The method of treatment of erosive gastroduodenal lesions that are resistant to conventional therapy in patients with bronchial asthma

 

(57) Abstract:

The invention relates to the field of medicine, gastroenterology and pulmonology, particularly, to a method of treatment of erosive gastroduodenal lesions that are resistant to conventional therapy in patients with bronchial asthma. For this set of patients additionally prescribe oral systemic corticosteroids at a dose of 10-15 mg/day (in terms of prednisolone) within 10-14 days. The method provides healing of erosions by eliminating local immune disorders in the mucous membrane of the stomach and intestine.

The invention relates to the field of medicine, gastroenterology and pulmonology, particularly, to a method of treatment of erosive gastroduodenal lesions that are resistant to conventional therapy in patients with bronchial asthma (BA).

Closest to the proposed method is an accepted method for the treatment of erosive gastroduodenal lesions, which is to assign antisecretory drugs and preparations against invasion of the mucosa gastroduodenal Helicobacter Pylori (Hp) [1]. However, despite adequate eradication therapy, in some cases, the BA treatment of chronic gastroduodenal edelstam on resistance to conventional therapy and the complexity of the mechanisms of formation of erosive gastroduodenal lesions in ad. Probably, although an important role in the development of chronic erosions assigned to the contamination of the mucous membrane of the stomach and duodenum (duodenum) Hp, if BA can play a role, other factors that must be considered in a comprehensive anti-erosion therapy in these patients. These factors include chronic inflammation and local immune disorders in the stomach and duodenum, which may contribute to chronic erosive process. When BA inflammatory changes in gastroduodenal can be supported not only by persisting in her Hp, but "inflammatory reaction" in the framework of the systemic inflammatory response mucous with BA, at which point some authors [2, 3, 4].

New technical goal: increase the effectiveness of treatment are resistant to conventional therapy erosive gastroduodenal lesions in patients with BA by reducing the number of relapses and reduce treatment time.

The set task is solved by a new method of treatment of erosive gastroduodenal lesions that are resistant to conventional therapy in patients with bronchial asthma, consisting in conducting eradication teratocarcinomas at a dose of 10-15 mg/day (in terms of prednisolone) within 10-14 days.

The method is as follows:

After diagnosis of erosive gastroduodenal lesions in patients with BA is therapy of erosive gastroduodenal lesions in the traditional way, including the appointment of H. pylori eradication therapy [1, 2] , 5-7 weeks is repeated endoscopic examination of the gastroduodenal zone and monitoring the effectiveness of eradication (histological examination of biopsy specimens from the body and antrum). If HP eradication, but the lack of positive endoscopic dynamics of the patient along with antisecretory drugs prescribed oral systemic corticosteroids at a dose of 10-15 mg/day (in terms of prednisolone) within 10-14 days. Then spend endoscopic monitoring the status of the gastroduodenal zone.

Dose systemic glucocorticoids and duration of treatment were selected on the basis of studying the occurrence of erosive gastroduodenal lesions at 271 patient aged 18 to 60 years with asthma of varying severity. It was found that BA patients treated with oral corticosteroids at a dose up to 15 mg/day (in terms of prednisolone), reduced the rice is gastroduodenal was 7.5%, while patients who were not treated with systemic glucocorticoids and treated with oral corticosteroids in supraphysiological doses (>15 mg/day, in terms of prednisolone), the occurrence of erosive gastroduodenal lesions was significantly higher (and 26,5 26,9%, respectively, p<0,05. If further study was allocated a group of 10 people with the optimal treatment of erosive gastroduodenal lesions, on what basis it was concluded that the optimum duration of therapy is 10 to 14 days, because treatment by a shorter duration did not lead to epithelialization erosions. In the treatment of systemic glucocorticoids in physiological doses of a short course with a duration of 10-14 days not noted side effects of the drug.

Example 1

Patient Boldarev N. And., 49 years old, came in March 2001.

Diagnosis: AD, atopic, moderate severity.

History: suffering BA 5 years.

Treatment: basic therapy ASTHMA: inhaled corticosteroids (budesonide 800 mcg/day), symptomatic therapy: b2agonists inhaled.

During the year concerned heartburn, epigastric pain within 30-60 minutes after eating, in the bloom. Cardia not closed. The stomach of the correct shape in the distal small curvature elevation of the mucosa with pupkoobraznym pressure at D~0,2 see the Angle is expressed. The gatekeeper rounded. The bulb of the duodenum - dimensional. Mucous horseshoe with moderate hyperemia.

Conclusion: the Failure of the cardia, reflux esophagitis I tbsp., chronic erosion antrum, duodenitis.

Histological examination of biopsies of the stomach (1 sampling of the gastric body and 2 biopsies from antrum) revealed high levels of contamination Helicobacter pylori CO antrum.

Treatment: triple scheme within 7 days:

quamatel 40 mg/day,

klacid 500 mg times/day,

metronidazole 250 MG4 times/day.

(Amoxicillin not assigned due to the presence of the patient rejecting drugs penicillin)

Discharged with recommendations apply quamatel 40 mg/day for 5 weeks.

The second appeal in October 2001. Complaints remain the same.

10.10.2001 repeat EGDS: there is a negative trend in the antrum of the stomach multiple erosions D~0.1 cm, the small curvature in preprocessor Department erosion D~0,1, see If GIS is established with representation from moderate degree of contamination of Helicobacter pylori CO antrum.

Treatment for 7 days:

omeprazole 20 mg times/day,

colloidal bismuth subcitrate 120 mg times/day,

tetracycline 500 MG4 times/day,

klion (metronidazole) 250 MG4 times/day.

Discharged with recommendations apply omeprazole 40 mg/day for 5 weeks.

26.11.2001 repeated endoscopy: endoscopic picture matches the description EGD 10.10.2001. Histological examination of biopsies of the stomach (1 sampling of the gastric body and 2 biopsies from antrum) Helicobacter pylori was not found.

Because of exacerbation of BA patient assigned to oral prednisolone 10 mg/day for 14 days. Continued therapy with proton pump inhibitor-omez 20 mg times/day. After 2 weeks at re-examination: the patient's condition has improved, exacerbation of BA removed, decreased gastrointestinal symptoms.

10.12.2001 repeat EGD: the cardia insufficiency, superficial gastritis, Bulut, erosion was salpetersaure.

Anti-erosion effect of physiological doses of systemic glucocorticoids, probably due to the anti-inflammatory effect, is realized not only in the target organ (the bronchi), but also in related gastroduodenal mucous.

Analnoe zone in patients with hormone-dependent bronchial asthma and patients not treated with systemic glucocorticoids, which allows us to speak of a greater severity of inflammation, predominantly in the antrum, at last. In individuals taking corticosteroids in low doses, marked by lower values of the total cellularity of the infiltrate, and the number of polymorphonuclear elements that characterize the activity of inflammation.

The proposed method, including the treatment of erosive gastroduodenal lesions using conventional regimens, with the use of eradication therapy and antisecretory drugs, and the use of systemic corticosteroids in doses of 10-15 mg/day, in terms of prednisolone, within 10-14 days, allows for efficient treatment of patients with BA resistant to traditional therapy erosive gastroduodenal lesions without the use of additional medication that reduces drug burden in this category of patients and reduces the number of relapses and treatment time.

Sources of information

1. Guidelines for the diagnosis of Helicobacter Pylori in patients with peptic ulcer disease and methods of their treatment. // Russian journal of Gastroenterol., heat. and color.-1998.- 2.- the tion for the treatment of diseases, associated with Helicobacter pylori, in Russia // Russian journal of Gastroenterol., heat. and color.- 2001.- 11.- S. 77-85.

3. Kolganova N. A., Grachev N. M., Beytuganov I. M. and other Clinical and morphological aspects of the diagnosis of pathology of the gastrointestinal tract and bronchial asthma. // Russian gastroenterology journal.-1997.- 3.- S. 39-43.

4. Wallaert Century Le systeme immutaire muqueux commun en pathologie respiratoire. // Rev. fr. allergol. at immunoi. Clin.- 1997.- 37(8).- R. 1052-1056.

The method of treatment of erosive gastroduodenal lesions that are resistant to conventional therapy in patients with bronchial asthma, consisting in conducting eradication therapy and the appointment of antisecretory drugs, different additional oral administration of systemic glucocorticoids at a dose of 10-15 mg/day (in terms of prednisolone) within 10-14 days.

 

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