Pancreatitis in children: causes, signs and treatment features

Pancreatitis in children occurs with the development of an inflammatory reaction in the tissues of the pancreas. In childhood, this pathology is often disguised as other diseases of the digestive tract (gastroduodenitis, gastritis, dysbacteriosis) and can occur for a long time with minor symptoms.

If signs of pancreatitis appear in children, you should contact a pediatrician or pediatric gastroenterologist. Without treatment, the disease becomes chronic and can cause complications, including pancreatic necrosis (a complication of acute pancreatitis with destruction of pancreatic tissue)1.

Reasons for the development of pancreatitis in a child

Pancreatitis in children develops under the influence of various external and internal unfavorable factors2:

• poor nutrition, overeating, excess fatty, spicy and overly spicy foods in the diet;
• severe allergic reactions to medications, food, environmental factors;
• congenital or acquired anomalies of the digestive organs;
• damage to the abdominal wall;
• progression of other gastrointestinal diseases*;

• benign and malignant neoplasms in the pancreas;
• helminthiases;
• endocrinological diseases;
• past viral diseases;
• hormonal disorders;
• uncontrolled use of medications.

Regardless of the reasons for the development of pancreatitis in children, the child needs qualified medical care and a comprehensive examination.

Based on diagnostic data, specialists identify factors that provoke an inflammatory reaction in the pancreas, select an effective treatment regimen, and carry out prophylaxis to prevent further relapses.

Clinical picture of ascariasis and enterobiasis in children at the present stage

What are the difficulties in diagnosing helminthiases? What is the treatment for helminthiasis?

Against the background of global environmental changes, the widespread use of immune, antibacterial and other drugs, frequent violations of adaptation processes (adaptation diseases), constant stress, increasing levels of education and culture of the population, many long-known human diseases have changed their clinical picture. Some symptoms practically ceased to occur, while others, on the contrary, began to come to the fore. This also applies to diseases caused by helminths, in particular parasitic roundworms (nematodes). In the temperate zone, the most widespread nematodes are roundworms and pinworms.

Helminths can cause dysfunction of the gastrointestinal tract (GIT), cause allergic (or pseudoallergic) reactions or aggravate them, cause intoxication, and also be a factor that weakens the immune system [2]. Nowadays, cases of massive infestation are rare, when diagnosis does not cause difficulties, and helminth balls cause intestinal obstruction - much more often helminths have become the cause of the development of allergic problems. At the same time, helminthiases are among those diseases that are difficult to diagnose due to objective and subjective difficulties (long periods of absence of oviposition, the possibility of the absence of females among the parasitic individuals, the likelihood of technical errors). Therefore, it is important to know the clinical picture of these diseases in order to be able to prescribe an in-depth examination or effective therapy based on a combination of indirect signs, even without direct evidence of the presence of helminthiasis.

In order to evaluate the clinical picture of nematodes, complaints, anamnesis and examination results of 150 children were analyzed in whom roundworms (116 children), pinworms (27 children), roundworms and pinworms (7 children) were found. Helminths were identified using standard methods: detection of roundworm eggs in feces using a smear method or pinworm eggs in a scraping for enterobiasis, as well as visual detection of roundworms or pinworms in feces, vomit, or during surgical or endoscopic intervention in the abdominal cavity or rectal area [3].

Among the children there were 67 boys and 83 girls. The age distribution is presented in table. 1. Children of primary preschool age (from one to three years old) predominated, their number was 63%. It is at this age that the greatest epidemiological preconditions for the appearance of nematodes occur.

In 150 children with proven infestations of roundworms and/or pinworms, the following clinical manifestations were noted.

107 children (71.3%) had allergic problems: skin rashes, diathesis, atopic dermatitis, neurodermatitis - 99 (66%), of which 18 had periodic problems, two children, in addition to skin rashes, had conjunctivitis ; ten (6.7%) had a proven food allergy to some foods with high levels of specific IgE in the blood serum; Six children (4%) had an asthmatic component or were diagnosed with bronchial asthma.

113 children (75.3%) had gastrointestinal dysfunction: unstable stool, undigested stool, the presence of “green” and mucus in the stool - in 66 (44%); constipation or a tendency to constipation - in 55 (36.7%), 17 children (11.3%) had unstable stool with a tendency to constipation, i.e. periods of normal or liquefied stool alternated with periods of constipation; flatulence, manifested by increased gas formation, bloating, rumbling, belching, occurred in 30 children (20%); nausea, vomiting, and regurgitation were observed in 29 children (19.3%).

In 60 (40%) children who, by age, could complain of abdominal pain, abdominal pain syndrome was noted: most often so-called “flying pains” were noted, which occurred regardless of food, periodically, usually without a specific localization or localized around navel (in the paraumbilical zone). Such pains went away on their own without medications or while taking sorbents and antispasmodics; some children needed to lie down for a while; Pain syndrome of this nature was observed in 54 children (36%). In eight children (5.3%), abdominal pain was constant, often associated with food (occurring after eating), intense, and often required drug treatment and hospitalization to exclude acute surgical pathology; one child underwent an appendectomy for this reason, and roundworms were found in the appendix with catarrhal changes; Two children had abdominal pain syndrome of both types.

66 children (44%) had appetite disturbances: in 54 (36%) appetite was often reduced or selective; in 12 (8%) - increased (the child is constantly hungry). Often, when asked about appetite, parents answered “when and how,” i.e., there were periods of normal appetite and decreased or increased appetite. In assessing this indicator, there is a large amount of subjectivity, since parents assess their children’s appetite differently.

Bruxism (teeth grinding) - a symptom that is often associated with helminthic infestations, but in fact is a nonspecific sign of intoxication of the central nervous system and can accompany any chronic intoxication - was noted in 25 children (16.7%).

Night sleep disturbances were observed in 81 children (54%): restlessness in the evening, difficulty falling asleep - in 15 children (10%); restless night's sleep (screaming, moaning, tossing and turning in sleep, waking up, crying, insomnia, nightmares) - in 76 (50.7%). Some parents of older children found it difficult to characterize the child's nighttime sleep, because the child sleeps in another room. Problems with falling asleep and sleeping at night are an important symptom of helminthic infestations, since it is known that intestinal nematodes (including roundworms and pinworms) are often activated at night.

54 children (36%) had itching and/or redness in the anus (anal escoriation) - in 43 children (28.7%); itching - in 38 (25.3%); both symptoms - in 27 (18%). Anal escoriation and itching are considered symptoms of enterobiasis (pinworms), but out of 54 children who had these symptoms, enterobiasis was proven in 17 children (31.5% of the number of children with these symptoms). In another 37 children (68.5% of the number of children with these symptoms), the presence of ascariasis was proven, but pinworms were not detected either visually or in tests. This may indicate either that in these cases there were pinworms that were not diagnosed, i.e., helminthiasis was mixed, or that anal escoriation and itching are symptoms characteristic not only of enterobiasis, but also of ascariasis.

29 children (19.3%) showed signs of general weakening of the immune system: frequently or long-term ill children (according to the generally accepted classification of Monto J. et al., 87) - 18 children (12%); recurrent stomatitis and gingivitis were observed in 13 children (8.7%); dental caries - in six (4%); recurrent purulent diseases of the skin or mucous membranes - in three (2%).

15 children (10%) had the results of a blood test of their immune status: 13 children had a reduced number of T cells; in all 15 children the number of T-helper cells was reduced, and in six of them it was significantly reduced; in 12 children the helper-suppressor ratio was reduced; in seven children there was a decrease in the level of IgA (secretory immunoglobulin), including in three a significant decrease, while in the remaining eight children the level of IgA in the blood serum was either normal or elevated; Six children had a decrease in the number of lymphocytes, including one child who had severe lympho- and neutropenia. These results confirm the known data that roundworms and pinworms have a depressing effect on immune function, and that people with weakened immune systems are more likely to develop helminthiasis [1].

49 children (32.7%) had various symptoms that can also be associated with the effects of helminths on the body: “geographical” tongue - in 12 children (8%); retardation in physical development, insufficient weight gain or weight loss over a period of time - in 21 children (14%); a painful appearance (blue under the eyes, pallor) was detected during examination in seven children (4.7%); Ten children (6.7%) had bad breath, especially in the morning; increased fatigue, asthenic syndrome - in eight children (5.3%); emotional lability, capriciousness, irritability of the child - in four (2.7%), and this indicator is subjective, as is the parents’ assessment of appetite; hypersalivation, another symptom usually associated with helminthiasis, was observed in three children (2%); various manifestations of hypovitaminosis, including rickets - in five children (3.3%). Often, during examination, changes in the skin in the form of “goose bumps” were revealed.

Most children had more than one symptom. Summarized data on the clinical picture are presented in table. 2.

Therapy in all cases consisted of two stages: first, anthelmintic therapy, and two different drugs were prescribed (decaris and vermox) with an interval of three to five days between them in order to maximally cover the different stages of the life of helminths; some time after anthelmintic therapy - drugs for microbiological and functional correction. Accordingly, the results of anthelmintic therapy, the results of the entire treatment, as well as follow-up within six months after therapy were assessed. In most cases, improvement occurred quickly during treatment. In 36 children, only after anthelmintic therapy, allergic manifestations significantly decreased or completely disappeared, in 39 children, after the first stage of therapy, the functioning of the gastrointestinal tract normalized, in 41 children, abdominal pain immediately stopped, and other symptoms also improved after anthelmintic drugs. This confirms that the symptoms were caused by the presence of helminths.

92 children had no complaints after the entire treatment; about 37 there is no data on changes in condition during and after treatment; in 16 children the effect was incomplete, i.e. some symptoms persisted after the end of treatment; in four children the effect of therapy was unstable, since relapses occurred after the end of treatment; Three children had no effect from therapy.

Literature

1. Blagova N. N. Some immunity factors in patients with ascariasis and enterobiasis during treatment with albendazole.
Author's abstract. dis. ...cand. honey. Sci. St. Petersburg, 1997. 2. Bogoyavlensky Yu. K., Rachkovskaya I. V., Chebyshev N. V. Nematodes and anthelmintics. M., 1994. 3. Laboratory diagnosis of parasitic diseases: https://www.infectology.spb.ru/. Bulletin of infectology and parasitology. Table 1. Age distribution

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Table 2. Clinical picture of intestinal nematodes

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Acute pancreatitis in children

The acute form of pancreatitis can develop as a result of an infectious lesion of the body against the background of damage to the pancreas. The disease often occurs after overeating and eating excessively fatty foods, as well as against the background of viral infections and helminth infections.

Acute inflammation of the gland is accompanied by a pronounced destructive-inflammatory process. The child must be hospitalized to avoid the development of complications and serious disturbances in the functioning of the digestive system2.

Timely consultation with a doctor will help to avoid negative consequences, for example, the development of purulent peritonitis (infectious inflammation of the peritoneum).

How to distinguish “bad” plaque from “good”

Photo: this is what a “milky” white coating looks like on a baby’s tongue

The appearance of a white coating on the tongue of an infant is not always a signal of concern. Take a closer look at your baby and let him take 1-2 sips of boiled water. If there are no negative changes in behavior, the baby is calm, eats well, and after drinking the amount of plaque decreases, then it is milk residue.

In the first weeks of life, the baby's main food is mother's milk, and it is not surprising that its remains are present on the tongue.

If the white coating on the tongue of a month-old baby has a dense consistency in the form of curdled flakes, you should urgently take the baby to the doctor

. Such symptoms indicate the development of thrush and other disorders in the child’s body.

Pathological plaque does not appear “alone”; changes in the baby’s behavior and well-being should also be observed: the baby is capricious, cries, refuses to eat, body temperature rises, and poor sleep is possible.

Chronic pancreatitis in children

Signs of chronic inflammation of the pancreas in children are determined primarily by the form of the disease and the condition of other organs of the digestive tract. Typically, children are bothered by aching pain under the chest, which intensifies after eating fatty and spicy foods, physical and psycho-emotional fatigue.

Chronic pancreatitis in childhood most often develops against the background of unfavorable heredity. If parents and close relatives develop a similar disease, the risk of its development in the child increases significantly.

The chronic course of the inflammatory process can lead to irreversible changes in pancreatic tissue and dysfunction of the organ. If characteristic signs of exacerbation appear, such as abdominal pain, bitterness in the mouth, vomiting, frequent and loose stools, you should contact a specialist. Self-medication may increase the inflammatory response.

Whitish tongue as a sign of thrush

A white tongue in a newborn with a thick, dense coating often indicates a fungal infection of the oral cavity, which is accompanied by the development of candidiasis (thrush).

Thrush is a disease that develops due to the active activity of yeast-like fungi Candida. They can be located in the human body without causing discomfort or pain. If the environment becomes favorable for microorganisms, they actively multiply, affecting the mucous membranes of the oral cavity.

Children in the first month of life are more susceptible to the disease; they could have received the infection at birth. If the mother is diagnosed with Candida fungus, infection is inevitable.

Photo: this is what a white coating looks like on a baby’s tongue with thrush

There are mild and severe stages of fungal infection. Treatment of a mild form lasts 7 days without the formation of wounds or the development of complications. To get rid of a severe form of candidiasis, you will need the help of a pediatrician and drug therapy. It is important to constantly monitor changes in the color of the baby’s tongue and oral mucosa and his well-being. Possible complications, increased body temperature.

White tongue is a frequent guest in newborns who are bottle-fed. Breastfeeding helps prepare the baby's immune system to be attacked by viruses and harmful bacteria. In addition, the mother's warmth calms the baby's nervous system. “Artificial” people need more time to strengthen the immune system, which increases the chances of developing the disease

.

Reactive pancreatitis in children

Reactive pancreatitis develops in children against the background of other diseases of the gastrointestinal tract, toxic damage (for example, due to drug poisoning), or an allergic reaction. In the overwhelming majority, the cause of the inflammatory process lies in the exacerbation of cholelithiasis and liver diseases.

Reactive pancreatitis develops several hours after adverse effects of internal and external factors. The following symptoms are noted3:

• pain that increases after eating;
• signs of gas formation;
• heartburn;
• nausea turning into vomiting;
• traces of bile and mucus in the vomit.

Causes of plaque on the tongue

There are many reasons why various plaques may appear on the tongue: from the banal consumption of foods that can change the color of the tongue, to serious health problems that require immediate medical attention.

The very first thing you need to do when you discover strange coatings on a child’s tongue is to remember what the baby ate in the last 24 hours. Very often, sweet carbonated drinks, caramels or other sweets contain active dyes that can give the oral mucosa the most exotic shades: crimson, purple, green, orange and others. Even natural berries and fruits can radically change the color of the tongue. Therefore, there is no need to panic right away. You should ask the child to brush his teeth and tongue, and then evaluate their condition and color. If the plaque has not changed or has reappeared without connection with food intake, then this is a reason to urgently visit your pediatrician.

So, what kind of plaque on a child’s tongue happens, what can cause its appearance and how to treat it, we will consider further.

White

White plaque can be found in the oral cavity of a baby most often. This phenomenon also happens normally when, after a night’s sleep, a thin white coating without an unpleasant odor is found on the tongue, disappearing after hygiene procedures and not causing any discomfort or unpleasant sensations.

The appearance of a dense whitish plaque, which is extremely difficult to remove from the surface of the tongue and does not disappear after brushing your teeth, may indicate problems with the gastrointestinal tract (gastritis, enteritis or dysbacteriosis). This phenomenon is often accompanied by bad breath. In addition, children may present complaints that may indicate gastrointestinal pathology:

• abdominal pain of various localizations;
• bloating;
• stool disorders;
• change in appetite

In order to get rid of such white plaque, it is necessary, first of all, to examine the digestive system and eliminate even the most minor disturbances in its functioning.

In infants up to 2 months of life, thrush or oral candidiasis is a common occurrence in a nursing mother, especially after taking antibiotics or an error in diet. With this pathology, abundant cheesy white deposits appear on the tongue and cheeks, which are easily removed, and small ulcers are found underneath them. After starting treatment for thrush with antifungal agents and treating the oral cavity with antiseptic solutions, the tongue and other mucous membranes quickly cleanse and regain their previous appearance.

Grey

A gray coating on the tongue can be a sign of some infectious diseases. For example, with scarlet fever, on the very first day the mucous membranes become covered with a dirty gray coating, which, starting from the tip of the tongue, gradually disappears and reveals a “raspberry tongue” - enlarged papillae on a bright red background, which is very reminiscent of raspberries.

With diphtheria, gray filmy deposits can be found on the root of the tongue, which are difficult to separate. Such plaques spread to the mucous membranes of the throat, palatine arches and are accompanied by coughing and attacks of suffocation.

Treatment of such infectious diseases is carried out only in a hospital setting. After healing, all plaque on the tongue disappears.

Dehydration in a child can also lead to the formation of a gray coating on the surface of the tongue. At the same time, the mucous membranes look dry and dull. Replenishing the required volume of fluid quickly eliminates this symptom.

Yellow

A dense yellow coating on the tongue indicates pathology of the liver or biliary tract. Often in children, diseases of the biliary system occur without a clear clinical picture, and the presence of bile stagnation can only be suspected by a change in the color of deposits on the mucous membranes of the oral cavity.

If a child has a yellow coating on the tongue, it is necessary to urgently consult a doctor and have an examination of the internal organs and the biochemical composition of the blood.

Orange

The orange color of the tongue is a marker that acidic contents from the stomach enter the oral cavity. This happens with exacerbation of gastritis with high acidity, with reflux disease, with pathology of the esophagus and the initial stages of ulcer development. In this case, the child may additionally complain of an unpleasant sour taste in the mouth, belching, and occasional heartburn. Treatment will consist of eliminating the underlying cause.

Green

The appearance of a green coating on the mucous membrane of the tongue often frightens parents, especially if it is found in a newborn or infant. The most common cause of this phenomenon is candidiasis - a fungal infection of the oral cavity that occurs due to imperfect immune defense in the body of a 1-year-old baby or while taking strong antibacterial drugs.

This plaque has varying color intensities and can spread to other parts of the oral cavity, found on the cheeks, palate and lips. After removing it, you can see the red surface of the tongue with small blisters or ulcers, which cause discomfort to the child.

You should start treating green plaque only after consulting a doctor. Therapeutic measures will consist of taking special drugs with antifungal action and local antiseptics to treat thrush and prevent bacterial complications.

Brown

A brown tongue in a child is not such a rare occurrence. There can be many reasons for this:

1. Severe diseases of the digestive system, accompanied by inflammatory changes, stagnation of bile in the bile ducts, and disruption of the digestive processes.
2. Constant dehydration of the child's body due to high ambient temperatures or insufficient fluid intake.
3. Insufficient intake of B vitamins.
4. Taking certain medications: antibiotics, antiseptic solutions, concentrated herbal decoctions.

It is very difficult to establish the exact root cause of the appearance of such a dark plaque. This can only be done by an experienced doctor, who, after additional examinations, will be able to prescribe the optimal treatment.

Black

The presence of a black coating on a child’s tongue looks quite scary, and there may be several reasons for this phenomenon:

• Bacterial sore throat is often accompanied by the appearance of dark plaques on the mucous membranes, even black. In this case, the child will have signs of inflammation in the tonsils: red throat, high fever, pain when swallowing, weakness.
• Hidden forms of diabetes mellitus, which lead to persistent disruption of the acid-base balance in the body. Excess acid or acidosis will cause darkening of the tongue.
• Taking some antibiotics causes the growth of pathogenic microflora in the mouth, which causes the mucous membranes to become permanently stained black.

Treatment of such plaque will consist of eliminating the causes that caused its appearance. After a sore throat is treated, medications are stopped, or diabetes is identified and compensated for, this symptom will most likely go away on its own.

Blue

A blue tongue is a sign of blood stagnation. Very often, various diseases of the cardiovascular (congenital heart defects, arrhythmias, heart failure) and nervous system (hemorrhages, cysts, epilepsy) lead to the fact that blood flows through the tissues more slowly than it should - cyanosis or cyanosis appears on the limbs, lips and language. Therefore, if you notice such a symptom in your child, you should urgently contact your doctor for advice.

Diagnosis of pancreatitis in children

The diagnosis is made based on the clinical picture, the results of the survey, examination of the child and the data of the examination. When palpating the abdomen, the gastroenterologist detects local pain in the epigastric region (in the upper and middle parts of the abdomen, between the costal arches). In order to identify concomitant pathologies of the digestive organs, specialists can also prescribe2:

• general radiography of the gastrointestinal tract*;
• computed tomography;
• Ultrasound;
• MRI**.

Treatment of pancreatitis in children

The choice of treatment methods for pancreatitis in children requires a careful study of the medical history, examination data and examination of the child. The acute form of the disease often requires hospitalization of the child. The inflamed pancreas needs rest, which can only be ensured by strict adherence to the following conditions2:

• bed rest;
• diet;
• possible short-term therapeutic fasting;
• drug treatment, including the administration of glucose, painkillers and anti-inflammatory drugs, as well as drugs intended to normalize digestion, for example, the drug Creon®.

In case of severe destruction (impaired functioning) of the pancreas, urgent surgical treatment is required.

Due to the high risk of complications, pancreatitis in childhood requires specialist supervision. Even if the symptoms of the inflammatory process are mild, it is necessary to consult a specialist to prevent undesirable consequences.

Gastroenterologists pay special attention to the development of measures to prevent exacerbations of pancreatitis in children. Prevention includes maintaining a balanced diet appropriate for the child’s age, preventing toxic damage to the body as a result of infectious processes and the course of diseases of internal organs.

A newborn has a white coating on the tongue - what to do?

The method of treating white plaque on a baby's tongue
depends on the cause of its appearance
. If the whitish spots are the remains of breast milk or formula, you need to clean the baby’s tongue. Use boiled water to rinse the baby's mouth with it after feeding.

If the defect is caused by disorders of the nervous system, contact a pediatric neurologist to identify the cause of the neurosis and take care of the baby’s peace of mind. There is no need to clean the tongue; the defect will go away on its own.

The appearance of whitish spots on the tongue may mean that the baby has digestive problems. Pay attention to your child's nutrition. The primary task is to eliminate dysbiosis by selecting a different formula during artificial feeding or adjusting the mother’s diet during breastfeeding. These actions are enough to eliminate the symptoms.

A white coating on the tongue of a newborn child may appear due to infectious diseases of the oral mucosa: herpes, scarlet fever, chicken pox. The disease occurs with elevated body temperature.

It is impossible to do without drug treatment. To avoid complications and the disease becoming chronic, the doctor may refer the baby for inpatient treatment.

Treating thrush

Treatment of a mild stage of thrush involves wiping the tongue with a soda solution. With its help, you can easily clean whitish accumulations and prevent the growth of bacteria.

Pay more attention to personal hygiene rules:

• For “artificial” babies, be sure to pour boiling water over the nipple and bottle before feeding.
• Clean and boil rubber toys regularly.
• Replace outdated nipples with new ones in a timely manner, taking into account the manufacturer's recommendations.
• When breastfeeding, keep your nipples clean. Before latching your baby, do not forget to wash your breasts with warm water. During the treatment of the disease, additionally treat it with soda solution.
• During lactation, try to avoid taking antibiotics, normalize your diet, fill it with vitamin products.
• After feeding, remove milk residues.

Important point! Do not kiss a sick baby on the lips, do not lick the pacifier - you risk becoming infected yourself and adding harmful bacteria and viruses with your saliva. Even after recovery, refrain from such actions.

A dense, cheesy coating on the baby’s tongue, palate and gums, and the appearance of whitish pimples indicate a complex stage of thrush. Drug treatment is carried out in strict compliance with the doctor’s instructions, without violating the regimen. Immunomodulatory and antifungal drugs are prescribed.

How to clean the tongue of a newborn

The most important factor influencing the speed of recovery from thrush is oral hygiene. Parents can clean the surface of their baby's tongue at home. Procedure:

• Make a weak 2% soda solution: 1 tsp. Dissolve baking soda in a glass of boiled water.
• Before cleaning your newborn's tongue, wash your hands with plain soap. Wrap a little sterile bandage around the pad of your index finger.
• Soak a bandaged finger in a soda solution and massage the problem surface with it. You need to clean your tongue as carefully as possible, without pressing.
• Repeat the procedure after each feeding, 4-5 times a day.

In addition to soda solution, you can clean the child’s damaged mucous membranes with medicinal gruel. To prepare it, mix 1/2 tablet of Nystatin (125 thousand units) with 1 ml of liquid vitamin B12. Apply the resulting mixture to the gums, palate, and plaque-covered surface of the tongue. Repeat the treatment after each feeding.

To remove unpleasant plaque, traditional medicine advises using honey and lemon juice. Be careful, such components can cause an allergic reaction in the baby and complicate treatment.

Diet for pancreatitis in children

With pancreatitis, the child must follow a diet.

The following foods and drinks are excluded2:

• fresh bread and pastries;
• sparkling water;
• fatty dairy products;
• smoked meats, seasonings and spices;
• store-bought juices;
• fat meat;

• cabbage;
• lemons;
• credit;
• legumes;
• coffee.

Slimy porridges prepared with vegetable decoctions are useful. You can use meat broths made from poultry (skinless chicken), veal, rabbit, which are previously steamed or boiled. During an exacerbation, food should be pureed and free of lumps and rough pieces that can injure the mucous membrane of the digestive tract.