Start of section
Production, amateur
Radio amateurs
Aircraft model, rocket-model
Useful, entertaining 		Stealth Master
Electronics
Physics
Technologies
Inventions 		Secrets of the cosmos
Secrets of the Earth
Secrets of the Ocean
Tricks
Map of section
Start
Forum
Use of the site materials is allowed subject to the link (for websites - hyperlinks)

Navigation: =>

Home / Patent catalog / Catalog section / Back /

GASTROENTEROLOGY
INVENTION
Patent of the Russian Federation RU2145226

METHOD OF SELECTING PHARMACOTHERAPY FOR DUODENAL YEARS

METHOD OF SELECTING PHARMACOTHERAPY FOR DUODENAL YEARS

The name of the inventor: Aliev IM; Briskin BS; Vertkin AL; Polonsky A.K .; Kornienko AA; Nazarova O.V.
The name of the patent holder: Aliev Ismail Mamedovich; Briskin Benujan Semenovich; Vertkin Arkady Lvovich; Polonsky Alexander Kupriyanovich; Kornienko Alexander Andreevich
Address for correspondence: 109387, Moscow, ul.Krasnodonskaya, 2, building 1, ap. 208, Aliev I.M.
Date of commencement of the patent: 1998.10.07

The invention relates to medicine and is intended for the selection of pharmacotherapy for duodenal ulcers. Preparations are prescribed taking into account gastric secretion. Additionally, microcirculation in the mucous membrane of the pyloroduodenal region is determined using endoscopic Doppler flowmetry. In the presence of increased secretion and reduced microcirculation, actovegin and additionally H2-blockers of histamine receptors are prescribed in patients under 50 years old, and in patients after 50 years of additional omeprazole. With normal secretion and reduced microcirculation, one actovegin is prescribed. With normal secretion and unchanged microcirculation, drugs that improve reparative processes are prescribed. The method allows for treatment taking into account pathogenetic features during the course of the disease with the use of a minimal amount of drugs.

DESCRIPTION OF THE INVENTION

The invention relates to medicine and is intended for the selection of pharmacotherapeutic agents in the treatment of duodenal ulcers.

Treatment of patients with peptic ulcer is a complex task. Despite the appearance of more and more new antiulcer drugs, up to the present time it has not been possible to solve the problem of treating patients with peptic ulcer and to reduce the number of its relapses. The variety of methods of treatment and medicines is explained, on the one hand, by the desire to influence the known etiological factors and links in the pathogenesis of peptic ulcer, and, on the other hand, their insufficient effectiveness.

Up to the present time, there is an opinion on the need for an integrated approach to the treatment of patients with peptic ulcer disease with an attempt to influence the main links of the pathogenesis of this disease and correction of the disorders occurring in the body. However, the approach to the treatment of this pathology from the position of monotherapy is becoming increasingly widespread. The appointment of a minimum amount of drugs, on the one hand, avoids the side effects of their use, on the other hand, the use of a single effective medication that affects the main links of the pathogenesis of peptic ulcer, as shown by clinical observations, allows to achieve the same, and sometimes whiter High results than the use of a complex of drugs.

One of the important sections in antiulcer therapy is taken by drugs that inhibit the secretory function of the stomach (Isakov VA, etc. New in the treatment of peptic ulcer of the duodenum.Math of the Fourth All-Union Congress of Gastroenterologists, M.-L., 1990, v. 1, Pp. 219-220).

The H2-blockers of histamine receptors (cimetidine, ranitidine, famotidine) occupy the leading place in the therapy of peptic ulcer with the above mentioned means. These drugs, connecting with histamine H2-receptors in parietal cells of the stomach, block the action of histamine, reduce the secretion of gastric juice, inhibit basal and night secretion, and secretion stimulated by food intake.

The method of choosing pharmacotherapy of duodenal ulcers by means of the appointment of funds with the account of secretory secretion is the closest analogue of the proposed method (AS Loginov et al., Ulcer and Helicobacter pylori, New Aspects of Pathogenetic Therapy, M., 1993, pp. 142-150) . However, suppression of the acid-forming function of the stomach with the help of antisecretory drugs does not always lead to the desired results in patients with peptic ulcer. On the one hand, this may be due to the fact that increased acid formation in the stomach can not always be attributed to aggressive factors, and in some cases this state may be a variant of constitutional features.

More and more attention is paid to the study of the protective properties of the mucosa, which play a more significant role in the development of ulcerative lesions than aggressive factors. Aggressive properties of gastric juice play a pathogenetic role in duodenal ulcer only in 50% of cases (Boger MM Peptic ulcer, Novosibirsk, 1986, p. 257). Barrier properties of the mucosa are caused not only directly by the epithelial layer, but represent a complex system that includes a layer of surface mucus, surface epithelial cells, and the circulatory system of the mucous membrane. The latter seems particularly important. The study of the state of regional microcirculation in the experiment shows that it is closely related to the structure and function of the gastro-duodenal zone, and consequently, to the pathogenesis and healing of ulcers. Blood flow in the mucous membrane, regulated by a neuro-humoral route, changes and under the influence of local metabolic factors, such as prostaglandins, leukotrienes and other endogenous metabolic mediators of the mucosa. The factors that form in the endothelium induce vascular relaxation or contraction, which determines the circulation in the gastroduodenal zone. It was shown that there is a close connection between the disruption of circulation in the gastric mucosa and the presence of increased acidity in the pathogenesis of experimental alcohol ulcers. The circulation was then evaluated spectrophotometrically (Sato N. et al., "Gastric blood flow in ulcer diseases" Scand J Gastroenterol., Suppl., 1995, 208, 14-20). Laser flow Doppler flowmetry (Fallone CA Topical nicotine profects rat gastric mucosa aganist ASA-induced damage Dig. -Dis. -Sci, 1995, 40.5, 936-942) is also used to assess the flow of the gastric mucosa. Various experimental factors confirm that a decrease in blood flow is one of the most important factors in the pathogenesis of ulceration of the mucosa.

In clinical conditions for the choice of pathogenetically determined pharmacotherapy of peptic ulcer of the duodenum, it is necessary to have reliable information about the state of microcirculation of the gastroduodenal mucosa in combination with gastric secretion data.

The technical result of the proposed method is the use of pathogenetically grounded pharmacotherapy, which makes it possible to achieve ulcer healing in conditions of using a small amount of drugs. The technical result is achieved due to the combined determination of the nature of gastric secretion and the state of microcirculation of the gastric mucosa with the help of endoscopic laser Doppler flowmetry and the selection of a combination of different preparations taking into account the obtained data.

To study the microcirculation of the gastric mucosa, the microcirculation parameters of the pyloroduodenal region were determined using laser Doppler flowmetry (LDF) using the domestic LAKK-01 apparatus. The following indices were recorded and calculated: arithmetic mean (H), mean square deviation (SDR), coefficient of variation (CV), frequency of vasomotion (VV), vasomotion amplitude (AV), vascular tone and microcirculation (MCR) efficiency. The study was carried out using a light guide guided through a gastroscopy.

The method is carried out as follows. The patient is evaluated using conventional techniques for gastric secretion. When performing gastroscopy through the lightguide, the state of microcirculation is evaluated using laser Doppler flowmetry. Based on the parameters obtained, the state of microcirculation is assessed as reduced or unchanged, comparing with the corresponding normal age indices. When choosing pharmacotherapy, take into account the state of secretion and the state of microcirculation. The choice of appropriate pharmacological agents is determined by the characteristics of these two states. As shown by clinical studies, there is no direct relationship between the state of secretion and the state of microcirculation in pyloroduodenal ulcers. Thus, increased secretion can be accompanied by both reduced and unchanged microcirculation; Normal secretion may be accompanied by reduced microcirculation; Normal state and secretion and microcirculation can and do occur in the presence of an ulcer.

In the event that increased secretion and reduced microcirculation is detected, actovegin is prescribed as a means to improve microcirculation, a drug from the group of H2-blockers of histamine receptors in patients under 50 and omeprazole after 50 (our studies showed the effectiveness of these drugs, depending on the age Patients).

When determining normal secretion and reduced microcirculation, only actovegin is prescribed, and with normal secretion and unchanged microcirculation, drugs that improve repair processes, for example methyluracil.

In the course of treatment with repeated gastro- and duodenoscopies with endoscopic determination of the state of microcirculation, it is possible to make appropriate correction of treatment depending on the state of microcirculation and secretion.

Example 1 . Patient NG, 42, was hospitalized in the gastroenterology department with a diagnosis of duodenal ulcer. Suffers from this disease for 5 years with spring and autumn exacerbation. The patient in the department was examined. With EHD-scopies on the anterior wall of the duodenum ulcer up to 0.6 cm in diameter with an inflammatory shaft, deformation of the bulb of the duodenum was detected. At a roentgenography of a stomach the diagnosis is confirmed. When studying the microcirculation of the stomach and duodenum revealed: microcirculation in the body and the bottom of the stomach is increased, in the antrum and pyloric sections of the stomach is reduced, and in the area of ​​the duodenal ischemia is determined.

In the study of acidity by the definition of gastrometry revealed: pronounced hyperacidity.

The patient is assigned H2-blockers of histamine receptors (ranitidine 150 mg x 2 times a day) and actovegin 2.0 x 2 times a day intramuscularly. Three days after the start of treatment, abdominal pain decreased, the condition improved. Seven days after the start of treatment, there is an improvement in microcirculation in the antrum and pyloric region of the stomach, the ischemia zone in the duodenal region disappeared, and the microcirculation parameters normalized in the region of the body and bottom of the stomach. The ulcer diminished in size almost twice (0.3 cm). In 12 days after the beginning of treatment the ulcer was healed, the microcirculation parameters in the body, bottom, antrum and pyloric parts of the stomach were normalized. However, there was a slight decrease in microcirculation in the area of ​​the duodenum.

The length of stay of patients in the hospital was 14 bed-days, whereas in the control group, where traditional methods were administered, 21 bed-days.

Example 2 . Patient A.S., 28 years old, entered emergency surgery in the surgical department with severe pain in the upper half of the abdomen. A differential diagnosis was made between acute pancreatitis and duodenal ulcer. Ulcerative and gastric history is absent. Against the background of treatment with spasmolytic pain in the abdomen decreased and the patient was examined. At US of organs of an abdominal cavity of a structural pathology from a liver, kidneys, a pancreas, a cholic bubble it is not revealed. With EHD-copy on the back wall of the duodenum ulcer up to 0.5 cm in diameter, covered with fibrin, moderately pronounced deformation of the pylorobulvar zone was found. With a fluoroscopy of the stomach, the diagnosis was confirmed. When studying microcirculation, it was found that in the pyloric part of the stomach the microcirculation was sharply reduced, and in the antrum part it was reduced insignificantly, and in the area of ​​the duodenum, especially on the posterior wall, ischemic foci were determined at a large extent despite the small size of the ulcer.

In the area of ​​the body and bottom of the stomach, microcirculation rates are slightly increased. In the study of acidity, the normocidal state is revealed. The actovegin was treated with 4.0 ml per 200.0 saline intravenously.

Seven days after starting treatment, the patient does not complain. The indices of microcirculation in the area of ​​the duodenum are increased almost 2.5 times in comparison with the baseline level, the ischemic ischemia is absent. Microcirculatory processes in the area of ​​the body and the bottom of the stomach were normalized. An ulcer of the same size, but there is no inflammatory shaft, there is a live granulation from the edge. After 14 days after the beginning of treatment, the ulcer was healed, the microcirculation rates were normalized in all parts of the stomach and duodenum. The length of stay of patients in the hospital was 16 bed-days, almost 1.5 times less than in the control group of patients.

Example 3 . Patient AK, 35 years old, entered the gastroenterology department with a diagnosis of duodenal ulcer. There is no gastric and ulcerative history. The patient in the department was examined. With EHD scopies on the anterior wall of the duodenum, immediately behind the doorkeeper, there is an ulcer up to 1.0 cm in diameter, covered with fibrin. With a fluoroscopy of the stomach, the diagnosis was confirmed. With Ph-metry - normocidal state. When studying the microcirculation of the stomach and duodenum revealed that the parameters of microcirculation within the norm. Treatment with methyluracil (to speed up the reparative process), vitamin therapy. Against the background of treatment, the patient's condition improved. With repeated EHD-scopies after seven days, the ulcer decreased in size to 0.4-0.5 cm, there was no inflammatory shaft, and live granulation was taking place from the edge. Indices of microcirculation of the stomach and duodenum within normal limits. After 12 days with EHD-scopy the ulcer was healed, the microcirculation and secretion rates were normal. The patient was hospitalized for 14 days.

The proposed method of choosing pharmacotherapy in the treatment of duodenal ulcers allows differentiation, taking into account the pathogenetic features of the course of the disease in a particular patient, to carry out treatment with the use of a minimal amount of drugs in a shorter time and with fewer complications. The use of endoscopic laser Doppler flowmetry makes it possible to conduct a reliable evaluation of microcirculation in the injury zone and, in combination with gastric secretion data, to select a particular approach in the therapeutic treatment of duodenal ulcers.

CLAIM

The method of choosing pharmacotherapy for duodenal ulcers, including the administration of drugs taking into account gastric secretion, characterized by the addition of microcirculation in the mucous membrane of the pyloroduodenal region with the help of endoscopic laser Doppler flowmetry and in the presence of increased secretion and reduced microcirculation, actovegin is prescribed and in patients under 50 years of age - H2-blockers of histamine receptors, in patients after 50 years - omeprazole, with normal secretion and reduced microcirculation - actovegin, with normal secretion and unchanged microcirculation - drugs that improve reparative processes.

print version
Date of publication 29.03.2007gg