Treatment of chronic gastritis, gastric ulcer and duodenal ulcer

 

(57) Abstract:

The invention relates to medicine, namely to a gastroenterologist, and for the treatment of chronic gastritis, gastric ulcer and duodenal ulcer. This affected area is irrigated with 3 ml of 0.5% solution of novocaine mixed with 2 ml of 2% lidocaine solution. Then injected through the catheter 6-10 ml of 1% solution of chitosan 0.2% solution of aqueous hydrochloric acid 2-4 times in 3-5 days. In between transendoscopic treatment for two weeks orally administered 1 tablet chitosan 4 times a day 30 minutes after meals and at night. The method allows to normalize the local immune status and significantly reduces the number of Helicobacter pylori.

The invention relates to medicine, namely to Microbiology and gastroenterology.

The urgency of the problem of chronic gastritis and peptic ulcer disease worldwide due to the growing number of patients with this disease and its complications. In recent years progress has been made in the study of the pathogenesis of these diseases due to the discovery of Helicobacter pylori (HP) [1]. This spiral-shaped gram-negative microorganism was considered the main reason for hronicheskoj is de signed to new approaches to the treatment of peptic ulcer, in particular antihelicobacter therapy, based on the eradication of HP.

The basic treatment include the use of H2-vitaminization blockers, blockers of the proton pump (omeprazole), prostaglandins (sucralfate, de-Nol), which with the exception of derivatives of bismuth did not possess anti-relapse activity. Treatment of the underlying funds accounted for 4-8 weeks. Antihelicobacter therapy based on the use of antibiotics (metronidazole, amoxicillin, clarithromycin, tetracycline, drugs colloidal bismuth), reduced the rate of complications and reduced the recurrence rate to 10% [2]. The disadvantage antihelicobacter therapy is the use of antibiotics that are addictive to him microorganisms, immune, allergic effect, inhibit the processes of tissue regeneration.

therapeutic efficacy of existing anti-ulcer drugs also depends on their ways of administration (oral, parenteral). The disadvantage of these techniques is considered to be incomplete delivery of drugs to the inflammatory focus.

Local transendoscopic introduction of drugs allows the playing technique [3-12] . We used tools that accelerate the healing of ulcers, providing anti-inflammatory effect, forming a protective film on the surface of ulcers, blocking nerve endings or nerve trunks with sorption and deadening activity.

The disadvantages of these methods of local treatment is the failure properties of drugs that combine many positive qualities, correcting the triad pathogenic factors: violation of local microcirculation, immunological imbalance, pathogens [6].

Similar to the proposed method, in our opinion, is a method of local treatment of recurrence of gastroduodenal ulcers with lysozyme with molecular iodine [13]. The method is aimed processing defect of mucous membrane and periultseroznoy zone 5 ml of an aqueous solution of lysozyme at a concentration of 5 mg/ml through a Teflon catheter when fibrogastroduodenoscopy. After three minutes of exposure to the treated area inflicted Lugol solution in a volume of 6 ml, which resulted in immediate formation of solid complexes of lysozyme with molecular iodine, immobilisers and sorbing STATCOM analogue is the following: 1) contraindications to the use of iodine-containing drugs in patients with intolerance, 2) the drug does not have an immunostimulating effect, 3) does not stimulate local circulation.

A prototype of the proposed method is a method of treating disorders duodenal permeability in ulcerative diseases and syndromes-post gastro-resection [14] by introducing intraduodenal drip of 0.5% solution of novocaine in average therapeutic dose to reduce treatment time and reduce recurrence of the disease before the introduction of hydrochloric acid and immediately after a meal introduction intraduodenal 10% aqueous solution of potassium chloride.

The disadvantages of the prototype: 1) proposes a method of treatment of disorders duodenal permeability in ulcerative diseases and syndromes-post gastro-resection, and not the treatment of peptic ulcer disease; 2) the only antimicrobial drugs in this method of treatment is hydrochloric acid, which has weak antibacterial activity and in the presence of which can grow acid-resistant Helicobacter pylori.

The authors propose an original method for the treatment of chronic gastritis and gastric ulcer and duodenal ulcer. Detection zone of inflammation, erosions or ulcers in the process of fibrolasts the CSOs solution of novocaine mixed with 2 ml of 2% lidocaine solution. When this occurs, first, the mechanical removal of the layer of fibrin on the surface of the ulcer or erosion, secondly, local anesthetic action, and thirdly, due to the skin effect, improves microcirculation and stimulating the affected area [7]. It is known [15] that novocaine is poorly absorbed through the mucous membrane, and lidocaine is well absorbed, but its spasmolytic effect is less pronounced. The mixture of these anesthetics leads to minimizing their disadvantages [15]. In addition, through the inflamed mucosa and ulcer defect absorption of novocaine will be much more effective.

Following the introduction of the mixture of the anesthetic through the catheter is introduced through the irrigation 6-10 ml of 1% solution of chitosan 0.2% solution of aqueous hydrochloric acid. After 3-5 days, the procedure is repeated until the complete cicatrization of the ulcer, erosion or disappearance of the site of inflammation. In this way, the drugs were administered 2-4 times. In between transendoscopic treatment for two weeks, patients took oral tablet formulation of chitosan - chitodes or phitochitodes for the treatment of acute gastrointestinal illness: 1 tablet 4 times a day 30 minutes after meals and at night. the application of chitosan was tested for antimicrobial activity of a 1% solution of chitosan 0.2% aqueous hydrochloric acid in the ratio of 38 strains of microorganisms, isolated from biopsies of the mucosa of the stomach and duodenum of patients with chronic gastritis and peptic ulcer disease. Bacteriostatic activity was studied by the method of diffusion in agar on the lawn gram-positive (Staph. aureus, Sireptococcus spp. , Sarcina spp. , Peptococcus spp., Peptostreptococcus spp.), gram-negative (E. coli, Serratia marcescens, Citrobacter freundii, Acinetobacter anitratus, Alcaligenes denitrificans, Hafnia alvei, Pseudomonas putida, P. maltophilia, P. putrefaciens, P. cepacia, Prevotella melaninogenica, and others), including Helicobacter pylori (HP) and 5 species of fungi of the genus Candida.

This revealed a high bacteriostatic activity against almost all the tested microorganisms, and in particular Helicobacter pylori. The exception was Candida tropicalis and C. pseudotropicalis.

This study was the basis for the local treatment of patients with chronic gastritis, gastric ulcer and duodenal ulcer by transendoscopic injection of 5-10 ml of 1% solution of chitosan 0.2% aqueous hydrochloric acid.

Before and after treatment were carried out microbiological and immunological control biopsies of the mucosa. This was done by bioptates of the fundus, antrum of the stomach, from the edges of the ulcer or erosion. The biopsy specimens in transport medium for recip is one and microaerophilic bacteria. Identification of selected bacteria was performed using API systems of the French firm bio Merieux, as well as enterotube, Oxiperm-Turov and myotubes (BBL). Lysozyme activity was determined by micromethod using a test culture of Micrococcus lysodeikticus.

The advantage of the proposed method of treatment is that, first, novocaine lidocaine absorbed in the mucous membrane inflamed zone, relieve spasm of peripheral vessels and ensure the improvement of local microcirculation and tissue trophism; secondly, the solution of the chitosan has a strong antimicrobial effect on Helicobacter pylori and pathogenic streptococci, staphylococci, lactobacilli, Prevotella, fungi of the genus Candida, etc. that are in the area of inflammation, resulting in normal biocenosis; thirdly, chitosan has immunomodulating activity and normalizes the content of lysozyme in the gastric mucosa; fourth, accelerate the process of tissue regeneration, which shortens the treatment time up to two weeks instead of 4-6 weeks in the treatment of traditional ways.

Were examined 54 patients with chronic gastritis, gastric ulcer and duodenal ulcer. Chronic gastrolyte the microbiological examination of biopsy specimens installed, that Helicobacter pylori was detected in 74% of the surveyed patients and stood in combination with staphylococci, streptococci, lactobacilli, enterobacteria and less with fungi of the genus Candida. The number of microorganisms in the different departments of the mucous membrane in terms of 1 g ranged from 102up to 106. The selected microorganisms had a number of pathogenicity factors: hemolytic, lecithinase, urease, catalase, RNase activity.

As a result of the treatment, the quantitative composition of microflora decreased in 100-10000 times. In biopsies showed isolated staphylococci, lactobacilli, enterobacteria, lacking in most cases, pathogenic properties. The specified method does not lead to 100% eradication of Helicobacter pylori, but the amount is reduced 100-1000 times. Thus, the microbiocenosis is normalized by the disappearance of microorganisms with pathogenic properties.

At endoscopy after 7-14 days after the start of treatment on the spot ulcers are formed first, erosion, and then lots of redness and scarring.

The invention is illustrated by the following laboratory and clinical data.

Example 1. Patient S., aged 38 years (protoctista cancer since 1992, i.e. for 7 years with an annual recurrence in the autumn-spring period. At endoscopy associated atrophic gastritis, in the bulb scar on the front wall, the rear erosion. 7 days after treatment single erosion has remained on the back wall. Ha 14th day in the bulb on the back one erosion with a clear reduction in size. The pain stopped on the 3-4th day. Microbiological examination of biopsies of the mucosa in the antrum discovered Helicobacter pylori (104CFU/g) in combination with aureus and enterobacteria (102CFU/g). From the edge of erosion selected isolated H. pylori (103CFU/g) Staphylococcus, diplococci and Lactobacillus (102-103CFU/g). In fundic Department - isolated staphylococci, sarcina and lactobacilli. After 14 days in fundic the Department the number of non-pathogenic staphylococci (coagulase and leticiacorreamusic) has increased 10 times, appeared non-pathogenic gram-positive diplococci. In the antrum was also attended by non-pathogenic diplococci and H. pylori. In the area of erosion was present non-pathogenic staphylococci, lactobacilli, diplococci and a small amount of H. pylori (102CFU/g). Lysozyme activity in biopsy samples of 0.5 g/mg, which is suitable for the m syndrome. First identified mirror ulcers on the anterior and posterior wall duodenal bulb diameter 0.3 see After 7 days of starting treatment with chitosan on the front wall - hyperemia instead ulcers, on the back - scatter erosion. On the 14th day in the bulb on the back - plot petechiae instead of erosion. Microbiological examination of biopsies of the mucosa showed that before treatment in the antrum of the stomach revealed Helicobacter pylori (107CFU/g), anaerobic streptococci (106CFU/g), staphylococci (105CFU/g), gram diplococci (105CFU/g), bacteroids (104CFU/g). In fundic Department HP is not detected. The flora was represented by a small number of Staphylococcus (103CFU/g), bacteroids (103CFU/g), enterobacteria (103CFU/g) and carcinog (103CFU/g). From the ulcer edge is selected veillonella (104CFU/g), bacteroids (103CFU/g) and hemolytic lactobacilli (103CFU/g). 14 days after treatment with chitosan amount of HP in the antrum decreased to 102CFU/g Microbiocenosis of the duodenum is normalized by the disappearance of pathogenic lactobacilli, bacteroids, veillonella and the emergence of non-haemolytic with whom you want to make of lysozyme in biopsy samples were normalized and amounted to 0.7 mcg/mg.

Example 3. Patient T., 46 years (protocols EGDS N 951, 958, 990, 1004), turned with pain and dyspeptic complaints. At endoscopy in the antrum of the stomach along the lesser curvature of the background hyperemia of the mucous membrane of two complete erosion with a diameter of 0.5 cm, the bulb on the front and rear ulcers 0.3 see 5 days after 2-fold transendoscopic irrigation chitosan - stomach erosions no, the inflammation decreased, ulcers in the bulb 0,2 see After 7 days (3x irrigation) - stomach inflammation no, on the rear wall of the duodenal scar on the front - 2 erosion. After the fourth irrigation chitosan (2 weeks) inflammatory phenomena were observed. Microbiological examination of the biopsies before treatment in the antrum of the stomach found streptococci (105CFU/g), hemolytic bacteroids (105CFU/g), hemolytic, veillonella (104CFU/g), enterobacteria (104-105CFU/g). In the field of ulcers selected streptococci (104-105CFU/g), hemolytic, peptococci (104CFU/g), hemolytic peptostreptococci (104CFU/g), lactobacilli (104CFU/g). Helicobacter pylori was not detected. 7 days after the start of treatment quantitative ludka and duodenum normalized and represented as non-haemolytic staphylococci, streptococci and enterobacteria in the total amount not exceeding 103CFU/g Level of lysozyme in saliva was also within normal limits.

References

1. Marshall B. J., Warren, J. R. Unidentifed curved bacilli in the stomach of patients with gastritis and peptic ulceration // Lancet.- 1984.- N 1.-P. 1311-1315.

2. Russ E. C., Zvartau, E. E. Pharmacotherapy of peptic ulcer.- M., 1998, 252 S.

3. Buyanov C. M., Mach Century H., Perminova, I. Therapeutic endoscopic gastroduodenal ulcers.- Stavropol, 1986, 96 S.

4. Braces A. F., Kramis R. And Acinic B. A. Injecting into the wall of the stomach under control eyes during fibrogastroscopy//Notice the Academy of Sciences of the Latvian SSR, 1974, No. 9, S. 118-121.

5. Namiki M. in Local gestion allantoinae in treatment of gastric ulcer. - J. Therp., 1970, vol. 53, N 3, p. 545-548.

6. Transfiguration Century. N. The mechanisms of formation of nonhealing ulcers of the stomach and duodenum and new pathogenetic mechanisms of influence. Abstract. D. Diss... m N. - M., 1987.

7. Vvedensky B. N. Endoscopic treatment nonhealing ulcers of the stomach and duodenum. Abstract. Diss... K. M. N. Yaroslavl, 1996.

8. Krichmar I. M. possibilities of endoscopic treatment of gastroduodenal ulcers in surgical practice //journal of surgery. Gr is gastroduodenal ulcers glue "gastrozol" outpatient//Clinical medicine, 1983, I. 61, No. 10, S. 27-30.

10. Tolmach D. C., Chubenko S. C. Therapeutic endoscopy diseases of the digestive system//nursing, 1990, No. 11, S. 84-86.

11. Faylov A. C., S. Iskhakov, Endoscopic therapy for peptic ulcer disease duodenal ulcer//Ross. W. Gastroenterol., gepatol., coloproctol. Annex N 3, 1996.- C. 283.

12. Bazlov S. N., Chernin Centuries, Archer E. C., Chervinets C. M., Egorova E. N. Pathogenetic rationale and effectiveness transendoscopic use iodized lysozyme in the treatment of recurrent peptic ulcer//Russian gastroenterology journal, 1998. - N 2. The materials of the Plenum BUT gastroenterologists Russia, June 1998. - S. 57.

13. Chernin Century, Archer E. C., Bazlov S. N., Chervinets C. M., Egorova E. N. A method of treating the recurrence of gastroduodenal ulcers by transendoscopic use of lysozyme with molecular iodine. - Priority 21 Dec. 1998, N state of registration 98122605 (FIPS CTD N 20).

14. Nazarenko, P. M. et al. A method of treatment of disorders duodenal permeability in ulcerative diseases and syndromes-post gastro-resection. RF patent 2088226, 27.08.97.

15. Encyclopedia of drugs. Register of medicines of Russia/Ed. by Y. F. Krylov. - M., 1999, ed. 6, 1070 S.

nasendoscopes the use of drugs, wherein the affected area is treated with 3 ml of 0.5 % solution of novocaine mixed with 2 ml of 2% lidocaine solution, and then 6 - 10 ml 1% solution of chitosan 0.2% solution of aqueous hydrochloric acid of 2 to 4 times in 3 to 5 days, and at intervals during the two weeks prescribe oral tablet formulation of chitosan 1 tablet 4 times a day 30 minutes after meals and at night.

 

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