Advantages of the application method for taking a biopsy of the gastric mucosa to assess its functional state and microflora composition in obese children
Authors: Koshurnikova A. S. , Bokova T. A. , Tereshchenko S. G. 
Published: March 2021

Relevance. Obesity is one of the most pressing problems of modern Pediatrics.

The purpose of the study: to study the morphofunctional state and features of the composition of the stomach microflora in obese children using and comparing various endoscopic methods of biomaterial sampling.

Materials and methods. 164 children aged 7 to 17 years were examined. The main group — 85 obese people, the comparison group‑79 children with normal body weight and digestive diseases. Esophagogastroduodenoscopy was performed, followed by pathomorphological, bacterioscopic, and microbiological examination of the biological material. In addition to sampling the biopsy of the antral part of the stomach with a sterile farcept, 40 patients were additionally taken from the wall biological material by obtaining a smear from the mucous membrane with the author’s endoscopic probe.

Research result. The frequency of inflammatory changes IN the gastrointestinal tract was high in both groups and did not depend on body weight. In the main group, duodeno-gastric reflux (DGR) (32–38% и 9–11%, p<0.05) and cardia insufficiency (46–54% и 36–46%, p>0.05) were more often diagnosed. With an increase in the degree of obesity, the total number of refluxes increased — from 45–53% at grade I to 64–75% at grade IV, and DGR — from 12–14% to 49–58%, respectively. The most frequent localization of inflammatory changes in children of the main group was the antral (43–50%), less often — the stomach body (26–30%), while in the comparison group the body was more often affected (42–52%) and less often the antral (24–30%). In most children, regardless of the group (56–66% и 51–65%), chronic gastritis of moderate activity was registered. A high degree was significantly more often detected in the comparison group (14–16% and 24–30%, p<0.05), while a weak degree was detected in children of the main group (16–19% and 5–6%, p<0.05). In children of the main group, H. pylori (HP) was more often detected (45–53% и 25–32%, p <0.05), while 1 degree of contamination was more often determined (43–51% и 39–48%), while in the comparison group — 3 degree (15–18% и 24–30%). With increasing degree of obesity increased frequency of contamination from the antrum, HP — from 36–42% when I level up to 60–71% in IV degree of obesity. When using the application in HP+ children of the main group were more often sown opportunistic pathogens in a more diverse species composition and a more pronounced decrease in planting indigenous microflora, and regardless of HP significantly more prevalent growth of E. coli and Candida. In the presence of DGR, independently of the group, a significantly higher growth of fecal flora and a more pronounced decrease in the seeding of indigenous microflora was obtained.

Conclusions.

1. A high frequency of inflammatory and functional disorders in children, regardless of body weight, was established.

2. Motor-evacuation disorders in children with obesity recorded often (63% and 43%). As the degree of obesity increases, their frequency increases. DGR in obese children is recorded significantly more often (38% and 11%, p<0.05).

3. Children with obesity have a higher frequency of registering a low degree of activity of chronic gastritis, and children with normal body weight have a high frequency. The degree of activity of the inflammatory process does not depend on the degree of obesity and the duration of the disease.

4. HP in obese children is detected 1.5 times more often than in children with normal body weight; the predominance of low (1 degree) contamination is characteristic. With an increase in the degree of obesity, the frequency of HP contamination increases (from 42% at grade I to 70% at grade IV obesity).

5. HP-positive children show significantly higher growth of E. Faecium, S. viridans and Streptococcus faecalis and lower seeding of Lactobacterium and Bifidobacterium.

6. DGR contributes to a more pronounced decrease in the growth of indigenous microflora, only Streptoco