Method of predicting unfavourable course of gastroesophageal reflux disease

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to therapy and gastroenterology. Clinical symptoms and risk factors are determined from life anamnesis: presence of dry cough, presence in anamnesis of chronic obstructive lung disease, presence in anamnesis of bronchial asthma, regular intake of broncholytic medications, presence of tickling in throat, presence in anamnesis of chronic diseases of ENT organs (laryngitis, pharyngitis, sinusitis, recurring otitis media), expression of cardialgia, regular intake of beta-blockers, regular intake of calcium antagonists, remotedness of endured myocardial ischemic attack. Their gradations and numerical values are determined, after which prognostic coefficients are determined. On the basis of comparison of prognostic coefficients values, risk of unfavourable course of gastroesofageal reflux disease is predicted.

EFFECT: method allows to increase accuracy of prediction.

1 tbl, 2 ex

 

The invention relates to medicine, namely to therapy and gastroenterology, and can be used to predict adverse flow of gastroesophageal reflux disease (GERD).

A known method for predicting the development of GERD by performing oesophageal manometry and measurement srednetemperaturnogo pressure in the lower esophageal sphincter odnoportsionnuyu catheter for recording esophageal motility. Additionally simultaneously perform antroduodenal interventions. Register phase hungry migrating motor complex intraduodenally zone and change srednetemperaturnogo pressure in the lower esophageal sphincter in each of these phases. The method can more accurately determine the risk of developing gastroesophageal reflux disease and to differentiate between the use of preventative measures (jerlov G., Savchenko S. p., Savchenko I. et al."A method for predicting the development of gastroesophageal reflux disease", EN 22830220 C1 IPC AV 1/273 (2006.01), AV 5/00 (2006.1)).

The disadvantages of this method include that it is not precise enough, because it was designed to predict the development of GERD on the basis of oesophageal and antroduodenal manometry, but does not take into account clinical risk factors and ECENA disease. In addition to the disadvantages of this method include the complexity of the methods of its implementation and high economic value.

Closest to the present invention is a method of predicting the course of gastroesophageal reflux disease comprising determining in a clinical study of the presence of constipation, chest x-ray - hernia hiatal, with 24-hour pH-metry in the esophagus - the number of acid refluxes 60 and above per day, in the study of electric activity of the stomach - frequency slow waves EMA in excess of 75% or more, and the amplitude is 200% or more. And in the presence of these characteristics predict an unfavorable course of gastroesophageal reflux disease.

The method is as follows. When enrolling patients complain of heartburn, recurrent pain in the chest, associated with food intake, resulting in the supine position, with the slopes and during physical activity, the tendency to constipation, hiccups. Weight over the past 3-5 years is stable. In the last 2-3 years revealed erosive gastritis and esophagitis, hiatal hernia of the diaphragm. The radiological examination revealed the presence of a hernia hiatal. During endoscopic examination revealed edema and hyperemia of the mucous membrane of the esophagus; sometimes you the keys erosion, covered with fibrin, dehiscence of the cardia. The mucosa of the stomach swollen and sometimes redness. The angle of the stomach is not modified. The porter's pass. Histological examination of esophageal mucosa to detect the presence of Mature granulation and necrotic tissue, infiltrated disintegrating the cells. Daily monitoring of pH in the esophagus reveals the presence of acid reflux in the amount of 60 and above. In the study of electric activity of the stomach, the frequency of slow waves EMA exceeds the norm by 75% or more, and the amplitude is 200% or more. Patients fill out a questionnaire. On the basis of data obtained clinical diagnostic studies predict an unfavorable course of gastroesophageal reflux disease. (Lazebnik LB, Y. Vasiliev, Yanova O., et al. "A method of predicting the course of gastroesophageal reflux disease", EN 2346652 C1 IPC AV 6/00 (2006.01), AV 5/05 (2006.1)).

The disadvantages of this method include the fact that the method takes into account only the typical clinical and instrumental signs of the disease, leading to an unfavorable course of gastroesophageal reflux disease, and does not account for extraesophageal (atypical) symptoms of the disease occurring in older age groups from third to one-half of cases of GERD, such as: dry cough, a history of the HRO is practical obstructive pulmonary disease, a history of bronchial asthma, regular intake of bronchodilator drugs, the presence of sore throat, history of chronic diseases of ENT-organs (laryngitis, pharyngitis, sinusitis, recurrent otitis media), the severity of cardialgia, regular use of beta-blockers, regular intake of calcium antagonists, as well as the prescription transferred violations of cerebral circulation.

In addition, the disadvantages of the prototype should include the complexity and the complexity of the methods of its implementation, the high economic cost and duration of implementation. Prognosis of was done in 32 patients.

The task of the invention is to develop a method for predicting adverse currents GERD, based on the assessment of the totality of symptoms that affect their risk.

The technical result of the proposed method is to improve the accuracy of predicting adverse flow of GERD, as well as to simplify the method.

The technical result of the proposed method is achieved by the fact that risk factors from the history and clinical examination of the patient.

The difference lies in the fact that determine clinical symptoms and risk factors of the history of life: the presence of dry cough, history of chronic obstructive pulmonary disease, is Alicia history of bronchial asthma, regular intake of bronchodilator drugs, the presence of sore throat, history of chronic diseases of ENT-organs (laryngitis, pharyngitis, sinusitis, recurrent otitis media), the severity of cardialgia, regular use of beta-blockers, regular intake of calcium antagonists, the prescription transferred violations of cerebral circulation.

The difference lies in the fact that the established risk factors assign grades (A1...8and numeric values, where

And1- the presence of dry cough, with assigned: 0 - no, 1 -;

And2- a history of chronic obstructive pulmonary disease, while assigned: 0 - no, 1 -;

And3- a history of bronchial asthma, while assigned: 0 - no, 1 -;

And4- regular intake of bronchodilator drugs assign: 0 - no, 1 - Yes.

And5- the presence of sore throat, while assigned: 0 - no, 1 -;

And6- a history of chronic diseases of ENT-organs (laryngitis, pharyngitis, sinusitis, recurrent otitis media), assign: 0 - no, 1 -;

A7- the severity of cardialgia, while assigned: 0 - no, 1 - minimal, 2 - moderate, 3 - significant;

A8- regular use of beta-blockers, while assigned: 0 - no, 1 -;

p> And9- regular intake of calcium antagonists, while assigned: 0 - no, 1 -;

And10- prescription of cerebral circulation, while assigned: 0 - no, 1 - up to 1 year 2 2 years 3 3 years 4 4 years 5 5 years or more.

Then determine the prognostic factors F1and F2by the formulas:

F1=-0,967 - 0,839*A1- 0,925*A2- 0,389*A3- 0,674*A4- 0,272*A5-0,426*A6+ 0,179*A7+ 0,213*A8+ 0,112*A9+ 0,096*A10

F2=-7,339 + 2,427*A1+ 2,739*A2+ 1,160*A3+ 2,017*A4+ 0,852*A5+ 1,220*A6- 0,561*A7- 0,640*A8- 0,313*A9- 0,308*A10

When the numerical values of F1more F2predict a low risk of adverse currents GERD, a value of F2more F1- high risk of adverse currents GERD.

The following table summarizes the characteristics of the signs and the coefficients of the discriminant functions (K1jTo2j).

SymptomsGradingTo1jTo2j
1. - The presence of dry0 - no-0,8392,427
cough (A1)1 -
2. - Presence0 - no-0,9252,739
history1 -
chronic
obstructive
lung disease
(A2)
3. - Presence0 - no-0,9251,160
history1 -
bronchial
the ASTM is (A 3)
4. - Regular0 - no-0,6742,017
receiving1 -
bronchodilators
drugs (A4)
5. - Presence0 - no-0,2720,852
sore throat1 -
(A5)

6. - Presence0 - no-0,4261,220
history1 -
chronic
diseases of ENT-
bodies
(laryngitis,
pharyngitis,
sinusitis,
recurrent
otitis media)
(A6)
7. - Severity0 - no0,179-0,561
cardiology (A7)1 - minimal
2 - moderate
3 - significant
8. - Regular0 - no0,213-0,640
receiving beta1 -
blockers (A8)
9. - Regular0 - no0,112-0,313
receiving1 -
antagonists
calcium (A9)
10. - Duration0 - no0,096-0,308
transferred1 - up to 1 year
violations2 - up to 2 years
brain3 - up to 3 years
blood supply4 - up to 4 years
(A10)5 - from 5 years or more

A comparative analysis was performed with the prototype showed that the proposed method differs from the known above-mentioned methods, and therefore meets the criterion of the invention of "novelty."

The analysis of patent and literature the authors found that the proposed method has characteristics that distinguish it not only from the prototype, but also other technical solutions in this and related fields of medicine. In the available literature is not identified with the person predicting adverse flow of GERD on the above risk factors.

Clinical observations of the authors of the proposed method show that the proposed technical solutions allow to predict the adverse flow of GERD in a particular patient. The accuracy of the forecast unfavourable flow GERD is 96,6%.

This allows to conclude that the technical solutions according to the criterion of "inventive step".

A method for predicting adverse currents GERD, constituting the invention, intended for use in health care. The implementation of its capabilities is confirmed as described in the application techniques and equipment. From the above it follows that the claimed invention meets the condition of paternopoli "industrial applicability".

The proposed method is as follows.

At clinical examination and analysis of the patient card identify clinical symptoms and risk factors: the presence of dry cough, history of chronic obstructive pulmonary disease, a history of bronchial asthma, regular intake of bronchodilator drugs, the presence of sore throat, history of chronic diseases of ENT-organs (laryngitis, pharyngitis, sinusitis, recurrent otitis media), the severity of cardialgia, regular intake of beta-bloccato is s, regular intake of calcium antagonists, the prescription transferred violations of cerebral circulation. Established signs are assigned grades and numeric values. Then using the formula to determine the prognostic factors F1and F2compare their numerical characteristics between themselves and assess the risk of development of severe forms of GERD. Thus, when the numerical values of F1more F2predict a low risk of adverse currents GERD, a value of F2more F1- high risk of adverse currents GERD.

The proposed method for predicting adverse currents GERD is illustrated by examples of specific performance.

Example 1.

Patient A., 1936 birth. The diagnosis of GERD. Erosive reflux esophagitis And the stage is set after the survey in 2003. Using data from the patient card identified the following risk factors: presence of dry cough - 1 (A1=1), history of chronic obstructive pulmonary disease - 1 (a2=1), a history of bronchial asthma - 0 (A3=0), regular intake of bronchodilator drugs - 1 (a4=1), the presence of sore throat - 1 (a5=1), history of chronic diseases of upper respiratory tract (chronic atrophic laryngitis and recurrent bilateral otitis media) - 1 (a =1), the severity of cardialgia - 3 (a7=3), regular use of beta-blockers - 0 (A8=0), regular intake of calcium antagonists - 1 (a9=1), the prescription transferred ischemic - 2 (a10=2).

F1=-0,967 - 0,839*1 - 0,925*1 - 0,389*0 - 0,674*1 - 0,272*1 - 0,426*1 + 0,179*3 + 0,213*0 + 0,112*1 + 0,096*2=-3,26

F2=-7,339 + 2,427*1 + 2,739*1 + 1,160*0 + 2,017*1 + 0,852*1 + 1,220*1 - 0,561*3 - 0,640*0 - 0,313*1 - 0,308*2=0,354

F2more F1(0,354>-3,26). Therefore, in this patient A. defined high risk of adverse currents GERD. When re-examination of patients diagnosed in 2008 D stage erosive reflux esophagitis complicated formed stricture, i.e. the prediction was confirmed.

Example 2.

Patient K., 1925 birth. The diagnosis of GERD. Erosive reflux esophagitis And the stage is set after the survey in 2003. Using data from the patient card, identified the following risk factors: presence of dry cough - 0 (A1=0), a history of chronic obstructive pulmonary disease - 0 (A2=0), a history of bronchial asthma - 0 (A3=0), regular intake of bronchodilator drugs - 0 (A4=0), the presence of sore throat - 0 (A5=0), a history of chronic diseases of upper respiratory tract (chronic atrophic laryngitis and recurrent middle of bilateral otitis media) - 0 (A =0), the severity of cardialgia - 1 (a7=1), regular use of beta-blockers - 1 (A8=l), regular intake of calcium antagonists - 0 (A9=0), the prescription transferred ischemic - 0 (A10=0).

F1=-0,967 - 0,839*0 - 0,925*0 - 0,389*0 - 0,674*0 - 0,272*0 - 0,426*0 + 0,179*1 + 0,213*1 + 0,112*0 + 0,096*0=-0,575

F2=-7,339 + 2,427*0 + 2,739*0 + 1,160*0 + 2,017*0 + 0,852*0 + 1,220*0 - 0,561*1 - 0,640*1 - 0,313*0 - 0,308*0=-8,540

F1more F2(-0,575>-8,540). Therefore, in this patient K. defined low risk of adverse currents GERD. When re-examination of the patient in 2008 diagnosis: Neurosigma reflux disease. Catarrhal reflux esophagitis, i.e. the prediction was confirmed.

Evaluation of the effectiveness of the proposed method of forecasting was conducted in the experimental group, 918 patients with GERD and in the control group of 152 patients without clinical and instrumental signs of GERD. The experimental group was presented 612 women and 306 men, average age of 77.0±5,9 years. Of them neurosigma reflux disease was diagnosed in 533, And-To the extent (Los Angeles classification) erosive reflux disease - 87, C-D grade erosive reflux disease - 233, Barrett's esophagus - in 65 patients. Patients of the experimental group were followed for 5 years. Completed a prospective study 891 patients (27 patients dropped out the cause of death from cardiovascular disease). The accuracy of the prediction amounted to 96.6%.

Thus, the proposed method provides the possibility of predicting the adverse flow of GERD in patients with episiode (atypical) symptoms of the disease, allowing earlier initiation of preventive measures. The method is simple to perform, because it includes the identification of risk factors based on traditional clinical examination of the patient.

A method for predicting adverse flow of gastroesophageal reflux disease (GERD), including the identification of clinical symptoms and risk factors from the history of life, characterized in that they determine the presence of dry cough, history of chronic obstructive pulmonary disease, a history of bronchial asthma, regular intake of bronchodilator drugs, the presence of sore throat, history of chronic diseases of ENT-organs (laryngitis, pharyngitis, sinusitis, recurrent otitis media), the severity of cardialgia, regular use of beta-blockers, regular intake of calcium antagonists, the prescription transferred ischemic establish their grades and numeric values, and then determine the prognostic factors F1and F2formula:
F1=-0,967 - 0,839∗And1- 0,925∗And2- 0,389∗And3 - 0,674∗And4- 0,272∗And5-0,426∗And6+ 0,179∗And7+ 0,213∗A8+ 0,112∗A9+ 0,096∗And10
F2=-7,339 + 2,427∗A1+ 2,739∗A2+ 1,160∗And3+ 2,017∗And4+ 0,852∗And5+ 1,220∗And6- 0,561∗And7- 0,640∗A8- 0,313∗A9- 0,308∗A10,
where A1...10- grades and numeric values of clinical symptoms and risk factors: A1- the presence of dry cough, with assigned: 0 - no, 1 -;2- a history of chronic obstructive pulmonary disease (COPD), assign: 0 - no, 1 -;3- a history of bronchial asthma (BA), assign: 0 - no, 1 -;4- regular intake of bronchodilator drugs assign: 0 - no, 1 -;5- the presence of sore throat, while assigned: 0 - no, 1 -;6- a history of chronic diseases of ENT-organs (laryngitis, pharyngitis, sinusitis, recurrent otitis media), assign: 0 - no, 1 -;7- the severity of cardialgia, while assigned: 0 - no, 1 - minimal, 2 - moderate, 3 - significant; A8- regular use of beta-blockers, while assigned: 0 - no, 1 -;9- regular intake of calcium antagonists, while assigned: 0 - no, 1 -;10- prescription of cerebral circulation, while assigned: 0 - n is t, 1 - up to 1 year 2 - from 1 year to 2 years, 3 from 2 years to 3 years, 4 from 3 years to 4 years 5 5 years or more and when F1more F2predict a low risk of adverse currents GERD, a value of F2more F1- high risk of adverse currents GERD.



 

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FIELD: medicine.

SUBSTANCE: method involves applying biological indicator as mixture composed of 0.1% aqueous solution of amino acids: leucine, glycine, proline, serine, phenylalanine, histidine, oxyproline, arginine, glutamic amino acid and aspartic amino acid, 0.5% aqueous solution of neuromediators like dopamine and histamine, 12% aqueous solution of magnesium sulfate in proportion of amino acids : neuromediators : magnesium sulfate = 4:1:5. Indicator kept on neck surface in thyroid gland projection during 3-5min. It is dried at T=+35-40°C, studied in polarized light with quartz compensator. Columnar, columnar-and-striated, sheaf-like crystals and discharged polygonal variegated chambers being observed, thyroid gland hyperfunction is to be diagnosed.

EFFECT: high accuracy of diagnosis.

13 dwg

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