The method of treatment of ulcerative colitis

 

The invention relates to medicine, in particular to a gastroenterologist, and can be used for treatment of ulcerative colitis. Prompted to enter intraarterially in the region of the affected colon intestinal wall microcrystalline suspension of hydrocortisone. At the same time introducing disaggregants and heparin. The method provides local deposition of the drug and prolonged therapeutic effect. 3 Il.

The invention relates to medicine, namely to a gastroenterologist, and can be used in the treatment of patients with ulcerative colitis (UC).

Ulcerative colitis: chronic destructive inflammatory disease of the mucous and submucous membranes of the colon with a primary lesion of the distal part (rectum). The incidence occurs in 2-7:100000 population, mainly women aged 15 to 30 years (Jarrell B. E., R. A. Carabasi, 1996). The etiology of inflammatory changes of the intestinal wall in this disease remains unknown, but the generally accepted theory is the influence of one or more antigens of intestinal origin leading to changes in immune reactivity and lo the and reactivity of the organism.

There is a method of treatment of NACA by the impact of drugs on the inflammatory process in the wall of the colon. The main importance is given to two groups: the sulfasalazin (salofalk) administered intravenously or orally, or topically, in the form of suppositories and enemas, and corticosteroids, also entered locally using enemas or systemically, intravenously (Jarrell B. E., R. A. Carabasi, M. GEOTAR, Medicine, 1997, 102 S.). However, the known method is not effective enough due to the low bioavailability of injected drugs.

The closest achieved a positive result is a method of treatment by use of corticosteroids (prototype), which has strong anti-inflammatory and IMMUNOSUPRESSIVE properties (Beeken W. L. 1988, in Russian. "Gastroenterology". M.: Medicine, 1988, H. 3, S. 63-64). From the last use prednisolone and hydrocortisone as parenteral (intravenous), and locally, through the mouth and enemas. However, the known method does not provide a local high concentration in the lesion, which in this case is the wall of the colon. When introduced through the mouth or into the lumen of the colon at the high activity of the inflammatory process in the preparations in the diseased intestinal wall is observed when injecting, because they do not have organosilicate. The use of higher doses and longer courses of corticosteroid therapy are accompanied by undesirable side effects that affect virtually every system of the body.

A positive result of the invention is to increase the efficiency of treatment of ulcerative colitis by directional corticosteroids, including hydrocortisone, in the vascular region of the affected colon.

A positive result is achieved by the fact that intraarterially injected hydrocortisone directly to the affected region of the colon in the form of a microcrystalline suspension after preliminary intraarterial administration antiplatelet reduce local thrombotic effects and improve microcirculation.

The essence of the invention: local administration of drugs leads to a more pronounced therapeutic their impact on the affected intestinal wall, smaller total doses and with fewer systemic side effects. As one of the ways to increase the local concentration of the medicinal agent in the intestinal wall serves intraarterial, vergleichende patients spend instrumental confirmation of the nature and localization of the pathological process, including barium enema, Sigma or colonoscopy with biopsy. Given the invasiveness of the method, it applies only when resistant recurrent disease, and if no effect after the well-known traditional course of treatment.

After sedation, interoperational, in aseptic conditions, the Seldinger technique under local anaesthetic procaine or other drug puncture the right or left femoral artery puncture needle from a set of Seldinger. Further, through its lumen is initially introduced metal angiographic guidewire and the last - radiopaque catheter for selective catheterization and angiography of the mesenteric vessels with a diameter of 6 French (Fr), the tip of which specially designed for carrying out selective catheterization of the visceral branches of the abdominal aorta. Under control of the x-ray television implement the installation of the tip of the catheter in the inferior mesenteric artery, which is determined by the localization of the pathological process (distal or proximal sections of the colon) (Fig.1). For special reasons (with long-term persistent course of inflammatory diseases of the colon, resistance to traditional treatments) with the selective angiography introduction of radiopaque water-soluble drugs (urographine, omnipak) registration of arterial, capillary and venous phases of blood flow. On angiograms determine the architectonics of arterial and venous bed of the affected intestinal wall, document the location of the catheter, the tip of which remains in the mouth of the artery for further regional infusion. For the prevention of thrombosis of the lumen of the catheter is filled heparinised saline solution, its peripheral end have cutaneous and fix skin suture, near the site of the puncture. The site of the catheter isolated aseptic bandage.

In the chamber to the peripheral end of the catheter is connected automatic dispenser, which provide regional drug infusion.

Given the nature of the pathological changes of the intestinal wall in the composition of the infusion includes two groups of drugs: the first consists of antiplatelet (trental 10 ml/a per day.) and anticoagulant (heparin 2500 UNITS/a, 4 times), aimed at improving the microcirculation in inflammatory-modified wall of the intestine, and the second group of drugs includes hydrocortisone and antibiotics, impacting directly on the inflammatory process in the intestine. The main drug is giddy, the size of which ranges from 50 to 800 μm (Hydrocortisone-Richter, manufacturing, Budapest - Hungary, 5 ml vials containing hydrocortisone acetate 125 mg). This drug has anti-inflammatory, desensitizing and anti-allergic effect, reduces the permeability of capillaries. The introduction of the drug in the form of poorly-suspension leads to its deposition in the capillary channel by microembolization part of them. This contributes to longer local therapeutic effect.

Regional intra-arterial infusion is used continuously for 5-7 days, depending on the clinical effect. It leads to rapid relief of the inflammatory process and gives a prolonged therapeutic effect. For local use hydrocortisone systemic side effects were not observed.

The proposed method is used in the treatment of 9 patients with ulcerative colitis. Complications associated with this method of treatment was not observed. Long-term outcomes up to 1 year were traced in 3 patients. In all cases, according to the clinic, the control rektoromanoskopii and colonoscopic evidence of exacerbation of the disease was not found.

Clinical physical rehabilitation hospital with complaints of frequent loose stools mixed with blood and mucus pain in the left iliac region, rumbling and bloating, nausea, vomiting, body temperature up to 38 degrees, pronounced weakness.

From the anamnesis of the disease: sick since 1997, when there was a clinic, similar to the above complaints. Then 2-3 times per year were hospitalized in the gastroenterology Department of a regional hospital. Each treatment consisted of 3 groups of drugs: prednisolone, sulfasalazine and metronidazole. Clinical improvement occurred after 3-5 weeks of inpatient treatment, and then the patient was discharged to outpatient treatment, which included taking sulfasalazine and prednisolone.

Objectively: the patient's condition moderate, exhausted, asthenic physique, pale skin turgor their somewhat reduced. The organs and systems without features.

Locally: the white furred tongue, stomach, palpation of the symptoms of peritoneal irritation not determined a sharp pain and rumbling in the projection of the transverse and sigmoid colon.

The results of the laboratory studies. Complete blood count: erythrocytes 3.9 million , hemoglobin 124 g/l, platelets 230 thousand, leukocytes to 27.7 thousand; WBC: eosinophi is eritrotsitov 21 mm/h Total protein blood to 68.4 g/l, albumin 46,3%, globulins:1-10,3%,2-16,0%,-12,3%,-15,1%. The serum sodium 136 mmol/l, serum potassium of 5.1 mmol/L. Coprogram: feces consistency, irregular, brown, acidic, erythrocytes - a large number, the leukocyte count to 20 in sight.

Sigmoidoscopy 464. Mucous loose, brightly hyperemic places erozirovanne. Starting with 15 cm from the anal verge contact vulnerable and identifies multiple ulcerative defects of irregular shape.

Selective catheterization mesenterica 372 Diameter of the inferior mesenteric artery 4.6 mm, arteries in the wall of the sigmoid and rectum convoluted, there is a symptom of their amputation rectosigmoidal angle and uneven contrast in the parenchymal phase in the region of the sigmoid colon (Fig.2). The inferior mesenteric vein in the return phase contrast with a diameter of 8.2 mm

For 9 days the patient was conducted regional, continuous intra-arterial infusion of two solutions: Solution 1. Hydrocortisone 0.5 mg, the solution of ringer-Locke 100 ml solution of heparin 2500 UNITS.

Solution 2. Doxycycline 0.1 g, Klavora is followed by 6 hours.

After 9 days held control of laboratory and instrumental examination.

General. an. blood: erythrocytes 3.7 million, hemoglobin 115 g/l, platelets 290 thousand , leukocytes 4.0 thousand, leukocyte formula: eosinophils 1%, stab neutrophils 5%, segmented neutrophils 47%, lymphocytes 40%, monocytes 7%.

Sigmoidoscopy 513. The mucosa at the site until 12 see rose-pink, moderately swollen, vascular drawing is saved. More proximally mucous in places moderately hyperemic, slightly swollen.

Re mesenterica before removing the catheter from the NBA. Kontroliruyutsya throughout the branches of the inferior mesenteric artery. There has been a significant decrease in the Deposit of the contrast agent in the wall of the sigmoid colon in the parenchymal phase and in phase venous return (Fig.3).

Clinically the patient notes the almost complete relief of pain along the large intestine. Stool once a day, pasty, without admixture of mucus and blood.

Examined after 6 months, no complaints, the General condition is satisfactory, pain in the course of the colon no, stool once a day, pasty, without admixture of blood and mucus. The sigmoidoscopy 1936. The mucosa at the site to OTDELA intestinal mucosa in places moderately hyperemic, slightly swollen, vascular drawing is saved.

The inventive method has the advantage from the prototype: use the regional administration of drugs pathogenetically directional, allowing you to have a local maximum therapeutic effect on the disease process in the bowel wall and to avoid adverse systemic effects of glucocorticoids. Introduction to the intestinal wall of water-insoluble forms of hydrocortisone in the form of a microcrystalline suspension is accompanied by its local deposition and long prolonged therapeutic effect.

Claims

The method of treatment of ulcerative colitis, which consists in the introduction of corticosteroid anti-inflammatory drugs, characterized in that the injected hydrocortisone intraarterially in the region of the affected colon intestinal wall in the form of a microcrystalline suspension with simultaneous introduction of antiplatelet and heparin to exclude thrombotic effects and microembolization.

 

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