Therapy method for sluggish ulcers and erosions in gastroduodenal system

FIELD: medicine, therapy, gastroenterology.

SUBSTANCE: method involves preliminary assay of the disorder type in gallbladder motor contraction and bile-excretion ways followed by prescribing thermal low-mineralized hydrocarbonate-sodium-sulfate-calcium-magnesium mineral water in the dose by 200-300 ml, 3 times per a day, 1 h before eating, tubages № 3 with mineral water, bathes and shower with mineral water every day for 10-14 days. In the hypotonic type of motor activity method involves mineral water at temperature 25-30°C, and in the hypertonic type - at temperature 38-40°C. Method provides accelerating in scars formation of ulcers and epithelization of erosions in gastroduodenal system, to prevent frequent exacerbations and to reduce activity of Chelicobacter-induced inflammation.

EFFECT: improved therapy method.

4 tbl, 2 ex

 

The present invention relates to medicine, in particular gastroenterology, namely the treatment of difficult-to-heal ulcers and erosions, and can be used in sanatoria and health resorts.

In recent years there has been an increase in patients with heavy forms of gastroduodenal pathology, which include long-term healing and often recurrent ulcers and erosion of the stomach and duodenum 12. This leads to reduced quality of life and long-term disability, sick.

Many works are devoted to problems of gastroduodenal ulcers and erosions, where the urgency of a thorough study of their heavy forms (Plagiaries, Epekeina, 1996; Wtihin, 1997-2002; Assumerlo et al., 1997, 1998; Russ B.C., Zvartau EE, 1998; Avikainen, 2001; Waveseries et al., 2001, 2002).

Pathogenetic heterogeneity and lack of effectiveness of treatment of patients with difficult-to-heal ulcers and erosions 12 duodenal ulcer results in a large number of therapeutic techniques using mostly tools of pharmacotherapy, affecting different etiopathogenetic stages of the disease.

Known methods of treatment of patients with difficult-to-heal gastroduodenal ulcers and erosions using medication antiulcer drugs: N2antagonists, histamine receptors, and is hibition proton pump, H. pylori schemes, including antibacterial drugs and colloidal bismuth subcitrate, "local" treatment by endoscopic injection of drugs (Pahlow, Aeation, 1994; ATL, 1996; Wtihin 1996-2002; Paucifolia, 1997; Cuvelier, 1997; Tilapia, 1999, 2001; Siemionow, 2000 and others).

The disadvantage of these methods is the impact only locally aggressive factors (allopathically diseases and Helicobacter pylori). However, the formation of refractory ulcers and erosions occurs largely as a result of complex disorders of the regulatory systems of the organism, the severity of which leads to a significant weakening of protective factors and reduction processes of repair and regeneration. To increase the effectiveness of treatment requires the use of factors that increase the sanogenetic of the entire organism. These requirements are met sanatorium-resort therapy, in particular drinking mineral water.

The closest in technical essence to the proposed method is a method of treatment of patients with peptic ulcer duodenal ulcer in acute phase, which consists in the appointment of a sick three-H. pylori therapy (omeprazole 20 mg 2 times a day metronidazole 500 mg 2 times a day and amoxicillin 1.0 g 2 times a day, followed by the maintenance therapy blockers of H 2receptors of histamine - famotidine (standards for the diagnosis and treatment of digestive diseases, 1998).

The disadvantages of this method is that in contrast to uncomplicated peptic ulcer disease, where scarring ulcers when this occurs in 80-90% of cases within 3-4 weeks, with difficult-to-heal ulcers and gastroduodenal erosions when using these drugs scarring erosive-ulcerous defects within a specified time not reached and is delayed up to 8-12 weeks. In addition, in 70% of cases there is a recurrence of ulcerative to 3-4 times per year.

The technical result of the proposed method of treatment of patients with difficult-to-heal ulcers and gastroduodenal erosions is the stimulation of hormone blocks the regulation and reparative ability of the gastroduodenal mucosa, manifested in the reduction of lead time and improving the quality of scarring ulcers, the potentiation of the effect of eradication of H. pylori therapy, thereby reducing the degree of contamination of the gastroduodenal mucosa by Helicobacter pylori, lengthens the period of remission and reduces the number of relapses of erozirovanne and ulcerative.

This technical result is achieved by the appointment of drinking mineral water "Essentuki-New" (carbonate-sulphate-chloride-sodium-calcium MB minor mineral is purpose - the 3.2-3.5 g/l) 3-3,5 ml per 1 kg of body weight 3 times a day 30 minutes before meals in the form of heat on pharmacotherapy (famotidine 20 mg 2 times a day, denol in a daily dose of 480 mg, divided into four admission; amoxicillin 1.0 g, 2 times a day metronidazole 500 mg 2 times a day during the week, then famotidine 20 mg at night over the next 3 weeks).

The use of mineral waters in combination with antiulcer drug therapy in the specified mode is a new direction in the treatment of patients with peptic ulcer disease with the presence of a nonhealing ulcer and previously in medical practice as doctors, therapists, and physicians health resort was not applied. Meanwhile, it is by this method, under the guise of" medicine has the most complete realization of the whole complex of reactions to drinking effects, especially hormonomodulizing influence of the course of drinking mineral water, contributing to a significant activation of reparative processes in the gastroduodenal mucosa, the elimination of destructive inflammatory changes, acceleration scarring erosive-ulcerous defects and a more rapid reduction of clinical symptoms of the disease. This technique is optimal for these patients because mineral water replaces in cases soposto the corresponding gastroduodenoscopy prokinetic, has a potentiating effect on H. pylori activity of medicines, providing additional antacid action.

Description of the method.

The method is as follows: the first medication in the morning, an hour before Breakfast patients taking 20 mg famotidine, 30 minutes before Breakfast 120 mg denol, diluting 200 ml of MB, after a meal, 0.5 g metronidazole, after 30 minutes, 1.0 g of amoxicillin. The second day reception at least 30 minutes before lunch - 120 mg of denol, squeezed MB. The third technique in the evening: 30 minutes before dinner 120 mg denol, squeezed MB, after eating - 0.5 g metronidazole, after 30 minutes, 1.0 g of amoxicillin. In 21 hours, 20 mg famotidine at night - the last (fourth) receiving 120 mg of denol within 7 days, then 20 mg famotidine overnight in over the next 3 weeks.

The method is illustrated by the above observations.

Example No. 1.

Patient K., aged 44, was treated at the clinic with 07.10. on 29.10.2000, history No....) primary Diagnosis: stomach ulcer duodenal ulcer in the process of decaying exacerbation (three difficult-to-heal ulcers, duodenal ulcer, erosive bulbi).

Upon receipt complained of periodic rare epigastric pain on an empty stomach and before eating, whining character, sometimes epigastric discomfort.

Sick since 1995, the disease occurs with frequent exacerbations (3-4 times per year), with azionario and outpatient treatment is ineffective, ulcerative defect of the long-term rubtsuyutza. When pain between exchange treatment occasionally used ranitidine. For sanatorium-resort treatment came first.

Objective examination: the white furred tongue, belly correct configuration, in the act of breathing involved all departments, soft to palpation moderately painful in piloroduodenalnoy area.

Laboratory data: General blood and urine tests without pathology. There are variations in the hormonal profile of blood cortisol 271,23 nmol/l insulin is 7.7 mIU/ml, gastrin - 2.8 pmol/L. "Helic"test: (++). AGGPS from 10.10. The mucosa of the gastric body swollen, hyperemic, loose. In the antral gastric mucosa mottled, dull, atrophic. The bulb of the duodenum grossly deformed. Mucous follicles edematous, hyperemic, with many point, acute erosions. On the front and rear walls of the bulb are one shallow ulcer up to 0.5 cm in diameter, covered with a grayish tinge. In the distal bulbs on the back wall is the third plague to 0.7 cm in diameter, covered with gray bloom. Postbulbar Department duodenum - without features.

Received the following treatments: mineral water Essentuki-New 200.0 ml 3 times a day 30 minutes before meals, diet (diet No. 1, then the diet №5) and m is documentsnew therapy (famotidine 40 mg/day, denol 480 mg/ day, amoxicillin 2.0 g/day, metronidazole 1 g/day) developed by us for the scheme of a combined mineral water and medicine.

After the treatment, the condition has improved, which was confirmed data for additional research. To control AGGPS from 26.10: endoscopic erosions and ulcers in the bulb DC already not is determined (step "red scar"), there has been only a moderate hyperemia of the mucosa of the duodenum.

Improved hormonal status of the patient with a tendency to normalization of cortisol 467,72 nmol/l insulin 17,64 mIU/ml gastrin 3.9 pmol/L.

Helic-test - slabopolozhitelnym (+).

Thus, after a course of combination therapy (MB Essentuki-New and medicines) has a positive clinical effect in the short term (16 days) provided clinical and endoscopic remission. The patient was discharged with significant improvement.

Example No. 2.

Patient C., 27 years old, was in the clinic with a 6.03. in 20.03.2001 year history No. 43). The primary diagnosis: stomach ulcer duodenal ulcer in the acute stage: difficult-to-heal ulcer bulb 12 duodenal ulcer. Concomitant diagnosis: irritable bowel Syndrome with constipation.

Upon receipt complained of pain in the epigastric area "empty stomach", intractable eating heartburn, the tendency to constipation, pain in the neck.

Ill for about two years, increasing 2-3 times a year with the presence of difficult-to-heal ulcer 12 duodenal ulcer. Was treated repeatedly inpatient and outpatient, got omez, ranitidine, denol, H. pylori therapy with metronidazole, furazolidone, however ulcer rubtsuyutza long, more than 2 months, and the effect of the treatment is short. Exacerbation occurred during the week before admission to the clinic. Were not surveyed. Medical treatment is not received.

Objective: the white furred tongue, belly correct configuration, evenly participates in the act of breathing, palpation painful in piloroduodenalnoy and epigastric regions, as well as along the colon. Emotionally labile, marked unstable red dermographism skin.

Laboratory data. General blood and urine tests - without a pathology. Cortisol - 736,5 nmol/l, insulin - of 8.2 mIU/ml, gastrin - 2.9 pmol/L. Helic-test is(+).

AGGPS from 10.03. The mucosa of the body and antrum of the stomach swollen, hyperemic. Mucous follicles 12 duodenal ulcer - edematous, hyperemic, loose. On the top of the bulb is a deep ulcer, up to 1.0 cm in diameter, covered with white bloom.

Received the following treatments: diet №5, mineral water Essentuki-New 200.0 ml 3 times a day 30 minutes before meals, warm, medic is Mentone treatment (famotidine 40 mg/day, denol 480 mg/day, amoxicillin 2 g/ day, metronidazole 1.0 g/ day) according to the scheme of combined intake of mineral water.

When re-ADFS from 28.03. noted positive dynamics: endoscopic ulcer in the duodenal bulb was not determined, but the scar is not yet fully formed (stage red scar").

Helic-test showed no infection.

Laboratory findings: cortisol - 478,5 nmol/l, insulin - 17,4 mIU/ml, gastrin - 3.4 pmol/l, which showed a significant increase in hormonal profile.

On a background of treatment heartburn disappeared on the third day, complaining of severe pain in the epigastric region - on the fifth day, palpation pain syndrome was not determined on the tenth day, normalized stool. Thus, after treatment, which the patient tolerated well, all subjective and objective manifestations of the disease disappeared amid improving indicators of hormonal status.

This example illustrates the synergistic effect and the effective interaction of medicines and MB Essentuki-New in a patient with difficult-to-heal duodenal ulcer in acute phase, as well as the good effect of eradication schemes used treatment helikobakterioza.

The proposed method was also studied in the experiment on 24 rats male line "Wistar" m is the eighteenth double acetate ulcers and performed in 62 patients with peptic ulcer disease duodenal ulcer in acute phase with frequently recurrent course and with the presence of difficult-to-heal ulcers and gastroduodenal erosions. To characterize the functional state of the body was conducted clinical and laboratory tests (clinical and biochemical analysis of blood, determination of gastrin, cortisol and insulin, esophagogastroduodenoscopy, screening for Helicobacter pylori infection).

The obtained data were compared with indicators of the patients of the control group (30 people), who received only drug therapy.

As a result of the treatment terms of relief of pain, dyspeptic and astheno-neurotic syndrome were 2 times lower in patients of the main group, possible scarring ulcers 4.8 days less the percentage of patients with complete endoscopic remission were 96.7% against 83,3%.

Table 1. The terms of relief of major clinical syndromes (in days).
Syndromes1 (control) group2 (sanatorium)The reliability of differences (P)
Pain8,0±0,364,3±0,290,001
Dyspeptic8,7±0,434,5±0,340,001
Astheno-neurotic18,0±2,309,9±0,250,001

Table 2. Frequency and timing of cicatrization of the ulcer.
GroupBefore treatment (presence of ulcers)After treatment (presence of ulcers)The reliability of differences, PPossible scarring
Abs.%Abs.%
130100516,7<0,00142,6±0,31
23010013,3<0,00119,8±0,25*
Note: * - significance of difference p<0,001

It was noted the positive dynamics of hormone levels, manifested in significantly increased levels of insulin, gastrin blood only in the 2nd (sanatorium) group. The increased ratio of insulin/cortisol and a decrease in the degree of cortisolemia was observed in both groups, but was significantly more pronounced in the second. According to the outlying observations (12-18 months) 2.3 times reduced the number of relapses, 5.4 times the total number of days of incapacity.

Index
Table 3. Dynamics of hormone levels.
group 1 (control)group 2 (San chickens, therapy)
Before the treatmentAfter the treatmentBefore the treatmentAfter the treatment
Gastrin3,6±0,173,8±0,273,8±0,284,6±0,21*
Insulin17,2±0,5618,1±0,4617,7±0,8822,5±1,11*
Cortisol731,1±66,35483,5±43,23*614,5±49,95437,0±27,71*
Insulin/cortisol × 1002,5±0,183,7±0,20*2,8±0,245,2±0,12*
Note: * - P<0,01.

Table 4.
Hormonal and metabolic indicators of animal model with dual acetate sores
IndicatorsGroups of animals
group 1 - control(10)group 2 CENTURIES(8)group 3 MB (8)group 4 MV+FP (8)
Insulin, pmol/l83,1±5,5688,0±7,354123,0±10,70* 164,1±was 12.75*#
Cortisol, nmol/l31,1±2,7146,8±1,67*52,2±4,2828,8±1,81#
Insulin/cortisol2,90±0,3351,91±0,198*2,40±0,1905,99±0,738*#
Glucose, mmol/l3,36±0,1364,63±0,207*3,74±0,2042,91±0,176*#
Insulin/glucose25,3±2,2419,4±1,83*34,1 ±4,7758,2±to 6.19*#
Triglycerides, mmol/l0,49±0,0250,69±0,042*0,b±0,028*0,48±0,025#
Cholesterol, mmol/l3,15±0,1891,84+0,149*1,68±0,084*2,73±0,202#
Total protein, g/l72,4±to 2.0653,4±2,38*56,b±2,40*74,4±2,30#
Coolant, points0,33±0,2103,56±0,607*3,71±0,567*1,71±0,336#
Note: the validity of the difference P<0,05, * - in comparison with the control group, # - compared to 3 group. MB - mineral water, the HV tap water, OP - pharmaceuticals.

In comparison with the prototype of the p method has a positive effect on the clinical course of the disease: there is much less pain, diarrhoeal and astheno-neurotic syndrome, scarring of the ulcer was observed in a short time (18-21 days)was observed qualitative scarring, mostly without rough scar deformation was observed potentiating effect on the eradication of pyloric Helicobacter received a stimulating effect on the hormonal regulation of gastroduodenal region and normalization of hormonal ratios.

The proposed method speeds up the scarring ulcers and epithelization erosie SDS, prevents frequent exacerbation of the disease, reducing the activity of H. pylori inflammation, and form a lasting remission, continued for 10-12 months.

A distinctive feature of the proposed method is to increase the efficiency of treatment of patients with difficult-to-heal ulcers and gastroduodenal erosions in the acute phase, associated not only with the potentiating effect of drinking mineral water and pharmaceuticals, but with a qualitatively new effect of this combination, due to the possibility of implementation on a background of reception of medicines powerful sanogenetic effect of therapeutic factors of the resort, increase the adaptive capacity of the organism and helps restore hormonal ratios and activity of regulatory systems of the entire organism.

Therapies difficult the healing of ulcers and gastroduodenal erosions system in the acute phase, including the use of famotidine, de-Nol, amoxicillin and metronidazole, characterized in that for an hour before Breakfast patients used 20 mg famotidine, 30 minutes before Breakfast 120 mg de Nola, washing it down with 200 ml of carbonate-sulphate-chloride-sodium-calcium mineral water of low salinity is 3.2 - 3.5 g/l "Essentuki-New, 3.0 - 3.5 ml per kg of body weight, after a meal, 0.5 g metronidazole, after 30 minutes, 1.0 g of amoxicillin for 30 min before lunch take 120 mg de Nola, washing it down with the same mineral water, 30 minutes before dinner take 120 mg de Nola, squeezed the same mineral water, after a meal, 0.5 g metronidazole, after 30 min 1,0 amoxicillin at 21 h take 20 mg famotidine overnight take 120 mg de Nola within 7 days, then 20 mg famotidine overnight in over the next 3 weeks.



 

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