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INVENTION
Patent of the Russian Federation RU2261448

METHOD FOR DETERMINATION OF THE RESISTANCE OF THE RESISTANCE OF THE MULTIDISIC SHELL OF THE TWELFTH DIAGNOSTIC

The name of the inventor: Onopriyev VI (RU); Kokueva O.V. (RU); Kopytov E.L. (RU); Melnikov SN (RU); Usova O.A. (RU); Salomatin V.P.
The name of the patent holder: Russian Center for Functional Surgical Gastroenterology (RCFS) (RU); Vladimir Onopriyev (RU); Kokueva Olga Vasilievna (RU); Kopytov Evgeniy Lvovich (RU); Melnikov Sergey Nikolaevich (RU); Usova Olga Anatolievna (RU); Salomatin Vladimir Petrovich
Address for correspondence: 350063, Krasnodar, ul. Gray, 4, KGMA, head. Patent Department Doronina
Date of commencement of the patent: 2003.10.21

The invention relates to medicine, namely to gastroenterology, and can be used to determine the disturbance of duodenal mucosa resistance in patients with duodenal ulcer. Determination of the resistance disorder is carried out by measuring the rate of reverse diffusion of hydrogen ions (ODN) in the duodenal region isolated with the aid of a probe with inflatable cuffs, and with increasing its values ​​more than 1.8 mmol / 15 min, the resistance of its mucous membrane of varying severity is shown to decrease. The method allows to increase the effectiveness of treatment of patients with duodenal ulcer, to shorten the period of temporary incapacity for work.

DESCRIPTION OF THE INVENTION

The present invention relates to medicine, namely to gastroenterology, and can be used to determine the disruption of duodenal mucosal resistance in patients with duodenal ulcer.

A method of indirect assessment of the resistance of the mucous membrane of the duodenum and the condition of the mucosal barrier, which consists in the determination of carbohydrate-containing biopolymers in serum and urine [Vasilenko V.Kh., Grebenev A.L., Sheptulin AA Ulcer disease: modern concepts of pathogenesis, diagnosis, treatment. - Moscow: Medicine, 1987, - 288 pp.]. This method is not specific for the duodenal mucosa, since carbohydrate-containing biopolymers determined in serum and urine are the result of absorption of the decay products of fucoglycoproteins that make up the mucus covering the whole or a large part of the gastrointestinal tract, which makes it impossible to assess the condition Resistance of the duodenal mucosa. In addition, this method does not allow to assess the state of the mucous barrier itself, which has a gel structure and performs the function of protection, since carbohydrate-containing biopolymers contained in serum and urine are the result of absorption from the lumen of the gastrointestinal tract of components of soluble, "spent" mucus, Which was part of a layer of mucous gel and not possessing the function of protection.

The closest to the proposed invention adopted for the prototype is the method for studying the resistance of the mucous membrane of the stomach and duodenum by determining the transmucosal potential difference (TRP) [Rustamov GA Influence of selective proximal vagotomy on the protective barrier and blood flow of the gastric mucosa: Author's abstract. Dis .... cand. honey. Sciences. - 1982, - 20 s.]. In the determination of TRP, one electrode is placed subcutaneously, and the other electrode through the endoscope channel in fibroadastroduodenoscopy contacts the area of ​​the duodenal mucous membrane under investigation, while measuring the potential difference between the electrodes. The magnitude of TRP depends on the ion fluxes in the epithelial cells of the mucous membrane (H ⁺ , K ⁺ , Na ^- , CI ^- , HCO ₃^- ) [Ivashkin VT]. Metabolic organization of the functions of the stomach. - L .: Science, 1981]. In healthy people, negative TRP values ​​are observed, the decrease in resistance of the gastric and duodenal mucosa is accompanied by an increase in TRP and a change in TRP and a change in positive ones, while high TRP rates are noted in the area of ​​the bottom of the ulcer.

The disadvantage of this method is its low specificity, i.e. Unreliability. On the one hand, he gives only general ideas about the state of mucosal resistance, since one of the factors determining the resistance of the duodenal mucosa is the secretion of bicarbonate ions (HCO ₃^- ) by the mucosa. However, the flux of other ions also affects the magnitude of the TRP: K ⁺ , Na ^- , CI ^- . On the other hand, if the ion fluxes, including H ⁺ and HCO ₃ ions, influence the magnitude of the TRP, then there should be significant differences in the TRP values ​​in the acid-producing and acid-neutralizing zones of the stomach, in the duodenum. However, according to a number of authors, such differences are not observed, and high TRP indices are detected with atrophic gastritis, duodenitis and in the region of the bottom of a ulcerative defect, where there is no mucous membrane at all [Postolov PM, Rustamov GA, Kuzin NM Influence of selective proximal vagotomy on the protective barrier of the gastric mucosa // Surgery. - 1982. - №3. - С.6-10; Rustamov GA, Postolov PM, Kuzin NM, Zavonov V.Ya. Protective barrier of the gastric mucosa with peptic ulcer // Klin. honey. - 1982. - №4. - P. 32-36].

The object of the present invention is to increase the reliability of methods for studying the resistance of the mucosa.

Since the resistance of the duodenal mucosa is defined as the ability to withstand aggressive gastric juice factors and, primarily, hydrochloric acid, the proposed method makes it possible to quantitatively determine the ability of the duodenal mucous membrane to prevent diffusion of hydrogen ions by determining the rate of reverse diffusion of hydrogen ions (ODN ⁺ ) into the mucosa Shell of the duodenum, and to reveal a violation of its resistance in patients with duodenal ulcer. The obtained results of the determination of the speed of ODN ⁺ in the duodenal mucous membrane allow us to clarify the pathogenetic mechanisms of peptic ulcer of the duodenum and make justified adjustments to the treatment.

SUMMARY OF THE INVENTION. Determination of the resistance disorder is carried out by measuring the speed of ODN ⁺ in the duodenal region isolated with the aid of a probe with inflatable cuffs and increasing the values ​​of more than 1.8 mmol / 15 min, the resistance of its mucous membrane of varying severity is diagnosed (1.9-2.8 Mmol / min 15 min - mild, 2.9-3.8 mmol / 15 min - moderate, 3.9 mmol / 15 min and higher - marked reduction in resistance).

In practice, the method is carried out as follows: after probing, the perfusion of the test solution is carried out for 15 minutes through the diagnostic gap (the duodenal segment disengaged by means of cuffs). 100.0 ml of 0.1 N was used as the test solution. Solution of HCl. The change in the initial pH of the test solution (pH.) Upward after perfusion (pH) indicates the amount of hydrogen ions diffusing into the mucosa of the duodenum.

Calculations are performed according to the formulas:

PH = -lg [H ⁺ ], hence [H ⁺ ] = 10 ^-pH .

Since [H ⁺ ex.] = 10 ^-pHex. , And [H ⁺ con.] = 10 ^-pHcon. ,

Hence the ODN ⁺ = 10 ^-pNex. -10- ^pic. (Mol / l · 15 min)

Since the volume of the test solution is constant (100 ml), it can be neglected, and express ODN ⁺ in mmol / 15 min.

96 patients with peptic ulcer of duodenum with different degree of activity of ulcer process and 20 practically healthy persons of control group were examined. All patients were distributed depending on the activity of the ulcerative process and the severity of duodenitis. The basis was the classification of the phases of peptic ulcer disease [Grigoryev P.Ya., Yakovenko E.P. Diagnosis and treatment of diseases of the digestive system. - М .: Medicine, 1996, - 515 p.], Supplemented by endoscopic criteria of ulcer activity. The characteristic of the process consisted of a stage of activity or scarring of the ulcerative focus and a picture of conjugate changes in the mucous membrane. Reliable rank differences in the rates of ODN ⁺ depending on the activity of the pathological process are revealed (Table 1).

As can be seen from the table, a lower rate of ODN ^{+ is} noted in patients with an inactive, healed ulcer, in the absence of signs of duodenitis (A0, remission phase), remaining significantly higher in comparison with healthy individuals (control). As the activity increases, the rate of ODN ⁺ increases (A1, the phase of fading exacerbation) and reaches a maximum with active ulcer and pronounced duodenitis (A2, exacerbation phase).

Clinical examples

1. Subject D., aged 19; Diagnosis: almost healthy.

The sounding of the duodenum was performed with the disconnection of its site by means of cuffs.

The diagnostic interval was perfused with a test solution in a volume of 100 ml for 15 minutes with a previously measured pH. The pH of the test solution was measured after perfusion. The probe is removed.

PH measurement results:

- Initial pH of the test solution (pH) - 1.02

- pH of the test solution after perfusion (pH) - 1.08

^ODH+ = 10 ^-pNex. -10- ^pic. = 10 ^-1.02 -10 ^-1.08 =

0,095-0,083 = 0,012 (mol / l · 15 min), or 1.2 mmol / 15 min

The performed endoscopic examination did not reveal any pathological changes. Thus, this patient does not have a decrease in the resistance of the mucous membrane of the duodenum.

2. Patient S., 37 years old; In the anamnesis a peptic ulcer of a duodenum.

Installation of the probe and perfusion of the diagnostic gap with the test solution was carried out according to the established procedure.

PH measurement results:

- The initial pH of the test solution (pH) - 1.04

- pH of the test solution after perfusion (pH) - 1.15

^ODH+ = 10 ^-pNex. -10- ^pic. = 10 ^-1.04 -10 ^-1.14 =

0.0912-0.077 = 0.0188 (mol / l · 15 min), or 1.9 mmol / 15 min

With endoscopic examination, the patient showed scar deformity of the bulb without pronounced inflammatory changes in the duodenal mucosa (A0, remission phase). In this patient, a slight decrease in the resistance of the duodenal mucosa was noted.

3. Patient M., 42 years old; Diagnosis: peptic ulcer of duodenum in the stage of exacerbation.

Installation of the probe and perfusion of the diagnostic gap with the test solution was carried out according to the established procedure.

PH measurement results:

- The initial pH of the test solution (pH) - 1.03

- pH of the test solution after perfusion (pH) - 1.26

^ODH+ = 10 ^-pNex. -10- ^pic. = 10 ^-1.03 -10 ^-1.26 =

= 0,093-0,055 = 0,038 (mol / l · 15 min), or 3.8 mmol / 15 min

With endoscopic examination, the patient has an active ulcer of the bulb with pronounced inflammatory changes in the duodenal mucosa (A3, exacerbation phase). This patient has a marked decrease in duodenal mucosal resistance.

Thus, based on the above clinical examples show that in healthy individuals at a speed of ODN ⁺ 1.8 mmol / 15 min or less, there is no decrease in the resistance of the duodenal mucosa, while the absence of pathology is confirmed endoscopically. An increase in ODN ⁺ more than 1.8 mmol / 15 min is associated with a decrease in duodenal mucosal resistance in patients with duodenal ulcer, with an appropriate endoscopic picture of the disease.

Establishment of the fact of reducing the resistance of the mucous membrane of the duodenum allows us to clarify the pathogenetic mechanisms of ulceration (weakness of the mechanisms of protection of the mucous membrane of the duodenum) and include in the complex of therapeutic measures of patients with duodenal ulcer and with an average degree of severity and expressed decrease in the resistance of the duodenal mucosa preparations that increase the protective potential of the mucosa Shell of the duodenum. This will increase the effectiveness of treatment of patients with duodenal ulcer, reduce the time of temporary disability.

CLAIM

A method for determining the disorder of duodenal mucosal duodenal ulceration including duodenal sounding, characterized in that the probe cuffs isolate the duodenal bulb, determine the rate of reverse diffusion of hydrogen ions and, at a value of more than 1.8 mmol / 15 min, establish a decrease in the resistance of the mucosa of the duodenum .

print version
Date of publication 29.03.2007gg

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