Decreased appetite

The centers of hunger and satiety are located in the hypothalamus. There are many ways in which pathological impulses are sent to these centers in case of diseases of the digestive organs, causing a decrease in appetite. The satiety center is stimulated by stretching of the stomach and the upper part of the small intestine. Information about the presence and absorption of nutrients comes from the chemoreceptors of the intestine to the appetite center. The centers of hunger and satiety are also affected by circulating factors (hormones, glucose, etc.), the content of which, in turn, depends on the state of the intestine. Signals caused by pain or emotional reactions that occur in diseases of the gastrointestinal tract come to the hypothalamus from higher centers.

A child's appetite is subject to significant fluctuations. It may be temporarily reduced, which may often be associated with poor nutrition, the quality of cooking, monotony of the diet, insufficient drinking (hot season) and other factors. Long-term appetite disorders, its reduction up to absence (anorexia) are associated with various pathologies and intoxications, diseases of the digestive organs, nervous systems, etc.

In the neonatal period, all pathological conditions that make the act of sucking difficult lead to a decrease in appetite: rhinitis, congenital defects in the development of the posterior nasal openings (stenosis, atresia), organic lesions of the central nervous system, suppression of the sucking reflex, for example, in prematurity or birth trauma, diseases of the oral mucosa,

In infants, decreased appetite occurs in cases of violation of feeding principles (overfeeding, high-calorie with excess fat, one-sided high-protein nutrition), forced feeding, distraction of the child's attention during meals with various stories, games, pictures. Sometimes, selective lack of appetite is observed only in relation to solid food.

One of the common reasons for decreased appetite in preschool and school-age children is a violation of the diet, eating sweets (ice cream, cookies, candy) between main meals.

Decreased appetite is observed in almost all acute and chronic diseases, anemia, some endocrine diseases (hypothyroidism, Addison's disease), liver diseases ( liver cirrhosis ), severe cardiovascular pathology, poisoning, hypervitaminosis D, idiopathic hypercalcemia, the use of certain medications (sulfonamides, antibiotics, salicylates). Loss of appetite is observed in intoxication and acidotic shift.

Persistent loss of appetite is typical for patients with chronic eating disorders, hylovitaminosis C and B. Active refusal to eat, perverted, selective appetite are characteristic features of children suffering from the neuropathic form of congenital dystrophy. Selective anorexia occurs with celiac disease (refusal to eat products made from wheat, rye flour, barley), enzymopathies - disaccharidase deficiency (refusal to eat a particular carbohydrate), exudative enteropathy (refusal to eat whole milk), with diseases of the liver and biliary tract (refusal to eat fatty foods), with food allergies to products containing an allergen. If parents or caregivers of the child constantly ignore age-appropriate nutritional principles, psychogenic anorexia develops, often accompanied by vomiting during meals. This may be a manifestation of the body's protective reaction in cases of forced feeding.

In school-age children, neurogenic anorexia may develop in combination with emaciation and amenorrhea, caused by growth characteristics, neuroendocrine restructuring and environmental factors. Nervous (mental, hysterical) anorexia is most often observed in pre- and pubertal girls and young women. Patients begin to limit themselves in food due to pathological dissatisfaction with their appearance, size and body weight.

There are 3 stages of the disease:

1. in stage 1, lasting months and sometimes years, initial neurotic and psychopathic symptoms are observed, as well as an inadequate assessment of one’s appearance;
2. in stage 2, an unreasonable fear of eating appears;
3. In stage 3, there is a detailed clinical picture of starvation with corresponding symptoms.

Patients are characterized by a negative, and sometimes literally hateful attitude towards food, especially carbohydrate foods. They not only sharply limit themselves in food, but also artificially induce vomiting, abuse laxatives. Many of them exercise intensively, try to do everything standing, limit their sleep time, and take forced poses when lying down (to increase energy expenditure).

Long-term food restriction up to almost complete starvation leads to exhaustion of patients and severe nutritional disorders. During periods of emotional stress, some patients eat a lot (bulanaya), and after eating, they artificially induce vomiting. In severe cases, exhaustion reaches the degree of cachexia.

Often this is a rather severe mental illness. Due to its polymorphic clinical picture this pathology is of interest to both psychiatrists and internists.

Anorexia is a very common symptom, characteristic of various diseases not only of the gastrointestinal tract. However, when refusing to eat, the doctor, first of all, thinks about diseases of the gastrointestinal system.

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