Method of medical treatment of duodenal ulcer associated with helicobacter pylori

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically to gastroenterology and concerns treatment of duodenal ulcer associated with Helicobacter pylori. For this purpose patients have got on intravenous drip ex tempore 200 ml of ozonised 0.9%-solution of sodium chloride with ozone concentration 2.5 mg/l during 20 minutes for treatment course 10 procedures. In addition patients are introduced ex tempore with ozonised hydrocarbonate chloride sodium low-mineralised water "Mineral therapeutic table water Obuhovskaya-13" dosed 200.0 ml three times a day, 30 minutes before meal, ozone concentration is 2.5 mg/l, treatment duration - 10 days. Application of ozonised mineral water which is not containing organic substances docomposed by ozone provides rapid relief of pain and dyspepsia for patients suffering from open ulcerous defect and prevents clinical relapse of disease during 12 months.

EFFECT: rapid relief of pain and dyspepsia for patients suffering from open ulcerous defect and prevented clinical relapse of disease.

2 ex, 3 tbl

 

The present invention relates to medicine, namely physiotherapy and gastroenterology, and is intended for the treatment of peptic ulcer of the duodenum (abdpc), associated with Helicobacter pylori (Hp).

Known methods of treatment (standard scheme) gastric ulcer and abdpc associated with Hp designed according to the Maastricht consensus II: "triple" - omeprazole 20 mg 2 times a day, clarithromycin 500 mg 2 times a day amoxicillin 1000 mg 2 times a day, and quadrature" - omeprazole 20 mg 2 times a day, the preparation of colloidal bismuth (de-Nol, ventrical etc.) 120 mg 4 times a day, tetracycline 750 mg 2 times a day and metronidazole 750 mg 2 times a day (Alternative scheme of eradication therapy and ways to overcome acquired resistance of Helicobacter pylori to treatment / Assumerlo // Clinical medicine. - 2004. No. 2. - P.9-15; Current concept of Helicobacter pylori infection: The Maastricht 2 - 2000 Concept Report / P. Malfertheiner, F. Megraund, C.O. Morain // aliment oil displayed pure. Pharmacol. Ther. - 2002. - Vol.16. - P. 167-180).

There is also known a method of complex therapy abdpc associated with Hp using the SCENAR (self controlled Energo neuro adaptive regulation) against the standard "triple" 7-day scheme of eradication therapy, which includes omeprazole 40 mg/day of clarithromycin 1.0 g/day of amoxicillin 2.0 g/day (Comprehensive treatment of Bo is lnyh peptic ulcer of the duodenum using SCENAR-therapy / kochurova IA / The dissertation on competition of a scientific degree of candidate of medical Sciences, Perm, 2005, 24).

Closest to the present invention is a method of ozone therapy in the complex treatment of HP associated abdpc using ozonated distilled water inside once a day for 5 days and ozonated saline solution intravenously with a concentration of About35 mg/l, three times a day on the background of omeprazole 40 mg/day, and De-Nol 480 mg/day (the Use of ozone therapy in the complex treatment of Helicobacter pylori-associated gastric ulcer and duodenal ulcer / Pavlov D.S., Ivannikov ACTING, Konstantinova SO, Andreeva O.A. / Russian journal of gastroenterology, Hepatology, coprology. - 2003. No. 3. - I. XIII. - P.28-29).

The proposed methods of drug therapy standard schemes ("triple" and "quadrature") often cause various side effects and complications. The most frequent of them are dyspeptic disorders, diarrhea, flatulence, abdominal pain, headache, dizziness, malaise, paresthesia, muscle and joint pain, depression, visual disturbances, skin rash, hives, itching, neutropenia, thrombocytopenia, coagulation disorders, stomatitis, glossily, disruption of the normal intestinal microflora and the development of fungal infections of the intestines, often mushrooms R is Yes Candida (tolerability and safety of H. pylori drugs in the treatment of peptic ulcer / Weertman, MAV, ACI, Alertcon // Clinical medicine. - 2001. No. 2. - P.53-57; Side effects of modern H. pylori therapy / Ivev, Essoukna, Egerev // Clinical medicine. - 2002. No. 6. - P.7-12). The incidence of side effects in therapy of H. pylori can reach 63%and 3-10% of patients causes premature termination of treatment (Successful Helicobacter pylori eradication incorporating a one-week antibiotic regimen / N.Hudson, W.G.Brydon, M.A.Eastwood // aliment oil displayed pure. Pharmacol. Ther. - 1995. No. 9. - P.47-50). None of the proposed and proven treatment regimens are not able to provide 100% eradication of HP (even with a combination of 3 and 4 antibacterial drugs), as well as to guarantee the occurrence of reinfection gastroduodenal mucosal system (SDS) H (The role of acid inhibition in the treatment of Helicobacter pylori infection. Scand. J. Gastroenterol. - 1994. No. 92. - P.16-23).

When using the known method of ozone therapy abdpc speed relieving pain and heartburn was 6 days, and the healing of erosive or ulcerative defects according to fibrogastroduodenoscopy (FGDs) were carried out for 16.3±3,0 day.

The results of the treatment abdpc the prototype significantly inferior to the claimed method as in terms of relief of clinical symptoms, and possible scarring of the ulcer (table 1).

Table 1

Comparative evaluation of results of treatment abdpc known and declared by the methods of ozone therapy
IndicatorsThe comparison groupp
The prototype M±mThe claimed method M±m
The disappearance of pain (days)6,0±0,42,5±0,1p<0,001
Dyspepsia (in days)6,0±0,33,4±0,2p<0,001
Scarring ulcers (in days)16,3±0,315,2±0,4p<0,05

In the application of SCENAR-therapy in complex treatment of abdpc ("triple" scheme combined with SCENAR-therapy) in patients of the main group marked relief of pain for 4 night (3,4±0.3 days), diarrhoeal - 5 (4,8±0.3) and objective symptoms of the disease - 7 (6,1±0,7). In the control group who received only medical therapy (triple scheme), this dynamics is delayed for 2-3 days (5,3±0,5-6,5±0.5 day). In the main group complete cicatrization of the ulcer after 2 weeks was observed at 64.3% of patients after 3 weeks - 100%of control, respectively, 48% and 76% of patients. However, only a small proportion of patients (6.4 per cent) after a course of complex treatment was observed n ramalina the mucous membrane of the stomach.

Eradication of HP in the main group of patients after 3 weeks occurred in 86.7% of patients in the control - 76,9%. This treatment reduced the activity and the severity of chronic gastritis (numbers not specified).

When studying the long-term results of treatment in the main group of patients with recurrence of the ulcer was not observed in any case, and reinfection HP decreased 1.5 times. In the control group of patients these data are not available.

Evaluation of treatment results abdpc 2 analogue and the inventive method are presented in table 2.

As can be seen from the presented data, the application of combined ozone (the claimed method) in patients with all clinical manifestations of the disease (pain, neuralgia, pain on palpation, and positive symptom Mendel) had a reverse development in significantly (p<0,01) earlier than when using 2 analog. After treatment of the claimed method full scarring two weeks occurred at a statistically higher number of patients (p<0,02). In addition, a similar trend was observed in relation to the normalization of histological picture of the gastric mucosa (p<0.001) and the HP eradication (p<0.05) in the three-week period (table 2).

When studying the long-term results of treatment it should be noted that a number of these indicators have 2 anal the ha does not have numeric values (the formation of erosive lesions of the mucous membrane SDS, recurrence of pain and dyspeptic syndromes, and adverse effects of drugs). At the same time when applying the inventive method of treatment patients were completely absent these negative manifestations of the disease or side effects of combined ozone therapy (table 2).

Table 2

Evaluation of treatment results abdpc way of combination therapy ("triple" scheme combined with SCENAR-therapy) and the claimed method
IndicatorsMedical technologyχ2; p
"triple" scheme combined with SCENAR-therapy % or M±mThe claimed method, % or M±m
Clinical indicators:2 weeks of treatment
The disappearance of pain (days)3,4±0,32,5±0,1p<0,01
Dyspepsia (in days)4,8±0,33,4±0,2p<0,001
Palpation tenderness in the epigastrium (in days)5,2±0,53,8±0,2p<0,02
Positive symptom Mendel (in days)3,8±0,42,8 0,2p<0,05
Scarring ulcers (FGDs)2 weeks of treatment
64,3±9,0 (18 out of 28 people)87,5±4,4 (49 of 56 persons)p<0,02
Normalization of histological picture of the gastric mucosa3 weeks of treatment
6,4 (2 out of 28 people)51,8 (29 out of 56 people)χ2=8,4; p<0,001
Eradication of HP3 weeks of treatment
86,7 (24 out of 28 people)100 (56 out of 56 people)χ2=3,85; p<0,05
Long-term results:
Education ulcer (FGDs)for 12 months
00
The formation of erosionsmissing data0
The recurrences of pain and dyspeptic syndromesfor the 6 months
"a number of patients" numeric data not available0
Reinfection HPfor 12 months
1,5 times less (20 of 28 persons)14 times less likely (18 of 56 persons)χ2=4,0; p<0,05
Complications and side effectsmissing data0

When analyzing the dynamics of reinfection HP mucosa SDS registered significant differences, testifying in favor of the claimed method of treatment. So, again microflora colonization of the mucosa by SDS patients receiving treatment technology 2 analogue was observed in 1.5 times less, and the claimed method is 14-fold (p<0,05).

The objective of the invention. Improving the efficiency of treatment by reducing treatment time abdpc, the gain of HP eradication, reducing reinfection of the mucous membrane of SDS and reducing material costs, and absence of complications and side effects noted with the use of drug therapy.

The problem is solved by the effects of combined ozone therapy - patients daily injected intravenously ex tempore 200 ml of ozonated physiological solution of 0.9% sodium chloride solution for 20 minutes with ozone concentration of 2.5 mg/l, treatment 10 treatments; in addition, patients enter into ex tempore ozonated Hydra is carbonate-sodium chloride brackish water TU - 9185-001-49533222-99 "Water mineral Obukhov-13" 200.0 ml, 3 times daily, 30 minutes before meals, with ozone concentration of 2.5 mg/l, duration of treatment is 10 days.

Physico-chemical properties of ozonated water mineral-dining room Obukhov-13" (TU - 9185-001-49533222-99) studied in the research Department of the resort resources fgun "Yekaterinburg medical research center for prophylaxis and health protection of industrial workers" of Rospotrebnadzor and confirmed by the relevant protocols of the experiments. Studies of the water showed that it has a distinctive and stable chemical composition, refers to hydrocarbonate-chloride sodium brackish water and contains standard components are valid for mineral medical-table water concentrations (sample 1).

Degassed and ozonated for 15 minutes this water has a concentration of ozone at the outlet of 2.5 mg/DM3(sample 2). While in comparison with native kept all organoleptic properties remained transparent, colorless and odorless, brackish taste. Chemical composition after ozonation was stable and corresponded to the formula Mgorlow (table 3).

Thus, the experiment showed that ozonated brackish water (TU - 9185-001-49533222-99 "mineral Water treatment and d the th Obukhov-13") can be used in the practice of treatment by SDS pathology, associated with .Pylori, including abdpc.

Clinical trials of the claimed method of treatment of patients abdpc associated with NR - therapeutic clinic fgun "Yekaterinburg medical research center for prophylaxis and health protection of industrial workers" of Rospotrebnadzor in 2004-2006, which is confirmed by medical records of 56 patients.

The method of combined ozone as follows: patients daily injected intravenously ex tempore 200 ml of ozonated physiological solution of 0.9% sodium chloride solution for 20 minutes with ozone concentration of 2.5 mg/l, treatment 10 treatments; in addition, patients enter into ex tempore ozonated hydrocarbonate-chloride sodium brackish water - TU - 9185-001-49533222-99 "Water mineral Obukhov-13" 200.0 ml, 3 times daily, 30 minutes before meals, with ozone concentration of 2.5 mg/l, duration of treatment is 10 days.

Clinical example 1. The patient is In s A.I., 45 years. Case history No. 41639, was admitted to the hospital with a diagnosis of peptic Ulcer disease duodenal ulcer associated with HP, aggravation, moderate currents. Erosive antral gastritis. SGPT Art. I, reflux esophagitis.

1,0224
Table 3

The chemical composition claroline ilizovano water (TU - 9185-001-49533222-99 "Water mineral Obukhov-13") before and after ozonation
ComponentsUnits, non sample
g/DM3mEq.mg-EQ.%
sample 1sample 2sample 1sample 2sample 1sample 2
(Na++To+)0,54370,492923,6521,4495,3294,28
Mg2+0,00320,00510,260,421,051,85
CA2+0,01800,01760,900,883,63a 3.87
NH4+no.no.no.no.no.no.
The sum of cations0,56490,515624,8122,74100,0100,0
Cl-0,56980,500316,0714,1164,7762,05
Br-0,00181 0,0018----
I-0,000340,00034----
SO42-0,02200,01700,460,351,851,54
The HCO3-0,50510,50518,288,2833,3833,38
Carbonateno.no.no.no.no.no.
NO2-0,00001no.----
NO3-no.no.no.no.no.no.
F-0,000840,00094----
PO43-no.no.no.no.no.no.
The amount of anions1,096924,8122,74100,0100,0
Mineralization1,66181,5380----
pHthe 5.457,20----
Oxidation, MgO/DM31,76the 1.44----

When entering noted complaints: pain in the epigastric region on an empty stomach and at night. Heartburn, often after a meal. Regurgitation of food or acid content. The reduced appetite.

From the anamnesis of disease: acute 2 times a year, mainly in the transitional periods of the year (autumn and spring). Remission is about 6 months.

An objective examination: the patient is reduced nutrition (lack of weight 12 kg). Tongue coated white bloom. Palpation of the abdomen is determined by the tenderness in the epigastric region, palpation of the greater curvature of the stomach, piloroduodenalnoy zone, positive symptoms Mendel and Bodylines.

Laboratory data: complete blood count, urine, scatology and without ECG features.

EGD: the mucosa of the lower third of the esophagus swollen, hyperemic. In the stomach a small amount of mucus. On the antral mucosa single surface of the data (point) erosion. Mucosa in the antrum swollen. The pylorus is preserved spacerowa, pass. The bulb of the duodenum moderately deformed, the front wall of ulcerative defect 0.5 cm in diameter, a depth of about 0.3 cm, covered with fibrin. Mucous follicles edematous, hyperemic. Biopsy of the 3 loci stomach and 2 - duodenal ulcer.

Microscopic examination of biopsy specimens: signs of active inflammation of the mucosa of the antrum and duodenal bulb. The colonization of the gastric mucosa HP (+++), mucous follicles - (++++).

The patient conducted daily combined with ozone therapy - intravenous drip was administered ex tempore 200 ml of ozonated physiological solution of 0.9% sodium chloride solution for 20 minutes with ozone concentration of 2.5 mg/l, treatment 10 treatments; in addition, the patient was injected inside ex tempore ozonated hydrocarbonate-chloride sodium brackish water - TU - 9185-001-49533222-99 "Water mineral Obukhov-13" 200.0 ml, 3 times daily, 30 minutes before meals, with ozone concentration of 2.5 mg/l, duration of treatment is 10 days.

The treatment was well tolerated, baldereschi and no side effects were noted. During therapy complaints were cropped to 2 (pain) and third day (dyspeptic symptoms), pain when s is LaCie belly disappeared on day 4, and positive symptoms Mendel and Bodylines on day 3.

Laboratory tests: complete blood count, urine, scatology and without ECG changes.

Re FGDs conducted in 2 weeks: mucosa of the esophagus without features. In the stomach a small amount of mucus. The mucosa of the stomach without the usual color, convoluted folds, erosion, inflammatory manifestations not. The pylorus is preserved freely pass. The bulb of the duodenum moderately deformed, the front wall of the fresh scar on the back - merging several whitish scars. Mucous follicles without features. Biopsy of the 3 loci stomach and 2 - duodenal ulcer.

Microscopic examination of biopsy specimens: evidence of active inflammatory process of the mucous membrane of the antrum and duodenal bulb was not found. The colonization of the gastric mucosa HP (-), mucous follicles - (-).

These follow-up monitoring: recurrence of the disease was not within 12 months. When control EGD inflammatory, erosive and ulcerative process is not registered. Microscopic examination of biopsy specimens of the gastric mucosa (4 biopsies from the gastric mucosa and 4 bulbs 12 duodenal ulcer - regional area scars and intact mucous): active inflammatory process and contamination HP is not detected (-).

Clinical example 2. Patient L-Skye NN, 34. Case history No. 2337, was admitted to the hospital with a diagnosis of peptic Ulcer disease duodenal ulcer associated with HP, aggravation, moderate currents. Chronic gastroduodenitis, aggravation.

When entering noted complaints: pain in the epigastric region on an empty stomach, resulting in 1.5-2 hours after a meal. Heartburn after baked and fried foods. After eating nausea. Belching food.

From the anamnesis of disease: acute 3-4 times a year, mostly after errors in diet and emotional stress. Remission duration of 3-4 months.

An objective examination: Language white furred at the base. Palpation of the abdomen is defined soreness in piloroduodenalnoy region, palpation of the greater curvature of the stomach and positive symptom Mendel.

Repeated laboratory data: complete blood count, urine, scatology and without ECG features.

Fibrogastroduodenoscopy: mucosa of the esophagus without features. In the stomach transparent content mixed with bile. The mucosa of the gastric body and antrum hyperemic, edematous. The folds of the mucous gipertrofirovannyy. The pylorus is preserved freely pass. The bulb of the duodenum deformed, the front wall of ulcerative defect 0.4 cm in diameter, covered with fibrin. Mucous follicles edematous, hyperemic. SATA biopsy of the 4 loci stomach and 3 duodenal ulcer.

Microscopic examination of biopsy specimens: signs of active inflammation of the mucous membrane of fundic and antral and duodenal ulcer. The colonization of the gastric mucosa HP (++++), mucous follicles - (++).

Ill have conducted daily combined with ozone therapy - intravenous drip was administered ex tempore 200 ml of ozonated physiological solution of 0.9% sodium chloride solution with an ozone concentration of 2.5 mg/l, treatment 10 treatments; in addition, the patient was injected inside ex tempore ozonated hydrocarbonate-chloride sodium brackish water - TU - 9185-001-49533222-99 "Water mineral Obukhov-13" 200.0 ml, 3 times daily, 30 minutes before meals, with ozone concentration of 2.5 mg/l, duration of treatment is 10 days.

The treatment was well tolerated, baldereschi and no side effects were noted. During therapy complaints were cropped to 2 (pain and dyspeptic symptoms), pain on palpation of the abdomen and positive symptom Mendel disappeared on day 3.

Repeated laboratory tests: complete blood count, urine, scatology and without ECG changes.

Re FGDs conducted in 2 weeks: mucosa of the esophagus without features. In the stomach a small amount of mucus. The mucosa of the stomach is not zmenena, the convoluted folds, normal height. The pylorus is preserved freely pass. The bulb of the duodenum strain on the front and rear walls of the scars. Mucous follicles without features. Biopsy of the 4 loci stomach and 4 - duodenal ulcer.

Microscopic examination of biopsy specimens: evidence of active inflammatory process of the mucous membrane of the antrum and duodenal bulb was not found. The colonization of the gastric mucosa HP (-), mucous follicles - (-).

These follow-up monitoring: recurrence of the disease was not within 12 months. When control EGD inflammatory process of the gastric mucosa and bulb 12 duodenal ulcer is not registered. Microscopic examination of biopsy specimens of the gastric mucosa (4 biopsies from the gastric mucosa and 4 bulbs 12 duodenal ulcer): active inflammatory process and contamination HP is not detected (-).

Thus, the data obtained indicate a significant (statistically) the superiority of the claimed method of treatment before way of comparison, which was expressed in a more rapid reduction of the clinical manifestations of the disease, scarring of the ulcer (2 weeks), reverse the inflammatory process (visual and microscopic examination of biopsy specimens), a more complete eradication E.g. the absence of clinical relapse and reinfection in the past 12 months, and side effects of medication therapy.

The method of treatment of peptic ulcer disease duodenal ulcer associated with Helicobacter pylori infection, including intravenous injection of ozonized physiological solution and internal ozonated water, characterized in that patients receive daily intravenous drip 200 ml of ozonated ex tempore physiological solution of 0.9%solution of sodium chloride for 20 min, with ozone concentration of 2.5 mg/l, treatment 10 treatments; in addition, patients enter into ex tempore ozonated hydrocarbondegrading sodium brackish water Water mineral Obukhov-13" 200.0 ml, 3 times a day, for 30 minutes before eating, with ozone concentration of 2.5 mg/l, duration of treatment is 10 days.



 

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EFFECT: higher efficiency of therapy.

3 ex

FIELD: medicine, gynecology.

SUBSTANCE: the present innovation deals with treating puerperal obesity-manifesting neuroendocrine syndrome. The method includes fractional nutrition, terrencur per 7.8-8.5 km/d, mineral baths and gynecological irrigations at applying hydrocarbonate-sulfate sodium-calcium mineral water of Slavyanovski well of 35-38°. During the whole course of therapy it is necessary to have the intake of the same mineral water thrice daily about 30-40 min before meals. One should carry out acupuncture reflexotherapy due to the second brake method during maximal activity of renal canals, those of urinary bladder, liver and pancreas. Acupuncture reflexotherapy should be alternated according to the days of affecting key points, group LO of "magic meridians", "key points" on the main syndrome. The innovation improves therapeutic result due to affecting autonomic nervous system.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves prescribing drinking radon-containing mineral water distinguished by radon activity of 185-370 kBq/l in the amount of 100 ml 3 times a day. Then, radon baths are given where radon activity is of 0.75-2.25 kBq/l, temperature is 36-37°C, procedure duration is 10-15 min. Then, vacuum depression of 4-9 atm with succession frequency of 15-25 pulses per 1 min and alternating sinusoid current of 100-200 Hz, current intensity of 20-40 mA and duration of 12-15 min is applied to kidney region and injured ureter segment region in everyday mode with 10-12 procedures long treatment course.

EFFECT: increased stimulated action to functional renal pacemaker and neuromuscular apparatus; higher percent of stone excretion.

4 cl

FIELD: EFFECT: medicine; surgery.

SUBSTANCE: heparin solution dosed 150-200 units/kg of body weight is mixed with 1-2 ml of 0.9% sodium chloride solution. This solution is applied for intraoperative slow injection in neurovascular bundle tissue of mesentery the most proximally of surgical insult point. After that puncture point ligation is performed.

EFFECT: effective intravascular inactivation of blood thrombin; reduction of vascular walls permeability; reduction of adhesion formation.

6 dwg

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