Colonoscopy preparation method in children of various age groups

FIELD: medicine.

SUBSTANCE: 24 hours prior to the examination, children aged 3 to 8 year old takes in 100 ml lactulose (Duphalac) with water of room temperature in amount 1-1.5 liters within 4-6 hours. The second dose lactulose (Duphalac) 100 ml follows with water of room temperature in amount 1-1.5 liters. To prevent overaerogenesis and to reduce discomfort, Espumisan (Simethicone) is prescribed in dosage 15 ml 3 times a day. For children aged 8 to 18 years old, there is prescribed 200 ml lactulose (Duphalac) with water of room temperature in amount 1.5-2.0 litres within 4-6 hours followed with the second dose of lactulose (Duphalac) 200 ml with water of room temperature in amount 1-1.5 litres. Additionally Espumisan (Simethicone) is introduced in dosage 15 ml 3 times a day or 3-6 capsules 3 times a day.

EFFECT: effective cleansing of gastrointestinal tract in children of different age, thus ensuring good visualisation of large intestine mucosa and decreasing drug load on organism of younger children, preserving normal microflora of large intestine and preventing overaerogenesis.

2 ex

 

The invention relates to medicine, more specifically to Pediatrics, namely to the field of gastroenterology and Coloproctology.

The invention can most effectively be used for colonoscopy in children.

There is a method of preparation for endoscopy children under the age of 8 years, which conducted a series of cleansing enemas with the intake of vegetable oil to enhance peristalsis: 2-3 enemas before and one the morning of the study. For 18-20 hours before colonoscopy child given to drink 15-20 ml of castor oil, evening put two enemas with an interval of 1.5 hours, and the morning of the study - two more enemas with the same interval (dolecki SJ, strekalovskaya VP, Klimanskaya E.V., Surikov O.A. Endoscopy of the digestive tract in children. - M.: Medicine, 1984, str).

These methods prepare the digestive tract for endoscopic study in younger children are accompanied by significant discomfort for the patient, traumatic psycho-emotional sphere.

There is a method of preparation for endoscopy children older than 14 years (Grigorieva GA Application fortrans in the preparation of patients for colonoscopy and surgical interventions. Farmateka No. 20, 2006, p.87), which includes cleansing of the bowel with saline laxative agent "Fortran", which causes the t increased peristalsis and leads to the emptying of the contents of the colon. The contents of one sachet of fortrans (64 g) dissolved in one liter of water. The dose is set at the rate of one liter of the solution prepared by 15-20 kg of body weight of the patient. Need to research the amount of solution take 200 ml every 20 minutes in the evening before the examination.

The disadvantage of this method is the necessity of large quantities of liquid (up to 4 liters), which is difficult for younger children.

This method is chosen for the prototype.

The objective of the invention is to develop a new effective way of preparing for colonoscopies study of children of different age groups, providing good visualization of the mucosa of the colon during colonoscopies research.

The problem is solved in that the method of preparation colonoscopies study of children of different age groups includes cleansing of the intestine by using the regulating motor function of the gastrointestinal tract, with children from 3 to 8 years for 24 hours prior to the study taking 100 ml of lactulose (duphalac)with water at room temperature in a volume of 1-1,5 litres for 4-6 hours, then take the second dose of lactulose (duphalac) in an amount of 100 ml with water at room temperature in a volume of 1-1 .5 liters, and add niteline to prevent excessive gassing and reduce discomfort take espumizan (semicolon) at a dose of 15 ml 3 times a day, and kids from 8 to 18 years of age take 200 ml of lactulose (duphalac)with water at room temperature in a volume of 1.5-2.0 liters for 4-6 hours, then take the second dose of lactulose (duphalac) in 200 ml of drinking water at room temperature in a volume of 1-1 .5 liters, additionally take espumizan (semicolon) at a dose of 15 ml 3 times daily or 3-6 capsules 3 times a day.

A significant difference of the proposed method against known is carrying out additional techniques preliminary preparation for a colonoscopy for children of different age groups, namely in the preparation of young children (from 3 to 8 years) they for 24 hours prior to the study taking 100 ml of lactulose (duphalac)with water at room temperature in a volume of 1-1,5 litres for 4-6 hours, then take the second dose of lactulose (duphalac) in an amount of 100 ml with water at room temperature in a volume of 1-1 .5 liters, and in addition to prevent excessive gassing and reduce the discomfort of taking espumizan (semicolon) at a dose of 15 ml 3 times a day, and when preparing older children (8 to 18 years) they take 200 ml of lactulose (duphalac)with water at room temperature in a volume of 1.5-2.0 liters for 4-6 hours, then take the second dose of lactulose (duphalac) in 200 ml of drinking water at room temperature in a volume of 1-1 .5 liters, fill in the compulsory taking espumizan (semicolon) at a dose of 15 ml 3 times daily or 3-6 capsules 3 times a day.

As a result of this endoscopic image mucous membrane of the rectum becomes clearer, less artifacts when assessing the condition of the rectum in General, what is new and meets the criterion of "novelty."

As a means of regulating motor function of the gastrointestinal tract, use of lactulose (Duphalac, Duphalac), registration number P # 011717/02, 23.03.05). This drug is a laxative with osmotic properties. Under the influence of duphalac there is a change in the microflora of the large intestine (the increase in the number of lactobacilli), which leads to increased acidity in the lumen of the large intestine and stimulates peristalsis.

In addition, under the influence of bifido - and follow the normal flora of the colon, part of the received lactulose transformed into short-chain fatty acids. These acids, on the one hand, irritate chemoreceptors that increase peristalsis, on the other hand, are nutrients for bifido - and follow. The increase in biomass of bifido - and follow-annoying baroretseptorov and leads to increased peristalsis and emptying of the digestive tract. Lowering the pH of the intestine changes solernou pressure causes excessive accumulation of fluid in the lumen of the intestine and accelerates the emptying. Lactulose (Duval is it a safe drug, allowed the younger children.

As a means to prevent excessive gassing and reduce discomfort impose espumizan (semicolon). This is a surfactant that reduces the surface tension of air bubbles in the digestive tract that break down. Available in the form of emulsions for oral administration in vials of 100 ml (Case of medicines in Russia, ed. 5, 1997/1998, str).

Held on 23 colonoscopies studies of children of different ages.

Examples of the implementation of the proposed method.

Example 1. Patient K., 4 years. Within 2 years was observed in the gastroenterological Department of the ncla RAMS about ulcerative colitis. Periodically marked abdominal pain, blood in the stool. Shows a colonoscopy.

To prepare for the colonoscopy was used the following scheme: in the morning while eating the child took 100 ml "Duphalac", squeezed 1,0-1,5 l of water at room temperature for 4-6 hours, then the child took another 100 ml "Duphalac", squeezed 1,0-1,5 l of water throughout the remainder of the day. Additionally, the child took 15 ml of the suspension of espumisan 3 times a day.

Colonoscopy bowel preparation for the study was assessed as good in the lumen of the intestine small amount of transparent content is about, which does not interfere with the inspection. Examined direct, sigmoid, colon, blind, and 3 segments of jejunum. Taken stair biopsy.

Example 2. Patient X., 13 years. Was admitted to the gastroenterology Department of the ncla RAMS primarily with complaints of abdominal pain, headache, weight loss, blood and mucus in the stool. Earlier in the other hospital was diagnosed with ulcerative colitis. To confirm the diagnosis shows a colonoscopy with the capture of stair biopsy and subsequent histological examination of biopsy specimens.

Preparation for colonoscopy were used the following scheme: on the day before the test, in the morning, during Breakfast, the child took 200 ml "Duphalac", squeezed 1,0-1,5 l of water at room temperature for 6 hours, after 6 hours the child drank 200 ml "Duphalac", squeezed 1,0-1,5 l of water for 5-6 hours. Additionally, the child took 3-6 capsules of espumisan 3 times a day.

Colonoscopy bowel preparation for the study was assessed as good in the lumen of the intestine small amount of transparent content that does not interfere with the inspection. Examined direct, sigmoid, colon, blind, and 3 segments of jejunum. Taken stair biopsy.

Previously, the preparation of the patient for a colonoscopy was carried out using 3 enemas the night before and 1 enema at the rum in the study day that caused a very negative reaction from the child.

Thus, the inventive method of preparation for colonoscopy provides effective cleansing of the gastrointestinal tract in children of different ages.

In the result, the inventive method allows to obtain good visualization of the mucosa of the colon when conducting colonoscopies research.

Method of preparation for colonoscopies study of children of different age groups, including purgation by using the regulating motor function of the gastrointestinal tract, characterized in that children from 3 to 8 years for 24 h prior to the study taking 100 ml of lactulose (duphalac)with water at room temperature in a volume of 1-1,5 l for 4-6 h, and then take the second dose of lactulose (duphalac) in an amount of 100 ml with water at room temperature in a volume of 1-1,5 l and, optionally, to prevent excessive gassing and reduce the discomfort of taking espumizan (semicolon) at a dose of 15 ml 3 times a day, and children aged 8 to 18 years of age take 200 ml of lactulose (duphalac)with water at room temperature in a volume of 1.5-2.0 l for 4-6 h, and then take the second dose of lactulose (duphalac) in 200 ml of drinking water at room temperature in a volume of 1-1,5 l, additionally take espumizan (semicolon) at a dose of 15 ml 3 times Danieli 3-6 capsules 3 times a day.



 

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