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INVENTION
Russian Federation Patent RU2120226

METHOD FOR INTEGRATED ASSESSMENT motor function stomach and small intestine HUMAN

METHOD FOR INTEGRATED ASSESSMENT gastric motility
And small intestine HUMAN

Name of the inventor: Churin BV
The name of the patentee: Scientific Research Institute of General Pathology and Human Ecology SB RAMS
Address for correspondence:
Starting date of the patent: 1994.06.08

The invention relates to medicine, gastroenterology. The method allows us to investigate the motor activity of the stomach, and 12 duodenal jejunal and give an opinion on the normal or impaired their work. In the antrum, the bulbs 12 duodenal ulcer, the transition zone 12 duodenal ulcer in the jejunum, proximal portion of the jejunum catheter with load cells. Record the amplitude of the waves of motor activity of the test sites after receiving protein. Calculate the amount of mechanical work performed by each site and their relationship. According to the obtained coefficients conclude on normal or impaired motor activity of the stomach and small intestine.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, namely to methods for integrated evaluation of motor function of the stomach and the proximal portion of the small intestine and can be used for diagnosis of gastrointestinal disorders, but also for research in physiology and pathophysiology of indigestion.

There is a method of integrated assessment of motor function of the stomach and small intestine (LA Houghton, NWReed, R.Heddle et al, 1988), comprising administering to the test through the lower nasal passage 8 catheters, perfused fluid to the pyloric antrum of the stomach and 12 duodenal ulcer , the measurement of motor activity of the stomach and duodenum 12 and fasted after administration of the reference food.

The disadvantage of this method is that it does not allow to quantify the motor activity of the jejunum, where along with the duodenum 12 most actively carried digestion (homeostasis food chyme, splitting food ingredients and monomers absorption), does not contain any assessment of the volume ratio of mechanical work done adjacent portions of the upper gastrointestinal tract (GIT). Furthermore, the use of catheters 8 total diameter 6.5 cm uncomfortable for the subject, as during the test it has to stay in a fixed position; perfused catheters in the liquid, mixing with food, leads to a distortion of the measurement results obtained.

The closest to the claimed technical solution is the way to a comprehensive assessment of gastric motility and small intestine, taken as a prototype (Churin BV, 1993), comprising administering to the strain gauges in the gastric antrum, the bulbs 12 duodenal ulcer, the transition zone 12- ulcer in jejunum and proximal jejunum at a distance of 16 and 32 cm from the Treitz ligament attachment registering physical activity in said areas, determining the duration of the periodic motor activity of gastrointestinal tract cycles (PDAPT) alternate reception during the day reference carbohydrate, protein or fatty foods after the passage of motor activity transition zone front 12 duodenal ulcer in the jejunum, the registration time of the appearance of the first phase of migrating rhythmic (MYFF) in the transition zone 12 duodenal ulcer in the jejunum, an opinion on the completion of digestion in the upper gastrointestinal tract.

The disadvantage of this method is the lack of quantitative criteria of physical activity (mechanical work) of individual sections of the stomach and small intestine and consistency in the adjacent areas, which is important for the diagnosis and prevention of peptic ulcer disease. Another disadvantage is the duration of the examination (24-48 hours).

The task to be solved by the claimed invention is to expand the functionality of the method by quantifying the locomotor activity of individual sections of the stomach and small intestine, and the ratio of the volume of executed mechanical work, shortening the survey.

To solve this problem perform the reception of the reference protein foods, for two hours after a meal recorded amplitude of motor activity waves (Awdal) antrum, bulbs 12 duodenal ulcer, transition zone 12 duodenal ulcer in the jejunum and the proximal portion of the jejunum, in the sum of the amplitudes of the waves determine the amount of mechanical work performed by each section of the digestive tract, and the ratio of the volume of mechanical work between adjacent areas on the coefficients

K1 = sum of Awdal antrum / Awdal amount bulbs 12 duodenal ulcer;

K2 = the sum of Awdal bulbs 12 duodenal ulcer / amount of Awdal transition zone 12 duodenal ulcer in the jejunum;

K3 = sum of Awdal transition zone 12 duodenal ulcer in the lean / Awdal amount of the proximal portion of the jejunum,

when the amount of mechanical work antrum 147-490 kPa, bulbs 12 duodenal ulcer - 392-833 kPa, transition zone 12 duodenal ulcer in the jejunum - 490-833 kPa, the proximal portion of the jejunum - 580-882 kPa and the values ​​of the coefficients K1 = 0,20-0,75; K2 = 0,50-0,85; K3 = 0,60-0,95 conclude on normal motor activity of the stomach and small intestine.

The process is carried out as follows:

One day prior to study medication and physiotherapy canceled. On the morning of the study, patients self-emptied intestines.

Locomotor activity (mechanical work) of the stomach and small intestine was investigated by the method developed by us using a special catheter with an outer diameter of 2 mm, equipped with four load cells (Gridchin VA Kiriushin LP, Malkov VA, Churin B. V., 1990; Churin BV, 1992).

After introduction of the catheter into the digestive tract through the lower nasal meatus it was adjusted so that the proximal strain gauge located in the antrum of the stomach, while the remaining load cells occupied the position in the bulb 12 of the duodenum, in the transition zone 12 duodenal ulcer in jejunum and in the proximal jejunum colon 16 cm distal to the Treitz ligament attachment. The distance between the sensors is equal to 16 cm between the sensors only in the antral stomach and bulb 12 duodenum it was 8 cm.

Mechanogram recorded on paper tape recorder. Within the first 30-90 minutes. study the amplitude of the motor activity of the digestive tract waves recorded on an empty stomach.

After passing the front of the motor activity (the main visual feature of the periodic activity of the gastrointestinal tract that occurs on an empty stomach), the transition zone 12 in the duodenum jejunum examinee given reference protein foods (150 g of minced meat of lean beef and 250 ml of broth).

On mechanogram for 2 hours after a meal recorded the amplitude of waves of motor activity (Awdal) in the antrum area, the bulb 12 duodenal ulcer, in the transition zone 12 duodenal ulcer in the jejunum and in the proximal jejunum 16 cm distal attachment Treitz ligament. On the sum of Awdal 2 hours assessed amount of mechanical work done by each section of the digestive tract in kilopascals (kPa). According coefficients K 1 -K 3 determined volume ratio of mechanical work between neighboring areas.

The duration of study was 2.5-3.5 hours.

In clinical conditions examined 81 men aged between 18 and 60 years, 12 of them are found to be healthy and 69 - the patients (51 persons -. Ulcer 12 duodenal ulcer, 6 - gastric ulcer body, 7 - chronic opisthorchiasis, 3 - chronic gastroduodenitis, 2 - chronic cholecystopancreatitis).

The results of assessment of the amount of mechanical work the upper digestive tract are shown in Table 1. As can be seen from the table, isolated 3 forms of motor activity of the digestive tract portions of the above, depending on the amount of mechanical work: a normal (healthy subjects), decreased or increased (in patients with peptic ulcer ).

For a more complete assessment of motor activity of the stomach and proximal portion of the small intestine was determined and the ratio of the volume of the mechanical work of the gastrointestinal tract between the adjacent portions of the formulas

K1 = sum of Awdal antrum / Awdal amount bulbs 12 duodenal ulcer;

K2 = the sum of Awdal bulbs 12 duodenal ulcer / amount of Awdal transition zone 12 duodenal ulcer in the jejunum;

K3 = sum of Awdal transition zone 12 duodenal ulcer in the lean / Awdal amount of the proximal portion of the jejunum.

We obtain optimal performance factors for healthy people: K1 = 0,20-0,75; K2 = 0,50-0,85; K3 = 0,60-0,95.

Examples of specific implementation method:

1. patients with SN-s, 37 s. 19/6/91

Health no complaints.

As a result of the clinical examination is recognized as healthy.

With a comprehensive assessment of motor activity of the stomach and small intestine in response to food load the following results: the amount of mechanical work (OMP) antrum (AOZH) = 481.2 kPa; OMP bulbs 12 duodenal ulcer (12-P) = 667.4 kPa; MRA transition zone 12 duodenal ulcer in the jejunum (C) = 811.4 kPa; OMP proximal jejunum (CCIP) = 864.4 kPa for 2 hours after administration of the reference food.

K1 = 0,71; K2 = 0,82; K3 = 0,94.

It is concluded that a normal motor activity of the gastrointestinal tract.

2. Patient B-s SA, for 22 years. 04.25.91.

The diagnosis: peptic ulcer in the acute stage, the body of the stomach ulcer.

Before getting to the clinic concerned about heartburn and epigastric pain shortly after eating.

About a year ago when fiberscopes on the middle third of the lesser curvature of the gastric body ulcers detected 10 mm x 8 mm. When fibrogastroduodenoscopy carried out 2 days prior to this study, in the same area of ​​the surface of the stomach ulcer found about 8 mm in diameter.

Health complaints prior to the study did not show.

Results of the study gastrointestinal motor activity:

OMP AOZH = 73.5 kPa; EFH 12-P = 568.4 kPa; OMP GP = 636.0 kPa; OMP CCIP = 550.8 kPa.

K1 = 0,13; K2 = 0,89; K3 = 1,16.

It made a general conclusion about the reduced level of physical activity of the stomach and proximal portion of the jejunum, and a violation of consistency in the mechanical work of the neighboring areas in the subject.

3. The patient P to NI, 40 years old. 05/05/91

The diagnosis: peptic ulcer disease in remission stage begins, ulcers bulbs 12 duodenal ulcer in the stage of white scar moderately severe deformation of bulbs 12 duodenal ulcer.

Health complaints prior to the study did not show.

Bohlen about 3 years, but then when fibrogastroduodenoscopy in the bulb 12 duodenal ulcer was found. The disease was exacerbated in the spring and fall. The latter ended on clinical and endoscopic data about a month ago. When fibrogastroduodenoscopy held a week before this study found a moderately severe deformation of bulbs 12 duodenal ulcer, on the front wall of a linear white scar of about 10 mm in length.

Results of evaluation of motor activity of the gastrointestinal tract:

OMP AOZH = 138.3 kPa; EFH 12-P = 918.3 kPa; OMP GP = 307.7 kPa; OMP CCIP = 307.7 kPa.

K1 = 0,15; K2 = 2,98; K3 = 1,0.

Therefore, on the background of reduction of motor activity of the stomach, the transition zone 12 in the duodenum and jejunum proximal jejunum occurs increased motor activity of the bulbs 12 duodenal ulcer. The disparity in the amount of mechanical work done is found among all the investigated areas of the digestive tract, especially pronounced between the bulb 12 duodenal ulcer and the transition zone 12 duodenal ulcer in the jejunum.

Made general finding of a violation of the motor activity of the gastrointestinal tract of the patient.

4. Patient A s AN, 25 years. 15.01.92 Mr.

The diagnosis: peptic ulcer in the acute stage, three ulcers in the bulb 12 duodenal ulcers, moderately severe deformation of bulbs 12 duodenal ulcer.

Results of evaluation of motor activity of the gastrointestinal tract:

OMP AOZH = 224.2 kPa; EFH 12-P = 185.2 kPa; OMP GP = 652.7 kPa; OMP CCIP = 773.2 kPa.

K1 = 1,25; K2 = 0,28; K3 = 0,84.

Conclusion: The observed reduction in motor activity bulbs 12 duodenal ulcer with preserved motor function in other parts of the digestive tract. The disparity in the amount of mechanical work takes place between the antrum and the bulb 12 duodenal ulcer, but also between the latter and the transition zone 12 duodenal ulcer in the jejunum, indicating a violation of motor activity of the stomach and small intestine.

5. Patient B-s EN, 34 years. 24/3/92

The diagnosis: peptic ulcer in the acute stage, ulcers bulbs 12 duodenal ulcer, severe deformation of the bulbs 12 duodenal ulcer.

Prior to the study of the motor function of the digestive tract worried about pain in the epigastric soon after eating. Bohlen about 6 years. Disease is exacerbated in the winter and summer. Last aggravation started 2 months ago. When fibrogastroduodenoscopy held for 3 days prior to the study of the motor activity of the gastrointestinal tract, found Foul bulb deformation 12 duodenal ulcer, on the back of which was an ulcer the size of 3 mm x 4 mm.

Results of evaluation of motor activity of the gastrointestinal tract:

SID: = 71.5; 852.6; 876.1; 576.2 kPa, respectively.

K1 = 0,08; K2 = 0,97; K3 = 1,52.

Conclusion: Reduced physical activity antrum, slightly elevated OMP bulbs 12 duodenal ulcer and the transition zone 12 pertsnoy guts in lean. However, the disparity in the amount of the work is found across all sites investigated, indicating a violation of motor activity of the stomach and small intestine.

Thus, the proposed method gives an integral assessment of motor activity of the stomach and simultaneously the three sections of the proximal small intestine, where, as known, takes place particularly intense digestion. The research is conducted under physiological conditions and can detect dysmotility, which are not available to clinical and conventional radiological and radioisotope methods. The method makes it possible to carry out a clinical setting not only an early and comprehensive diagnosis of gastric motor activity, 12 duodenal and jejunal intestines, but more specifically to plan treatment and preventive measures.

BIBLIOGRAPHY

1. LA Houghton, NWReed, R.Heddle et al, Relationship of the motor activity of the antrum, pylorus and duodenum to gastric emptying of a solid-liquid mixed meal // Gastroenterology. - 1988, vol. 94, N 6, p. 1285-1291.

2. Churin BV Migrant rhythmic phase in the motor activity of the gastrointestinal tract in the digestive process in healthy men // Human Physiology, 1993, Vol. 19, N 4, p. 138-144.

3. Gridchin VA, Kiriushin LP, Malkov VA, Churin BV Pressure control device and the temperature in the stomach and small intestine // Electronics Industry, 1990, N 12, p. 25-26.

4. Churin BV Booth intracavitary pressure control of the upper gastrointestinal tract // Human Physiology, 1992, N 4, p. 170-173.

CLAIM

The method of integrated assessment of motor function of the stomach and small intestine in a human comprising administering through the lower nasal passage of the catheter with load cells, their placement in the gastric antrum, the bulbs 12 duodenal ulcer, transition zone 12 duodenal ulcer in the jejunum, proximal portion of the jejunum on 16 cm distal to Treitz ligament attachment reception reference food after passing the front motor activity transition zone 12 duodenal ulcer in jejunum, characterized in that the take protein food for 2 hours after meals recorded amplitude of motor activity waves (Avda) gastrointestinal sites -kishechnogo tract (GIT), the sum of Awdal for 2 h determine the amount of mechanical work performed by each section of the digestive tract, and the ratio of the volume of mechanical work between adjacent areas on the coefficients

K1 = sum of Awdal antrum / Awdal amount bulbs 12 duodenal ulcer;

K2 = the sum of Awdal bulbs 12 duodenal ulcer / amount of Awdal transition zone 12 duodenal ulcer in the jejunum;

K3 = sum of Awdal transition zone 12 duodenal ulcer in the lean / Awdal amount of the proximal portion of the jejunum,

and the amount of mechanical work antrum 147-490 kPa, bulbs 12 duodenal ulcer - 392-833 kPa, transition zone 12 duodenal ulcer in the jejunum - 490-833 kPa, the proximal portion of the jejunum - 580-882 kPa and the values ​​of the coefficients K1 = 0,20-0,75; K2 = 0,50-0,85; K3 = 0,60-0,95 conclude on normal motor activity of the stomach and small intestine.

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Publication date 30.03.2007gg