A method for predicting the course of gastric ulcer and duodenal ulcer

 

(57) Abstract:

The invention relates to medicine, namely to methods of diagnosis. To predict the course of gastric ulcer and duodenal ulcer in serum define the content of ferritin before treatment and at 4-6 days of treatment. At lower levels to 280-350 ng/ml in gastric ulcer and 360-400 ng/ml ulcers in the duodenum predict the course of peptic ulcer without exacerbations. The method improves the accuracy of predicting the course of disease.

The invention relates to medicine and can be used in the prognosis of gastric ulcer and duodenal ulcer.

There is a method of predicting the state of the small intestine in Crohn's disease by dynamic studies of faecal excretion of calprotectin (1). This method is adopted for the similar.

There is a method of predicting the course of peptic ulcer disease, namely, that carry out biochemical research, determine the content of interleukin-1 in terms of an interleukin-1, spontaneous and stimulated tests that predict favorable and negative is anicello limited.

The aim of the invention is to improve the accuracy of predicting the course of gastric ulcer and duodenal ulcer.

The technical result is achieved by the fact that as a biochemical indicator use ferritin determined before treatment and at 4-6 days of treatment, and at lower levels to 280-350 ng/ml in gastric ulcer and 360-400 ng/ml ulcers in the duodenum predict the course of peptic ulcer without exacerbations.

The method is as follows.

On admission the patient find out the presence of ulcer history, seasonal exacerbations of the disease. Find out the presence of complaints of dyspepsia (nausea, vomiting, belching, feeling of heaviness in the epigastrium, pain.

Objective examination find out the presence of pain in the epigastric region palpation.

Spend endoscopic examination, which determine the condition and integrity of the mucous membrane of the stomach and duodenum, the presence, shape and size of the ulcer, the presence of hyperemia and inflammatory shaft, the nature of the edge of the ulcer.

In savor is. Ulcers in the duodenum - 1600-1700 ng/ml.

Treatment with the use of a seven-day scheme (drugs bismuth (de-Nol 200-240 mg 2 times a day, clarithromycin 250-500 mg, blocker proton pump 20-40 mg 2 times daily and metronidazole 500 mg 2 times a day).

4-6-th day from the beginning of treatment is again carried out the determination of serum ferritin and during gastric ulcer without subsequent exacerbations its level is reduced to 280-350 ng/ml ulcers of the duodenum in the case of its course without further worsening the level of ferritin decreases 360-400 ng/ml.

After the end of treatment to control endoscopic examination. Note the decrease the severity of hyperemia and edema of the mucosa. The bottom of the ulcer cleared.

Way of the following examples.

Example 1.

Patient, 19 years old, was admitted with a diagnosis of peptic ulcer, acute stage. When receiving complains of epigastric pain, feeling of heaviness in the epigastric bloating. Palpation of the epigastrium painful.

If gastroduodenoscopy mucosa of the gastric antrum hyperemic, and ovatum bloom, the edges of the ulcer createrootpane saped.

Level feritin in serum is 1200 ng/ml.

Treatment with the use of a seven-day scheme (de-Nol 200 mg 2 times a day before meals, omeprazole 20 mg 2 times a day, clarithromycin 250 mg 2 times and metronidazole 500 mg 2 times a day).

On the 4th day from the start of treatment was again determined the level of serum ferritin, which amounted to 300 ng/ml.

After the end of treatment had a control endoscopic examination. Note the decrease the severity of hyperemia and edema of the mucosa of the antrum. The edges of the ulcer to crawl against ulcerative defect, reducing its diameter to 0.8, see the bottom of the ulcer cleared.

Subsequent follow-up polythoridae observation revealed no exacerbations during gastric ulcer.

Example 2.

The patient And society, 29 years old, suffers from peptic ulcer disease duodenal ulcer within 5 years. The disease occurs with seasonal exacerbations.

At entry complaining of hunger pains in the epigastric region, belching and nausea.

Objective examination marked tenderness in the epigastric region palpation, g and edema of the mucosa of the duodenal bulb detect a defect of mucous oval inflammatory shaft high. The bottom of the ulcer has a plaque grayish-yellow color.

Determine the content of ferritin in serum. It is 1600 ng/ml.

Treatment with de-Nol 240 mg 2 times a day, clarithromycin 500 mg, omeprazole 40 mg 2 times daily and metronidazole 500 mg 2 times a day).

On the 6th day from the beginning of treatment is again carried out the determination of serum ferritin and ferritin level is reduced to 360 ng/ml.

After the end of treatment to control endoscopic examination: the phenomenon of hyperemia and edema of the mucosa of the duodenal decreased, took the form of slit-like through napoletane the edges of ulcers, the severity of inflammation of the shaft is decreased. The bottom of the ulcer cleared.

During the follow-up observation period of 1 year, the patient was not observed exacerbation of the disease in the autumn and spring periods.

Example 3.

Patient P, 48 years old, when receiving complains of pain in the epigastric region. From the anamnesis it is known that in the last twelve years, suffering from stomach ulcers that occur with seasonal (autumn-spring) exacerbations.

Palpation of epigastrial antrum round shape with high inflammatory shaft diameter 2 cm The bottom of the ulcer is covered with gray-yellow tinge. Mucosa in the antrum of the stomach swollen with hemorrhages.

The content of ferritin in serum is to ensure 1200 ng/ml.

Treatment with de-Nol 200 mg 2 times a day, clarithromycin 250 mg, 2 times, omeprazole 30 mg 2 times daily and metronidazole 500 mg 2 times a day.

On the 5th day from the start of treatment the level of serum ferritin is 324 ng/ml.

When the control endoscopy performed after the treatment, it is noted that swelling and hemorrhagic phenomena of the antral mucosa of the stomach is decreased, the size of the ulcer was reduced to 1.1 cm in diameter, inflammatory periultseroznoy the shaft is decreased. The bottom of the ulcer is clean.

On the basis of the dynamics of the content of ferritin forecast for gastric ulcer without exacerbations.

During the follow-up observation period of 18 months the patient was not observed exacerbation of the disease, which confirmed the correctness of the prediction.

According to the proposed method conducted prognosis of gastric ulcer and duodenal ulcer in 27 patients. The proposed ferry is their prediction accuracy. Ferritinemii the test is simple in definition, which also supports the achievement of the objectives of the invention.

Sources of information

1. W. Fischbach et al. Z. Gastroenterol. 2000, 38, 627-630.

2. J. Tibble et al. Gut. 2000, 47, 506-513.

A method for predicting the course of gastric ulcer and duodenal ulcer by carrying out biochemical studies of blood, characterized in that as a biochemical indicator use ferritin determined before treatment and at 4-6 days of treatment, and at lower levels to 280-350 ng/ml in gastric ulcer and 360-400 ng/ml ulcers in the duodenum predict the course of peptic ulcer without exacerbations.



 

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