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INVENTION
Patent of the Russian Federation RU2261091

METHOD OF THERAPY OF DIFFICULTIES AND EROSIONS OF GASTRODUODENAL SYSTEM

The name of the inventor: Efimenko N.V. (RU); Osipov Yu.S. (RU); Polushina N.D. (RU); Mosiyants LM (RU); Uvarova N.G.
The name of the patent holder: STATE ESTABLISHMENT "Pyatigorsk STATE RESEARCH INSTITUTE OF RESURRECTION OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION"
Address for correspondence: 357501, Stavropol Territory, Pyatigorsk, Kirova Ave., 30, State Institution "Pyatigorsk State Research Institute of Balneology of the Ministry of Health of the Russian Federation", patent specialist
The effective date of the patent: 2003.08.21

The invention relates to medicine, namely, to gastroenterology. Preliminarily determine the type of disturbance of the motility of contraction of the gallbladder and bile ducts, then assign a thermal, low-mineralized bicarbonate-sodium-sulphate-calcium magnesium mineral water to 200-300 ml three times a day one hour before meals, tumbles No. 3 with mineral water, baths and Shower with mineral water daily for 10-14 days. In the hypomotor type of motor, mineral water is used 25-30 degrees, and for the hypertonic type - 38-40 degrees. The method allows to accelerate the scarring of ulcers and the epithelization of erosions of the gastroduodenal system, to prevent frequent exacerbations, to reduce the activity of Helicobacter pylori.

DESCRIPTION OF THE INVENTION

The present invention relates to the field of medicine, in particular gastroenterology, namely to the treatment of hard-healing ulcers and erosions, and can be used in sanatorium-and-spa institutions.

In recent years, there has been an increase in patients with weighted forms of gastroduodenal pathology, which include long-term non-healing and often recurrent ulcers and erosions of the stomach and duodenum. This leads to a decrease in the quality of life and long-term disability of patients.

Many works are devoted to the problems of gastroduodenal ulcers and erosions, where the urgency of careful study of their weighted forms is substantiated (P.Ya.Grigoriev, E.P. Yakovenko, 1996; V.T.Ivashkin, 1997-2002; J.S. Zimmermann et al. , 1997, 1998; Ryss BC, Zvartau EE, 1998; AV Kalinin, 2001; YV Vasiliev, co-author, 2001, 2002).

Pathogenetic heterogeneity and ineffective treatment of patients with hard-healing ulcers and eruptions of the duodenum causes a large number of therapeutic techniques, mainly using pharmacotherapy agents that affect the various etiopathogenetic links of the disease.

There are known methods of treatment of patients with hard healing gastroduodenal ulcers and erosions using medicinal antiulcer drugs: H ₂ -blockers of histamine receptors, proton pump inhibitors, antihelikobakternyh schemes, including antibacterial drugs and colloidal bismuth subcitrate, "local" treatment by endoscopic medication administration (P.A. Koltsov, AI Shatikhin, 1994; AA Sheptulin, 1996; VT Ivashkin 1996-2002; PA Nikiforova, 1997; SVBelmer, 1997; TLLapina, 1999, 2001; SI Pimanov, 2000, etc.).

The disadvantage of these methods is the impact only on local "aggressive" factors (acidophilic and infectious - Helicobacter pylori). However, the formation of refractory ulcers and erosions is largely due to complex violations of the body's regulatory systems, the severity of which leads to a significant weakening of "protective" factors and a decrease in the processes of repair and regeneration. To increase the effectiveness of treatment, it is necessary to use factors that increase the sanogenetic capabilities of the whole organism. Sanatorium-and-spa therapy, in particular, drinking mineral water, meets these requirements.

The closest in technical essence to the proposed method is the method of treatment of patients with duodenal ulcer in the phase of exacerbation, consisting in the appointment of patients with a three-component antihelicobacter therapy (omeprazole 20 mg twice a day, metronidazole 500 mg twice a day and amoxicillin 1, 0 g 2 times a day with the subsequent maintenance therapy blockers of H ₂ -receptor histamine - famotidine (Standards for diagnosis and treatment of digestive organs, 1998).

Disadvantages of this method is that, unlike uncomplicated peptic ulcer, where cicatrization of ulcers occurs in 80-90% of cases within 3-4 weeks, with hard-healing ulcers and erosions of the gastroduodenal zone with the use of these medicines scarring of erosive-ulcer defects in The specified dates do not come, but are delayed up to 8-12 weeks. In addition, in 70% of cases there is a recurrence of ulceration up to 3-4 times a year.

The technical result of the proposed method of treatment of patients with hard healing ulcers and erosions of the gastroduodenal zone is the stimulation of hormonal blocks of regulation and reparative capacity of the gastroduodenal mucosa, manifested in accelerating the timing and improving the quality of ulcer scarring, potentiating the effect of eradication anti-Helicobacter therapy, which helps to reduce the degree of contamination with the gastroduodenal Helicobacter mucosa, The period of remission and reduces the number of relapses of erosion and ulceration.

The specified technical result is achieved by the prescription of drinking mineral water "Essentuki-Novaya" (carbonic acid hydrocarbonate-sulphate-chloride sodium-calcium MB of low mineralization - 3.2-3.5 g / l) for 3-3.5 ml per 1 kg of body weight 3 times a day 30 minutes before meals in a warm state against the background of drug therapy (famotidine 20 mg twice a day, denol at a daily dose of 480 mg divided into four doses, amoxicillin 1.0 g 2 times a day, metronidazole 500 mg 2 times a day for a week, then famotidine 20 mg overnight for the next 3 weeks).

The use of drinking mineral waters in combination with drug antiulcer therapy in this mode is a fundamentally new direction in the treatment of patients with peptic ulcer disease with the presence of a long-lasting non-healing ulcerative defect and previously in medical practice both therapists and spa physicians were not used. Meanwhile, it is with this technique that under the "cover" of medicines there is the possibility of the most complete realization of the entire complex of reactions to drinking effects, especially the hormone-modulating effect of the course of drinking mineral water, which contributes to the significant activation of reparative processes in the gastroduodenal mucosa, the elimination of inflammatory-destructive changes, the acceleration of scarring erosively Ulcer defects and faster reduction of clinical symptoms of the disease. This technique is optimal for this category of patients also because the mineral water replaces in the cases of concomitant gastroduodenostasis prokinetics, has a potentiating effect on the anti-Helicobacter pylori activity of medicines, has an additional antacid effect.

Description of the method

The method is carried out as follows: first medication in the morning: one hour before breakfast, patients take 20 mg of famotidine, 30 minutes before breakfast, 120 mg of denol, with 200 ml of MB, after eating 0.5 g of metronidazole, after 30 minutes, 1.0 g of amoxicillin . The second reception in the afternoon: 30 minutes before lunch - 120 mg of denol, washing down MB. The third reception in the evening: 30 minutes before dinner, 120 mg of denol, drinking MB, after eating - 0.5 g of metronidazole, after 30 minutes, 1.0 g of amoxicillin. At 21 hours - 20 mg famotidine, at night - the last (fourth) reception of 120 mg of denol for 7 days, then 20 mg of famotidine overnight for the next 3 weeks.

The method is illustrated by the above observations

Example №1

Patient K., 44 years old, was treated at the clinic from 07.10. To 29.10.2000 (medical history No. ...) The diagnosis is basic: duodenal ulcer in the stage of fading exacerbation (three hard-healing ulcers of the bulb of the duodenum, erosive bulbite).

At admission, he complained of occasional rare epigastric pains on an empty stomach and before a noisy meal, sometimes discomfort in the epigastrium.

Has been sick since 1995, the disease proceeds with frequent exacerbations (3-4 times a year), inpatient and outpatient treatment is ineffective, the ulcerative defect does not permanently cicatrize. When there was pain in the period between the course treatment episodically I used ranitidine. I arrived for the first time for sanatorium treatment.

In an objective study: the tongue is coated with white coating, the abdomen is of the correct configuration, in the act of respiration it participates in all parts, soft, with palpation moderately painful in the pyloroduodenal region.

Laboratory data: general blood and urine tests without pathology. There are deviations in the hormonal profile of the blood: cortisol - 271.23 nmol / l, insulin - 7.7 mIU / ml, gastrin - 2.8 pmol / l. "Helic" -test: (++). EGDFS from 10.10. Mucous body of the stomach edematous, hyperemic, loose. In the antral part of the stomach, the mucosa is variegated, dull, atrophic. The bulb of the duodenum is roughly deformed. Mucous bulbs edematic, hyperemic, with a lot of point, sharp erosion. On the anterior and posterior walls of the bulb there is one shallow ulcer up to 0.5 cm in diameter, covered with a grayish coating. In the distal part of the bulb, a third ulcer, up to 0.7 cm in diameter, is covered with a gray coating on the posterior wall. The postbulbar department of the duodenum is without features.

I received the following treatment: mineral water Essentuki-Novaya 200.0 ml 3 times a day 30 minutes before meals, diet food (diet number 1, then diet number 5), and drug therapy (famotidine 40 mg / day, denol 480 mg / Day, amoxicillin 2.0 g / day, metronidazole 1 g / day) according to the developed by us scheme of combined intake of mineral water and medicines.

After the treatment, the condition improved significantly, which was confirmed by additional studies. On control EGDFS from 26.10: endoscopically erosion and ulcers in the bulb DC are no longer determined (stage of "red cicatrix"), there is only a mild hyperemia of the duodenal mucosa.

The patient's hormonal status improved with a tendency to normalize cortisol 467.72 nmol / l, insulin 17.64 mIU / ml, gastrin 3.9 pmol / l.

Helic test - weakly positive (+).

Thus, after a course of combined therapy (MB Essentuki-Novaya and medicines), a positive clinical effect is noted, in a short time (16 days), clinical endoscopic remission is provided. The patient is discharged with significant improvement.

Example №2

Patient V., 27 years old, was in the clinic from 6.03. To 20.03.2001 year (case history №43). The main diagnosis: duodenal ulcer in the acute stage: hard-healing ulcer of the bulb of the duodenum. Concomitant diagnosis: Irritable bowel syndrome with constipation predominance.

At admission I complained of pains in the epigastric region on a "hungry stomach", docked with food, heartburn, a tendency to constipation, a headache in the nape of the neck.

Sick for about two years, exacerbation 2-3 times a year with the presence of hard-healing ulcer of the duodenum. He was treated repeatedly hospitalily and outpatiently, received omez, ranitidine, denol, anti-Helicobacter pylori metronidazole, furazolidone, but the ulcer cicatrices for a long time, more than 2 months, and the effect of treatment is short-lived. The aggravation occurred a week before admission to the clinic. Was not surveyed. I did not receive medication.

Objectively: the tongue is coated with a white coating, the abdomen is of the correct configuration, is evenly involved in the act of breathing, with palpation painful in the pyloroduodenal and epigastric regions, and along the colon. Emotionally labile, there is unstable red skin dermographism.

Laboratory data. General tests of blood and urine - without pathology. Cortisol - 736.5 nmol / l, insulin - 8.2 mIU / ml, gastrin - 2.9 pmol / l. Helic-test - (+).

EGDFS from 10.03. Mucous body and antrum of the stomach edematous, hyperemic. Mucous bulbs of the duodenum are edematic, hyperemic, friable. On the top wall of the bulb is a deep ulcer, up to 1.0 cm in diameter, covered with a white coating.

Received the following treatment: diet number 5, mineral water Essentuki-Nova 200.0 ml 3 times a day 30 minutes before meals, warm, medical treatment (famotidine 40 mg / day, denol 480 mg / day, amoxicillin 2 g / day , Metronidazole 1.0 g / day) according to the scheme of combined intake with mineral water.

With repeated EGDFS from 28.03. - Positive dynamics was noted: endoscopically the ulcer in the bulb of the duodenum was no longer determined, but the scar was not fully formed (the stage of the "red scar").

Helic-test showed no infection.

Laboratory indices: cortisol - 478.5 nmol / l, insulin - 17.4 mIU / ml, gastrin - 3.4 pmol / l, indicating a significant improvement in the hormonal profile.

Against the background of the treatment, heartburn disappeared on the third day, complaints of pain in the epigastric region - on the fifth day, palpation pain was not determined on the tenth day, the stool was normalized. Thus, after the treatment, which the patient tolerated well, all the subjective and objective manifestations of the disease disappeared against the background of improved hormonal status indicators.

This example illustrates the complementary influence and effective interaction of medications and MB Essentuki-Nova in a patient with a hard-to-recover duodenal ulcer in the phase of exacerbation, and a good eradication effect of the treatment regimen for helicobacteriosis.

The proposed method was studied in an experiment on 24 male rats of the Wistar line with a model of a double acetate ulcer and was performed in 62 patients with duodenal ulcer in the exacerbation phase with frequently recurring course and with the presence of hard-healing ulcers and erosions of the gastroduodenal zone. To characterize the functional state of the organism, clinical and laboratory studies (clinical and biochemical blood tests, determination of gastrin, cortisol and blood insulin, esophagogastroduodenofibroscopy, helikobacteriosis) were performed.

The obtained data were compared with the parameters of the control group (30 patients) who received only medication.

As a result of the treatment, the periods of arrest of pain, dyspeptic and astheno-neurotic syndromes were 2 times less in patients of the main group, the time of scarring of ulcerative defects was 4.8 days less, the percentage of patients with complete endoscopic remission was 96.7% versus 83.3% %.

There was a positive dynamics of hormonal indicators, manifested in a significant increase in the level of insulin, gastrin blood only in the 2nd (sanatorium) group. An increase in the insulin / cortisol ratio and a decrease in the degree of cortisolemia was observed in both groups, but was significantly more pronounced in the second group. According to the data of remote observations (12-18 months), the number of relapses decreased 2.3 times, 5.4 times the total number of days of incapacity for work.

In comparison with the prototype, this method has a positive effect on the clinical course of the disease: pain, dyspepsia and astheno-neurotic syndromes were significantly reduced, scarring of the ulcerative defect was observed in a short time (18-21 days), qualitative scarring was observed, mostly without gross cicatricial deformity, There was a potentiating effect on the eradication of pyloric Helicobacter, a stimulating effect on the hormonal regulation of the gastroduodenal region and the normalization of hormonal relationships were obtained.

The proposed method accelerates the scarring of ulcers and epithelization of erosion of GDS, prevents frequent exacerbations of the disease, reducing the activity of Helicobacter pylori, and forms a stable remission that persists for 10-12 months.

A distinctive feature of the proposed method is an increase in the effectiveness of treatment of patients with hard-healing ulcers and erosions of the gastroduodenal zone in the exacerbation phase associated not only with the potentiating effect of drinking mineral waters and pharmaceuticals but also with a qualitatively new effect of such a combination, conditioned by the possibility of implementing a powerful sanogenetic Effect of therapeutic factors of the resort, increasing the adaptive capabilities of the organism and contributing to the restoration of disturbed hormonal relationships and the activity of regulatory systems of the whole organism.

CLAIM

The method of treatment of hard-healing ulcers and erosions of the gastroduodenal system during the exacerbation phase, including the use of famotidine, de-nol, amoxicillin and metronidazole, characterized in that one hour before breakfast patients take 20 mg of famotidine, 30 minutes before breakfast, 120 mg de-nol, Its 200 ml of carbonic acid hydrocarbonate-sulphate-chloride sodium-calcium mineral water of low salinity - 3,2 - 3,5 g / l "Essentuki-Novaya", 3.0 - 3.5 ml per kg of body weight, after eating 0 , 5 g metronidazole, after 30 minutes 1.0 g amoxicillin, 30 minutes before lunch take 120 mg de-nil, washed down with the same mineral water, 30 minutes before dinner take 120 mg de-nol, washed down with the same mineral water , After eating 0.5 g of metronidazole, after 30 minutes, 1.0 amoxicillin, 21 mg of famotidine are taken at night, 120 mg of de-nol is taken at night for 7 days, then 20 mg of famotidine overnight for the next 3 weeks.

print version
Date of publication 29.03.2007gg

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