Method for treating the cases of gastric and duodenal peptic ulcer

FIELD: medicine.

SUBSTANCE: method involves applying eradicative anti-helicobacterial therapy comprising Omeprazol administration at a dose of 20 mg twice a day and Ximedone at a dose of 500 mg twice a day in 12 days long course.

EFFECT: enhanced effectiveness of eradication; reduced adverse side effects risk.

 

The invention relates to medicine, namely to surgical diseases.

According to the registration of morbidity in Russia every tenth adult resident suffers from this or that disease of the digestive system. Especially significant and widespread among the adult and children's population has a peptic ulcer. Among patients with peptic ulcer disease, under medical supervision, every ninth arrives in the hospital due to complications arising, in respect of which for health reasons most exposed operations. From complications related to inadequate medical treatment of patients with peptic ulcer disease, in Russia annually kills about 6,000 people in working age. The most threatening complication of gastric ulcer and duodenal ulcer is acute bleeding. Despite all the achievements, postoperative mortality in this disease remains very high (12%-13%). But the incidence of postoperative complications and mortality after re-bleeding increase 1.5-2 times.

The aim of the method of treatment of gastroduodenal ulcer is healing, prevention of recurrence and complications. Currently, the main condition of anti-relapse treatment of peptic ulcer disease is recognized as holding eradication of anti micobacteria therapy. Peptic ulcer complicated by bleeding, is also an absolute indication for H. pylori therapy after successful endoscopic hemostasis. It is proved that early eradication of Helicobacter pylori (H. pylori) in patients with peptic ulcer bleeding prevents the development of re-bleeding all patients, while in patients not treated with H. pylori therapy, recurrent ulcer bleeding occur in 30% of cases and more.

Now for eradication therapy using three - or four-part (quadrature) scheme that meets the following requirements: 1) the destruction of H. pylori is not less than 80% of cases; 2) the occurrence of side effects is less than 5% of cases; the duration of treatment no more than 7-14 days.

The well-known scheme with the use of proton pump blocker in combination with clarithromycin (500 mg twice daily) and amoxicillin (1000 mg twice a day) for at least 7 days (Vasiliev J.V., 2003).

The well-known scheme using colloidal bismuth subcitrate - 240 mg two times a day together with clarithromycin 250 mg twice a day and furazolidone 100 mg twice a day for 7 days (Isakov V.A., Shcherbakov P.L., 2002).

The well-known scheme: a proton pump blocker at standard dose twice a day + bismuth subsalicylate/subcitrate 120 mg Chet is d times daily + metronidazole 250 mg four times daily + tetracycline 500 mg four times per day (Abdulkhakov R.A., 2002).

The disadvantages of the known schemes of eradication therapy: use of a multipillar scheme, including three or four of the medicinal product, i.e. they are bulky, expensive, not without side effects; patients it is difficult to perform a medical prescription that is often the cause of failure of medical treatment.

The aim of the invention is the determination of specific H. pylori effects of drug ksimedon.

As the study material as well as biopsies of the gastric mucosa taken at fibrogastroduodenoscopy in patients with peptic ulcer of stomach and duodenum (4 biopsies from each patient: 2 biopsies from antrum, 2 biopsies from the gastric body). The biopsies were transported to the laboratory of Department of Microbiology, Kazan state medical Academy in the transport thioglycolic environment for 4-6 hours.

Bacteriological diagnosis helikobakterioza conducted comprehensive method, developed at the Department of Microbiology, Kazan state medical Academy, with the simultaneous use of mikroskopicheskogo, biochemical and cultural methods.

One sampling was divided into two parts. The first part was prepared smear, stained with diluted Magenta and microscopically. Tribal affiliation Helicobacter the s was determined by the morphology of bacteria: gram-negative curved or twisted sticks typical mobility: rapid translational and spiral movement crushed in a drop.

The second part of the biopsy was subjected to biochemical research, which is based on the ability of H. pylori to produce urease in conditions of weak acid environment of the stomach. Allocation of ammonia in the decomposition of urea by urease bacteria there is a change in pH of the medium and, accordingly, the change in color of the indicator. We used in our work widely in the world Clo-test. The medium composition: urea 10 mg, tetracycline 10 IU, phenol red 8-10 crystals. The indicator phenol red is yellow at pH 6.8 and bright crimson at pH of 8.4. Medium were prepared monthly and stored at 4°C.

The second sampling was ground in 1.0 ml of physiological solution was seeded 0,05 ml Crops was conducted on the 3 cups with a dense nutrient medium (blood agar (CA) to control the growth of microbes under aerobic conditions, blood agar with amphotericin (KAA) for verification of H. pylori and blood agar, which was added in dilutions ksimedon 1:50, 1:100, 1:150 (that correspond to the daily therapeutic doses of this drug: 0.5 g, 1.0 g and 1.5 g). Cultivation was done based on the average volume of the stomach.

Crops were incubated in a desiccator in microaerophilic and capnophilic conditions at a temperature of 37°C and 100% humidity for 5-7 days.

On cups with KAA received abundant growth characteristic of H. pylori small (about 1mm) transparent shiny colonies. On cups with ximedona at a dilution of 1:50 inhibition of growth of colonies of Helicobacter not mentioned, and at a dilution of 1:100 and 1:150 in all cups of growth of colonies of H. pylori were absent, which indicates the presence of bactericidal effect of this drug against Helicobacter pylori.

Positive results of antimicrobial activity in vitro was the basis for the study of Ximena in vivo.

The studied group of patients with peptic ulcer of stomach and duodenum. All patients performed-day courses of anti-ulcer therapy with two drugs (omeprazole 20 mg 2 times a day, ksimedon 500 mg 2 times a day). The biopsies of all patients were examined for the detection of H. pylori (method see above) before and after the course of treatment. After treatment the patients had a complete absence of H. pylori in the gastric mucosa and positive clinical effect with the healing of ulcers.

Examples

1. Patient Kotlyarevsky Anna Maxova. The age of 56.

DS: peptic Ulcer.

Received treatment: omeprazole 20 mg 2 times a day, ksimedon 500 mg 2 times a day, for 12 days.

The results of bacteriological studies:

1. Before treatment: Antral Department - dense nutrient medium is observed characterized by the growth of colonies of H. pylori in the amount of 9.0×103SOME 1 sampling.

The body is the RCU - on solid nutrient media celebrated the characteristic growth of colonies of H. pylori in the amount of 6.1×103SOME 1 sampling.

2. After treatment: Antral Department - dense nutrient media H.pylori is not selected.

The body of the stomach - dense nutrient media H.pylori is not selected.

2. Patient Farheen The Ville Zufarovich. born in 1980

DS: peptic Ulcer of the duodenum.

Received treatment: omeprazole 20 mg 2 times a day, ksimedon 500 mg 2 times a day, for 12 days.

The results of bacteriological studies:

1. Before treatment: Antral Department - dense nutrient medium is observed characterized by the growth of colonies of H. pylori in the number 7.8.0×103colony forming units (CFU) per 1 sampling.

The body of the stomach - dense nutrient media celebrated the characteristic growth of H. pylori colonies 5,0×103SOME 1 sampling.

2. After treatment: Antral Department - dense nutrient media H.pylori is not selected.

The body of the stomach - dense nutrient media H.pylori is not selected.

3. Patient Lyudmila Shvetsova Elicina. Age 48 L.

DS: Multiple gastroduodenal ulcers.

Received treatment: omeprazole 20 mg 2 times a day, ksimedon 500 mg 2 times a day, for 12 days.

The results of bacteriological studies:

1. Before treatment: Antral Department - dense nutrient media noted the nature of the initial growth of colonies of H. pylori in the number 8.5.0× 104KOE 1 sampling.

The body of the stomach - dense nutrient medium is observed characterized by the growth of colonies of H. pylori in the amount of & nbsp; 4.8.0×l04KOE 1 sampling.

2. After treatment: Antral Department - dense nutrient media H.pylori is not selected.

The body of the stomach - dense nutrient media H.pylori is not selected.

Sources of information

1. Isakov V.A., Shcherbakov P.L. proposals for the use of the recommendations from the second of the Maastricht agreement for the eradication of Helicobacter pylori. //J. “prospects of Clinical gastroenterology, Hepatology”. - M., 2002. No. 4. - P.31-34.

2. Vasiliev J.V. peptic Ulcer disease: pathogenesis, modern strategy of diagnosis and treatment. //J. “Practical medicine”. - Kazan, 2003. No. 4. - P.56-60.

3. Abdulkhakov R.A. Modern principles of treatment of peptic ulcer. //“KAZ. The honey. J.” - 2002. - C, No. 3. - S-236.

The method of treatment of peptic ulcer of stomach and duodenum, including eradication of H. pylori therapy, characterized in that the quality of medicines prescribed omeprazole 20 mg 2 times a day and ksimedon 500 mg 2 times a day for a course of 12 days.



 

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