Method for treating gastroesophageal reflux cases

FIELD: medicine.

SUBSTANCE: method involves giving magnesium-sodium-hydrocarbonate mineral water of moderate mineralization degree at room temperature in the amount of 150-200 ml. 20-30 min later alternating electromagnetic field operating in low frequency bandwidth of 0.022 Hz-270 kHz is administered in scanning mode of 43 produced by Rematherp apparatus. The total treatment course is 8-10 procedures long.

EFFECT: enhanced effectiveness of treatment; stimulated reparative processes in esophageal mucous membrane.

 

The invention relates to medicine, in particular to gastroenterology, physical therapy and regenerative medicine, namely to the treatment of patients with gastroesophageal reflux disease, and can be used in hospital, clinics, offices and health centers.

Gastroesophageal reflux disease (GERD) is a chronic disease that occurs as a result of regular cast aggressive (gastric and/or duodenal contents into the esophagus. Modern views on GERD focused on the symptoms of the disease. Leading gastroenterologists consider the approach to diagnosis, treatment and control effectiveness, focused on the dynamics of symptoms, very rational. There are two main types of GERD: reflux esophagitis, characterized by the presence of erosions, and endoscopically negative reflux disease, which reveals edema and hyperemia of the mucous membrane of the esophagus. The severity of subjective symptoms of GERD does not correlate with the severity of endoscopic picture. For neurosignal reflux disease (NERD) liquidation of clinical manifestations is a decisive criterion for the effectiveness of therapy.

In the structure of GERD patients with intact mucous membranes prevail - 70% have a NERD and only 30% erosive.

The prevalence of GERD among adult the population of developed countries is 20-40%, a huge number of people have weekly GERD symptoms that significantly disrupts the quality of life of a significant number of patients: impaired work, they are not able to eat and relax. So this problem has important medico-social and economic value. Experimental data and clinical observations clearly indicate that the development and progression of motor dysfunction of the upper gastrointestinal tract contribute to autonomic dysfunction, negative emotions, stress.

Patients with GERD are significant health problem from the point of view of the lack of effectiveness of most of the methods used and large economic costs for treatment. Despite the wide Arsenal of drugs used to treat patients with GERD, the number of patients tends to increase, threatening complications such as peptic stricture, erosive and ulcerative lesions, bleeding, Barret's esophagus, are forced to resort to more radical methods of treatment. On the other hand, the growth of medicinal and hepatitis side effects caused by long-term intake of essential drugs for the treatment of said pathology (proton pump inhibitors, H2-blockers) do not allow to overestimate current is here searches non-pharmacological methods of treatment of GERD (Starostin D. Proton pump inhibitors in the treatment of gastroesophageal reflux disease // Ross. Journal of gastroent., gepatol., of Coloproctology. - 1996. - T6. No. 4. C7; Castell D.O., Tohnston V.T. Gastroesophageal Reflux Disease Current Strategies for Patient Management. Archives of Family Medicine, 1996. - 5. - 221-7).

The closest in technical essence to the proposed method of treatment of patients with GERD, reflux esophagitis is a method of influence on the patient to electromagnetic fields decimeter waves (UHF) on a collar zone. When conducting UHF-therapy using the apparatus "Wave-2" capacity of 25-30 watts. Exposed rectangular emitter 35×16 cm, 8-10 minutes over the course of treatment is appointed 8-10 treatments a day (Efendiyeva M.L., 2003, thesis for the... , "non-pharmacological correction of neurohumoral regulation of the lower esophageal sphincter in the various forms of pathology"). The disadvantages of this method are the following reasons: the main landmark is properly selected methods - subjective feelings of the patient - the appearance of a burning or stinging; the availability of a wide profile of contra-indications: uterine fibroids, adenomyosis, ischemic heart disease, thyroid disease, acute inflammatory diseases, etc.

The technical result of the proposed method for the treatment of GERD patients is the reduction of the clinical manifestations of the disease, reducing the number of gastroe ofhealing reflux, reduction of terms of treatment, the application of the method of concomitant diseases.

This technical result is achieved by the fact that the patient takes magnesium-sodium-bicarbonate-sulphate mineral water of medium mineralization (13 g/l), at room temperature in the amount of 150-200 ml, then after 20-30 minutes of exercise exposure to an alternating electromagnetic field in the low-frequency range of 0.022 Hz to 270 kHz in the scanning mode 43 of the device, "Rematec", daily treatment 8-10 procedures.

The rationale of these parameters.

Prerequisite destination magnesium-sodium-bicarbonate-sulphate mineral water at a dose of 150-200 ml for 20-30 minutes prior to physiotherapy was the data obtained when performing pH monitoring of the esophagus. Studies have found a significant reduction of gastro-oesophageal reflux in 20 to 30 minutes after a single dose of this mineral water. The proposed method of treatment with mineral water of medium mineralization in the amount of 150-200 ml and then after 20-30 minutes of exposure to an alternating electromagnetic field in the low-frequency range of 0.022 Hz to 270 kHz in the scanning mode 43 of the device, "Remotec has a positive effect on the neurohumoral regulation of the lower esophageal sphincter, increasing its separately the th function, reduces inflammatory changes in the esophagus, eliminates vegetative dysfunction.

Description of treatment method.

Daily 20-30 minutes before carrying out physiotherapy patient takes magnesium-sodium-bicarbonate-sulphate mineral water of medium mineralization, t - 23°-25°C in the amount of 150-200 ml, then the patient laid on the couch. Therapeutic signal from Rematec" is applied to the body, limbs and head of the patient through contactless inductors, representing a "blanket" insulated copper wires. The inductors are fed with alternating electric current voltage to 20 volts in amplitude, in the form of bundles of single-phase rectangular pulses. The pulse has two components: the envelope and the carrier. Envelope corresponds to one of the frequencies of the periodic system fundamental frequency of human organs and tissues, and supporting effect on microcirculatory or cellular structural levels of organization. The impact of the following parameters: mode No. 43, the exposure time 43 minutes, acting factor - variable electromagnetic field, the range of frequencies of 0.022 Hz-270 kHz, in the course of 8-10 treatments daily.

Examples of the method.

Example 1. Patient K., 38 years old.

The diagnosis of Gastroesophageal reflux disease. Erosive reflux esophagitis. Asthenoneurotic the syndrome.

Complaints at admission: heartburn, usilivayuscayasya under uncertainty in food, belching air, regurgitation, aching pain in the epigastric region, unstable mood, sleep disturbances, and headaches.

From the anamnesis it is known that the above symptoms are troubling for 2 years. Periodically took antacids with little effect. During endoscopic examination at admission revealed isolated erosion of the distal esophagus, edema and hyperemia of the mucous membrane, the failure of the cardia, which corresponded to the degree of esophagitis according to the Los Angelevski classification.

The patient underwent a course of treatment: single dose of mineral water at a dose of 200 ml for 30 min prior to exposure to an alternating electromagnetic field from the "Rematec"mode 43, duration of exposure to 43 minutes. The course was conducted 10 sessions daily. Portability procedures good, negative reactions were noted.

As a result of therapy were observed regression of clinical signs of disease have disappeared heartburn, aching epigastric pain, feeling of regurgitation, decreased belching, has significantly improved the patient's mood, decreased emotional and autonomic disorders.

Positive dynamics of the patient, along with subjective sensations, also confirmed the JV is social studies. In routine EGD - lost to erosion, significantly decreased hyperemia and edema of the mucosa of the distal esophagus.

PH monitoring of the esophagus revealed a decrease in reflux from 8 to 2.

Study of serum basal level of vasointestinal polypeptide (FORK) showed a decrease from 38 PG/ml 32 PG/ml (normal 29,8±to 2.8 PG/ml).

The positive dynamics of indicators characterizing autonomic balance, established according to the analysis of heart rate variability: the initial state of the autonomic nervous system was characterized by the predominance of the activity of the sympathetic (TR=2675 MS*2, LF=1342 MS*2, HF=386 MS*2, VLF=947 MS*2, LF/HF=3,48, %VLF-35,4, after treatment there was a decrease in the level of sympathetic influences (% LF=32,2, % FIF=52,9 % VLF=15, reflecting a balanced type of vegetative regulation).

Positive dynamics of the psychological state of the patient according to the compact multi-factor personality questionnaire (RESINS): dropped profiles on the 2nd scale from 67 to 47 and 4th scale from 58 to 52, which showed improvement in psychological adaptation, reducing conflict, intolerance and aggression. We also identified significant improvement of health, activity and mood test SAN.

Example 2. Sick,, 36 years.

Diagnosis: Neurosigma reflux disease. Catral the hydrated reflux esophagitis. Failure of the cardia.

Complaints at admission: daily heartburn, belching, regurgitation, aching pain in the epigastric region, decreased mood, weakness, fatigue, and headaches.

From the anamnesis it is known that the above symptoms are troubling for 4 years. Periodically taking antacids and prokinetic with little effect. During endoscopic examination at admission revealed edema and hyperemia of the mucosa of the distal esophagus, cardia insufficiency, which is consistent with the degree And esophagitis according to the Los Angelevski classification.

The patient underwent a course of treatment: single dose of mineral water at a dose of 150 ml for 20 minutes before exposure to an alternating electromagnetic field from the "Rematec"mode 43, duration of exposure to 43 minutes. The course was conducted 8 sessions daily. Portability procedures good, negative reactions were noted.

As a result of therapy were observed regression of clinical manifestations of the disease has decreased heartburn, aching epigastric pain, feeling of regurgitation, has significantly improved the patient's mood, decreased emotional and autonomic disorders.

Positive dynamics of the patient, along with subjective sensations, also confirmed the special study is any. In routine endoscopy is completely gone edema and hyperemia of the mucosa of the distal esophagus.

At pH monitoring of the esophagus and stomach marked decrease in the number of refluxes into the esophagus with a pH<4 to 7 per hour up to 3.

The study of the basal level of vasointestinal polypeptide in the serum showed a decrease from 37.8 PG/ml to 31 PG/ml (normal 29,8±to 2.8 PG/ml).

The positive dynamics of indicators characterizing autonomic balance, established according to the analysis of heart rate variability: the initial state of the autonomic nervous system was characterized by the predominance of the activity of the sympathetic - TR=2964, LF=754,3, HF=270, LF/HF=2,7, % VLF=62,5, after treatment there was a decrease in the level of sympathetic influences % LF=32,12, % HF=30,5, % VLF=56,8 that reflects a balanced type of vegetative regulation.

Positive dynamics of the psychological state of the patient according to the compact multi-factor personality questionnaire (TAR), which was manifested in the decline of RESINS on scales triads alarm (1, 2, 7) and a significant improvement in health, activity and mood test SAN. Thus, decreased the profiles on the 1st scale from 58 to 49 and 2nd scale from 61 to 52, which showed improvement in psychological adaptation, reducing conflict, intolerance and aggression.

The proposed method Leche is of gastroesophageal reflux disease was tested on 50 patients aged from 22 to 62 years, with disease duration up to 4 years. The treatment results in positive dynamics in the form of relief of clinical symptoms (heartburn, belching, regurgitation) and improve emotional state was observed in all patients, the disappearance of signs of esophagitis - epithelialization erosion, reduction of edema and hyperemia of the mucous membrane of the esophagus according to esophagogastroscopy - 40 (80%) patients, normalization of autonomic balance was observed in 42 (84%).

The proposed combined method of treatment of GERD improves blood supply to the mucosa of the esophagus and the stimulation of reparative processes (epithelial erosions), reduce inflammation (swelling and redness of the mucous membrane of the esophagus). This was confirmed by the decrease in the level of vasointestinal polypeptide, the main neurotransmitter that regulates the function of the lower esophageal sphincter, and, as a consequence, the reduction of gastroesophageal reflux (according to pH-monitoring). This leads to the regression of clinical signs of disease (decreases heartburn, belching, discomfort disappears behind the breastbone), improvement of psychological status of patients. Long-term results of treatment testified to the preservation of the achieved results for 8-10 months.

The proposed method for the treatment of GERD simple, affordable, has a minimum protivotoka the project, can be used both in hospital and in the outpatient setting, does not require high material costs and does not cause adverse reactions.

A method of treating gastroesophageal reflux disease, including the effects of an alternating electromagnetic field, characterized in that the patient takes magnesium-sodium-bicarbonate-sulphate mineral water of medium mineralization at room temperature, in the amount of 150-200 ml, then after 20-30 min exercise the influence of an alternating electromagnetic field in the low-frequency range of 0.022 Hz to 270 kHz in the scanning mode 43 of the device, "Rematec", daily treatment 8-10 procedures.



 

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3 tbl

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