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Method for predicting the development of postgastroresectional peptic ulcers

IPC classes for russian patent Method for predicting the development of postgastroresectional peptic ulcers (RU 2304785):
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FIELD: medicine, gastroenterology.

SUBSTANCE: the present innovation deals with predicting the development of postgastroresectional peptic ulcers in patients due to detecting the level of gastrin after stimulation, pepsinogen, prostaglandins PGE2 and PG F2α, correspondingly, in mucosa of gastric stump and in mucosa of gastroenteroanastomosis. At increasing gastrin level up to 12.5 pM/l and higher, that of pepsinogen up to 10.0 mcg/l and higher and decreasing the level of prostaglandin PGE2 up to 570 and lower and at the decrease of prostaglandin PG F2α level up to 652 ng/g and lower one should predict the development of postgastroresectional peptic ulcer. Application of the present innovation enables to increase the accuracy in predicting the development of postgastroresectional peptic ulcers.

EFFECT: higher accuracy of prediction.

3 ex

 

The invention relates to medicine and can be used to predict development-post gastro-resection peptic ulcers.

A known method for predicting the development of post-resection syndromes for holding pelorosaurus options gastrectomy (Davydkin VI, Chapaev P.A. Disadvantages privatecoach operations. Jasper. the wedge. Gastroenterol. 2004. No. 1, page 195-199)adopted for the similar.

There is a method of predicting post-resection syndrome by testing medical vagotomy and analysis of gastroduodenoscopy (jerlov G.K., Purse A.P. and other Organ and organomodified technology in the treatment of gastroduodenal ulcers. Railway experts. the wedge. Gastroenterol. 2004, No. 1, s). This method is adopted for the prototype.

However, the known method is not sufficiently accurate, as it does not take into account the correlation factors of aggression and protection of the gastroduodenal zone.

The aim of the invention is to improve the accuracy of forecasting-post gastro-resection peptic ulcers.

The technical result is achieved that determine the level of gastrin after stimulation of pepsinogen, prostaglandins PG E2 and PG F2α, respectively, in the lining of the stomach stump and in the lining of the gastrojejunostomy, and when the level of gastrin to 12.5 pmol/l and above, pepsinogen to 10.0 µg/l or more, and red eye reduction the research Institute of the level of prostaglandin PG E2 to 570 ng/g and below and at the level of prostaglandin PG F2α to 652 ng/g and lower than forecast development-post gastro-resection peptic ulcers.

The method is implemented as follows.

The patient underwent resection of the stomach, was admitted with complaints of aching, cutting, stabbing, or dull pain that occurs intermittently or disturbing the patient constantly. Pain localized in the epigastric region with irradiation to the left shoulder or lumbar region, associated with food intake. In some cases, there had been painless form-post gastro-resection peptic ulcers.

When esophagogastroduodenoscopy revealed changes of the esophageal mucosa in the form of edema and hyperemia, as well as a single point of erosion of the lower third of the esophagus. The detected edema hyperemia of the mucous membrane of the stomach stump.

The radiological examination showed development of hypotension esophagus, cardia insufficiency. The stump of the stomach of the big sizes with no signs of deformation. Express evacuation of the barium suspension from the stump of the stomach, as well as slowing the emptying of the loops of the small intestine.

Conducted biochemical studies of gastrin level after stimulation of pepsinogen, prostaglandins PG E2 and PG F2α, respectively, in the lining of the stomach stump and in the lining of the gastrojejunostomy.

Found increased levels of gastrin to 12.5 pmol/l and above, pepsinogen to 10.0 µg/l or more, and the reduction of UB is nya prostaglandin PG E2 to 570 ng/g and below, reducing prostaglandin PG F2α up to 652 ng/g and below.

Identify the signs and symptoms of gastric dyspepsia, radiographic evidence of a decline in motor function of the proximal and distal to the operated section of the digestive tract, changes in the level of gastrin, pepsinogen and prostaglandins E2 and F2αthat allows to predict the development-post gastro-resection peptic ulcers.

Way of the following examples.

Example 1.

Patient K., 42 years old, underwent gastrectomy 6 years ago and was admitted with complaints of aching, dull pain that occurs periodically in the epigastric region with irradiation to the left shoulder, associated with food intake.

Esophagogastroduodenoscopy revealed edema and hyperemia of the mucous membrane of the esophagus and gastric stump.

Radiographically installed the hypotonia of the esophagus. The stump of the stomach of the big sizes. Evacuation of the barium suspension of the stomach stump accelerated.

For biochemical analysis of the level of gastrin after stimulation of pepsinogen, prostaglandins PG E2 and PG F2α, respectively, in the lining of the stomach stump and in the lining of the gastrojejunostomy detected increased levels of gastrin to 12.5 pmol/l, pepsinogen to 10.0 ág/l, decrease prostaglandin PG E2 to 570 ng/g, reducing prostaglandin PG F2α up to 652 ng/,/p>

The presence of radiographic evidence of a decline in motor function proximal to the operated section of the digestive tract, the nature of changes in the level of gastrin, pepsinogen and prostaglandins E2 and F2α allowed to predict the development-post gastro-resection peptic ulcers. The patient refused preventive treatment.

Follow-up observations over the next 8 months revealed development-post gastro-resection peptic ulcers.

Example 2.

Patient, 45 years old, was admitted with complaints of sharp, stabbing pain in the epigastric region with irradiation in the region, associated with food intake. 8 years ago, I had a resection of a stomach.

When esophagogastroduodenoscopy revealed changes of the esophageal mucosa in the form of edema and hyperemia, as well as a single point of erosions lower thirds. The detected edema and hyperemia of the mucous membrane of the stomach stump.

X-ray examination: the hypotonia of the esophagus, cardia insufficiency, increasing the size of the gastric stump. Seen rapid evacuation of the barium suspension from the stump of the stomach, as well as slowing the emptying of the loops of the small intestine.

Biochemical study of the level of gastrin after stimulation of pepsinogen, prostaglandins PG E2 and PG F2α, respectively, in the lining of the stomach stump and slimy is the gastrojejunostomy: the level of gastrin - of 15.3 pmol/l, pepsinogen - 12.5 µg/l, the level of prostaglandin PG E2 - 545 ng/g, the level of prostaglandin PG F2α - 638 ng/g

Identify evidence of a decline in motor function of the proximal and distal to the operated section of the digestive tract, changes in the level of gastrin, pepsinogen and prostaglandins E2 and F2α allows to predict the development-post gastro-resection peptic ulcers.

The patient refused preventive treatment, but a year later he was admitted again with endoscopically and radiographically visualized-post gastro-resection peptic ulcer.

Completed the treatment. The ulcer healed. The patient was discharged in satisfactory condition.

Example 3.

The patient And, 29 years old, was admitted with complaints of feeling of heaviness in the epigastric region. Pain is absent.

When esophagogastroduodenoscopy found edema of the mucosa of the esophagus and gastric stump. The radiological examination showed development of hypotension esophagus. The stump of the stomach increased, not deformed. Observed acceleration of the evacuation of the barium suspension of the gastric stump.

Conducted biochemical studies of gastrin level after stimulation of pepsinogen, prostaglandins PG E2 and PG F2α, respectively, in the lining of the stomach stump and in the mucous gastroenterologist the oz. Found increased levels of gastrin to 14.7 pmol/l, pepsinogen to 11.3 µg, reducing prostaglandin PG E2 to 558 ng/g, reducing prostaglandin PG F2α to 645 ng/g

Detect the presence of radiological evidence of a decline in motor function and proximal with respect to the operated section of the digestive tract, changes in the level of gastrin, pepsinogen and prostaglandins E2 and F2αthat allows to predict the development-post gastro-resection peptic ulcers.

Over the next 1.5 years of painful sensations in the operated stomach did not arise. However, when control endoscopy revealed the presence-post gastro-resection peptic ulcers. Treatment. Control endoscopy revealed scarring of the ulcer.

According to the claimed method produced prognostic assessment of occurrence-post gastro-resection peptic ulcers in 25 patients. The proposed method has improved the accuracy of the forecast development-post gastro-resection peptic ulcers based on the accounting ratios of the factors of aggression and protection of the gastroduodenal zone.

A method for predicting the development-post gastro-resection peptic ulcers by biochemical studies of blood and esophagogastroduodenoscopy, characterized in that determine the level of gastrin after the stimulus is tion, of pepsinogen, prostaglandins PG E2 and PG F2α, respectively, in the lining of the stomach stump and in the lining of the gastrojejunostomy, and when the level of gastrin to 12.5 pmol/l and above, pepsinogen to 10.0 µg/l or more, and reducing prostaglandin PG E2 to 570 ng/g and below and at the level of prostaglandin PG F2α up to 652 ng/g and lower than forecast development-post gastro-resection peptic ulcers.

 

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