxed, bile is secreted slowly, which leads to its stagnation in the gall bladder. Mixed biliary dyskinesia in children combines the signs of hypermotor and hypomotor forms.

Symptoms of biliary dyskinesia in a child

The main manifestations of biliary dyskinesia in children are pain syndrome, dyspeptic syndrome and positive cystic symptoms. The nature of the manifestations depends on the form of dysfunction.

The course of hypertonic-hyperkinetic dyskinesia of the biliary tract in children is characterized by paroxysmal (stitching, stabbing, cutting) pains in the right hypochondrium, which are of short duration (5-15 minutes). On palpation, the gallbladder area is painful, positive gallbladder syndromes are determined. In hypertensive dyskinesia of the biliary tract, the child often has loose stools, nausea, loss of appetite, vomiting, bitter taste in the mouth, general weakness, headache.

The provoking factors of pain and dyspepsia are, as a rule, physical exertion, eating fried or fatty foods, negative emotions. During interictal periods, the well-being of children is satisfactory; sometimes they may be disturbed by brief abdominal cramps.

The hypotonic form of biliary dyskinesia in children is rare. In this case, the pain in the hypochondrium is constant, dull, dull character; sometimes there is only swelling and heaviness in this area. There may be dyspepsia: alternating constipation and diarrhea, loss of appetite, belching air, flatulence. Due to cholestasis and overstretching of the gallbladder during palpation, an enlarged and painless liver is determined.

Diagnosis of biliary dyskinesia in a child

Children with biliary dyskinesia are referred by a pediatrician for consultation with a pediatric gastroenterologist. To clarify the clinical diagnosis and determine the type of biliary dyskinesia in children, a complex of clinical, laboratory, instrumental studies is carried out.

In patients with dyskinesia, pain is determined in the projection of the gallbladder and in the epigastric region. The most important in the diagnosis of biliary dyskinesia in children is ultrasound of the gallbladder, which is used to evaluate the shape, size, deformity of the gallbladder, the condition of the ducts, and the presence of stones. To determine the contractility of the gallbladder and the condition of the sphincter of Oddi, an ultrasound of the gallbladder of a child is repeated after taking a provocative breakfast.

Duodenal intubation in children with biliary dyskinesia allows us to estimate the volume of portions of bile, its microscopic and biochemical composition. When examining duodenal contents, signs of inflammation, a tendency to the formation of stones, Giardia, etc. may be detected.

If it is necessary to study the morphology and function of the biliary system, oral or intravenous cholecystography (cholecystocholangiography), radionuclide cholescintigraphy, retrograde cholangiopancreatography, MR cholangiography are performed. In order to exclude other gastrointestinal diseases, gastroscopy, fecal helminth analysis, coprogram, bacterial dysbacteriosis, and biochemical blood tests can be performed for a child.

Treatment of biliary dyskinesia in children

The basis of the productive treatment of children with biliary dyskinesia is diet food with restriction of the use of fatty, fried, spicy, salty, sweets, soda. Recommended fractional (5-6 times a day) nutrition, enrichment of the diet with foods high in fiber, vitamins A, B, C, bifidobacteria and lactobacilli, refined vegetable oils.

The regulation of the motor mode of the child, the creation of a favorable emotional background. In all cases, attention should be paid to the treatment of the underlying disease.

Children with hyperkinetic-hypertensive type of biliary dyskinesia are prescribed sedatives (herbal preparations, valerian), and antispasmodics to relieve painful attacks (papaverine, drotaverine). The basis of the treatment of hypertonic-gykinetic dyskinesia of the biliary tract in children is choleretic and cholespasmolytic (flamin, preparations of dry bile). Psychotherapy, acupuncture, physiotherapy (paraffin baths, diathermy, inductothermia, electrophoresis with antispasmodics), and massage of the cervical-collar zone have proven themselves in the treatment of biliary dyskinesia in children.

In hypotonic-hypokinetic dyskinesia of the biliary tract in children, stimulating procedures are prescribed: physical therapy, hydrotherapy, massage. Cholagogic preparations with a cholinokinetic effect (xylitol, sorbitol, magnesium sulfate), vegetable extracts (corn silk, rosehip, calendula) are used; therapeutic cholagogic tubages are performed. From physiotherapeutic methods galvanization, electrophoresis with magnesium sulfate, Bernard’s currents are used.

Timely diagnosis and adequate treatment of dyskinesia, taking into account its type, allows to normalize the processes of gall and digestion, prevent inflammation and early stone formation in the biliary tract in children. Prolonged disruption of the biliary system can lead to the development of cholecystitis, cholangitis, gallstone disease, intestinal dysbiosis.

Children with biliary dyskinesia need a dispensary observation by a pediatrician, pediatric neurologist and gastroenterologist, ultrasound monitoring, conducting choleretic courses twice a year, and recreation in specialized sanatoriums. It is necessary to follow the nutrition and mode of the child, his emotional state.

Biliary dyskinesia in children  – a change in the tone and motility of the biliary system, which violates the full flow of bile into the duodenum. Dyskinesia of the biliary tract in children is manifested by stabbing pains in the right hypochondrium, dyspeptic disorders associated with errors in nutrition.

С целью диагностики дискинезии желчевыводящих путей у детей выполняется УЗИ желчного пузыря натощак и после приема желчегонного завтрака, дуоденальное зондирование, реже – холецистография, гепатобилисцинтиграфия. Лечение дискинезии желчевыводящих путей у детей проводится с учетом ее типа с помощью диеты, фармакотерапии, фитотерапии, физиотерапии.

Дискинезия желчевыводящих путей у детей – дисфункциональное расстройство билиарного тракта; нарушение сократимости желчного пузыря и желчных путей, сопровождающееся расстройством функции желчеотведения. В структуре заболеваний билиарной системы у детей дискинезии желчевыводящих путейпринадлежит первое место; за ней следуют воспалительные заболевания (холецистит, холангит), аномалии развития желчных путей и желчнокаменная болезнь.

In pediatric gastroenterology, dysfunctional disorders of the biliary system are detected in 70-90% of children suffering from diseases of the digestive system

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