Method for quick test diagnostics of pharmacological sensitivity to inhibitors of gastric secretion

FIELD: medicine, gastroenterology.

SUBSTANCE: it has been suggested a new method to detect pharmacological sensitivity to preparations as acidosuppressors. After the intake of the preparation a patient should undergo fibrogastroduodenoscopy 3 h later, then, through endoscopic catheter one should introduce 0.3%-Congo red solution intragastrically and the test is considered to be positive at keeping red color that indicates good sensitivity to the given preparation, and in case of dark-blue or black color the test is considered to be negative that indicates resistance to this preparation. The suggested innovation widens the number of diagnostic techniques of mentioned indication.

EFFECT: higher efficiency of diagnostics.

2 ex

 

The invention relates to medicine, namely to a gastroenterologist.

There is a method of assessing the sensitivity of gastric glands to the preparations reducing secretion of hydrochloric acid in the stomach, which consists in registration intraoral pH using special probes introduced into the stomach. The increase of pH from 1.0 to 2.0 to 4.0 to 6.0 after ingestion or intravenous antisecretory drug is considered as a good indicator of sensitivity to this drug and, accordingly, no change in pH indicates a resistance to it (Togusova D.A. the Use of daily monitoring of intragastric acidity in clinical practice. Methodical recommendations. Moscow: RSMU, 1998. - P.10-16).

A significant disadvantage of this method is the need to conduct pH-metry special expensive equipment, which makes it impossible to determine the pharmacological sensitivity using this method in the vast majority of medical institutions. In addition, when using intragastric pH-metry with conducting pharmacological tests duration and without invasive investigation increases to 2.5-3 hours, which is very difficult and inconvenient for patients, especially children.

Another known method is repeated fibrogastroduodenoscopy the Pius, which is 3-4 weeks from the start of treatment with any drug. The criterion for a good pharmacological sensitivity is eliminating defects, reducing the severity of inflammatory changes and, conversely, the preservation of previously identified changes is an indicator of pharmacological resistance to the drug (Zimmermann AS Chronic gastritis and peptic ulcer disease (Essays clinical gastroenterology). Perm: Perm. state honey. Academy, 2000, s, 200; Annex 8 to the order of Ministry of health of the Russian Federation No. 151 dated may 7, 1998 “On temporary industry standards of health care for children”).

The disadvantage of this method is the later assessment of the sensitivity (only after 2-3-4 weeks)that in case of resistance to the drug leads to a long, almost 2 times the duration of treatment of gastroduodenal diseases.

At the same time, there is a method of chromoendoscopy using Congo red to define the boundaries kislotoproduktsiya area of the stomach (Ottenjan R. et all. Gastroscopische markirung Korpus der-Antrumgrenze. Klin Wsch 1967. Bd 45, N19, s.1006-1008; Nazarov et al. Endoscopy of the digestive tract. Moscow, publishing house “Triad-Pharm, 2002, s.89) and the nature of gastric secretion (Inshakov LN. et al. Chromoendoscopy in complex diagnostics of diseases of the digestive tract and respiratory organs. Uch. the allowance. With the b.: publishing house of St. Petersburg maps., 2002, p.8-10).

However, the disadvantage is that it is not used for the evaluation of the pharmacological tests.

The technical result of the invention is to simplify, cheapen, and also reducing timing of pharmacological sensitivity to drugs-acidoterrestris.

The technical result is achieved by the fact that the patient after administration of the drug, three hours is fibrogastroduodenoscopy, then through the endoscopic catheter is inserted into the stomach 0.3% solution of Congo red and the sample is considered positive while maintaining the red color that shows a good sensitivity to this drug, and with the appearance of a dark blue or black color negative, indicating a resistance to the drug.

The method is as follows:

- Three hours before fibrogastroduodenoscopy the patient takes certain dose intended for the treatment of antisecretory drug.

Three hours after admission fibrogastroscopy according to the usual method.

- After endoscopic inspection is performed chromoendoscopy by insertion through the catheter into the stomach cavity of 0.3% solution of Congo red as indicator.

Assessment sample: the sample is positive while preserving the red color of the indicator is, that shows a good sensitivity of gastric glands to the investigational drug, the sample is evaluated negative when a dark blue or black color, indicating resistance to this drug.

Example 1. Patient Oleg W., age 12, case history No. 645. Entered the goose “Children's clinical hospital senior Voronezh-1” 7 may 2003 with complaints within one month prior to admission to epigastric pain paroxysmal character of medium intensity, without a clear link to the provoking factor, episodic heartburn. From the anamnesis it is known that similar complaints have been recorded since 6 years, was repeatedly treated and examined in hospitals, Voronezh. 8 and 12 years were identified erosion in the duodenal bulb, and Helicobacter pylori. Heredity in astrobiology burdened - the mother peptic ulcer disease. On the eve of hospitalization received treatment (omeprazole, but, silos) in the clinic at the place of residence within 10 days with little effect, and therefore sent to the hospital.

The history of life without features.

When you receive a state regarded as moderate. Abdomen palpation soft, pain in the epigastrium, the liver is not enlarged. The survey: clinical tests (complete blood count, urine, scraping on e/b) without pathology, blood biochemical parameters in normal, when eCOGRA the AI abdominal organs and kidneys revealed no pathology.

Given the presence of erosions in history, the ineffectiveness of blocker N+To+ATP-ases of omeprazole, decided to conduct a sensitivity to it using the proposed method. may 13, after taking an 8 hour and 40 mg of omeprazole in the 11th hour made fibrogastroduodenoscopy, revealed erythematous gastritis, duodenitis, when introduced into the stomach of a solution of Congo red received black color in the body of the stomach, the sample is evaluated as negative, indicating that resistance to omeprazole. With these results, the patient was assigned to another antisecretory drug quamatel, against which is received a quick and positive dynamics: the heartburn was stopped on day 2 pain 3, tenderness to palpation on day 9.

Example 2. Patient Alla M., age 13. Case history No. 531. Entered the goose “Children's clinical hospital senior Voronezh-1” April 10, 2003 with complaints of recurrent pain in the epigastrium medium intensity, usually within 30-60 minutes after meals for 2-3 weeks. Dyspeptic complaints were not. Has not previously been examined and were not treated, although occasionally bothered by similar complaints. Heredity in astrobiology not burdened.

The history of life without features.

When you receive a state regarded as moderate. Abdomen palpation soft, painful epigastric, pécs is ery not increased. In clinical tests (complete blood count, urinalysis, scraping on enterobiasis) without pathology. Biochemical analysis of a blood in norm, ultrasound abdomen revealed an inflection point of the gall bladder, diffuse pancreatopathy.

April 15, during the planned fibrogastroduodenoscopy conducted the test with a blocker of N2receptor-famotidine: 7 h 30 min the girl took 40 mg of famotidine, 10 h 35 min made FGDs revealed erosion in the bulb 12 duodenal ulcer, erythematous gastritis, introduction into the stomach through an endoscopic catheter solution of Congo red gave a red colour, which is regarded as a positive test and testified to the good sensitivity to this drug.

The patient continued taking famotidine, which was quickly achieved positive dynamics: eliminated epigastric pain, tenderness to palpation.

Thus, the proposed method allows you to quickly, with minimal cost to determine the pharmacological sensitivity and resistance to antisecretory drug and, therefore, to prescribe the most effective treatment.

The method of rapid diagnosis pharmacological sensitivity to inhibitors of gastric secretion, including fibrogastroscopy and the introduction of a 0.3% solution of Congo red through endosc the microscopic catheter, characterized in that it is an inhibitor of gastric secretion, and after 3 h is fibrogastroscopy with the introduction of the Congo-red, while the red color indicates sensitivity to the drug, the appearance of a dark blue or black color - on resistance.



 

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