MD1152Z - Method for determining the degree of severity of gastroesophageal reflux disease - Google Patents
Method for determining the degree of severity of gastroesophageal reflux disease Download PDFInfo
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- MD1152Z MD1152Z MDS20160127A MDS20160127A MD1152Z MD 1152 Z MD1152 Z MD 1152Z MD S20160127 A MDS20160127 A MD S20160127A MD S20160127 A MDS20160127 A MD S20160127A MD 1152 Z MD1152 Z MD 1152Z
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Abstract
Description
Invenţia se referă la medicină, în special la gastroenterologie, şi poate fi utilizată pentru stabilirea gradului de severitate a bolii de reflux gastroesofagian (BRGE). The invention relates to medicine, in particular to gastroenterology, and can be used to determine the severity of gastroesophageal reflux disease (GERD).
Se cunoaşte metoda de diagnostic al BRGE prin evaluarea simptomelor sugestive: (arsuri la stomac şi regurgitaţie), care constă în aceea că se efectuează examinarea clinică a pacientului şi în cazul când sunt prezente simptome tipice specifice de pirozis şi regurgităţi putem diagnostica BRGE [1]. The method of diagnosing GERD is known by evaluating suggestive symptoms: (heartburn and regurgitation), which consists of performing a clinical examination of the patient and in the case when typical symptoms of heartburn and regurgitation are present, we can diagnose GERD [1].
Dezavantajul este că sensibilitatea simptomelor în esofagita erozivă de reflux este de 30…76%, specificitatea de 62…96%, iar intensitatea manifestărilor clinice slab corelează cu expresia modificărilor endoscopice. Bolnavii cu forme erozive ale BRGE au acuze similare ca şi bolnavii cu forme nonerozive. La unii bolnavi lipseşte simptomul clasic - pirozisul, dar predomină alte acuze (greţuri, dereglări de somn), care la fel diminuează calitatea vieţii. S-a constatat că în 33,55% cazuri BRGE este asociată cu dispepsia funcţională şi sindromul colonului iritat. The disadvantage is that the sensitivity of symptoms in erosive reflux esophagitis is 30…76%, the specificity is 62…96%, and the intensity of clinical manifestations poorly correlates with the expression of endoscopic changes. Patients with erosive forms of GERD have similar complaints as patients with non-erosive forms. In some patients, the classic symptom - heartburn - is absent, but other complaints predominate (nausea, sleep disorders), which also reduce the quality of life. It was found that in 33.55% of cases GERD is associated with functional dyspepsia and irritable bowel syndrome.
Este cunoscută şi o altă metodă de diagnostic al BRGE bazată pe chestionarul GERD-Health Quality of Life Questionnaire (GERD-HRQL). Chestionarul de screening GERD-HRQL, elaborat şi validat pentru cuantificarea severităţii simptomelor obişnuite de arsură şi regurgitate ale BRGE, sănătăţii şi calităţii vieţii, este menit pentru a aprecia răspunsul în urma tratamentului chirurgical (fundoplicaţia) endoscopic sau farmacologic (inhibitori ai pompei de proton). El conţine 16 întrebări, dintre care 6 evaluează severitatea arsurilor, 6 - severitatea regurgităţilor, 1 - disfagiei, 1 - odinofagiei, 1 - influenţa administrării medicamentelor pentru pirozis şi regurgitate asupra activităţii de fiecare zi, 1 - satisfacţia pacientului de starea lui proprie în prezent. Estimarea expresiei simptomelor se efectuează prin descrierea lor în ultimele 2 săptămâni printr-un scor la fiecare întrebare de la 0 puncte (fără simptome) până la 5 puncte (simptomele fac incapabilă viaţa cotidiană) cu punctaj sumar maxim pentru arsură 30 puncte, punctaj sumar maxim pentru regurgitate 30 puncte, iar suma totală a punctelor tuturor întrebărilor este de 75 puncte [2]. Another method of diagnosing GERD is known, based on the GERD-Health Quality of Life Questionnaire (GERD-HRQL). The GERD-HRQL screening questionnaire, developed and validated to quantify the severity of common symptoms of heartburn and regurgitation of GERD, health and quality of life, is intended to assess the response to surgical (fundoplication), endoscopic or pharmacological treatment (proton pump inhibitors). It contains 16 questions, of which 6 assess the severity of heartburn, 6 - the severity of regurgitation, 1 - dysphagia, 1 - odynophagia, 1 - the influence of heartburn and regurgitation medication on daily activities, 1 - the patient's satisfaction with his or her current condition. The estimation of the expression of symptoms is performed by describing them in the last 2 weeks through a score for each question from 0 points (no symptoms) to 5 points (symptoms make daily life impossible) with a maximum summary score for heartburn of 30 points, a maximum summary score for regurgitation of 30 points, and the total sum of the points of all questions is 75 points [2].
Dezavantajele acestei metode constau în aceea că ea nu este utilă pentru studii clinice; nu cuprinde totalmente elucidarea diferitor blocuri ale simptomelor clinice; nu include întrebări ce ar depista manifestările atipice (bronhopulmonare, otorinolaringiene, cardiologice, stomatologice), alarmante; nu apreciază complet durata, frecvenţa şi expresia simptomelor tipice şi atipice; nu include relevarea factorilor care ameliorează şi/sau agravează BRGE; nu este reprezentativă, sensibilă şi comodă, şi, deci, nu poate stabili gradul de severitate a afecţiunii; nu reflectă dinamica evoluţiei maladiei pe timp scurt şi lung pe durata tratamentului, iar evaluarea psihometrică este limitată. The disadvantages of this method are that it is not useful for clinical studies; it does not fully elucidate the different blocks of clinical symptoms; it does not include questions that would detect atypical manifestations (bronchopulmonary, otorhinolaryngological, cardiological, dental), alarming; it does not fully appreciate the duration, frequency and expression of typical and atypical symptoms; it does not include the detection of factors that improve and/or worsen GERD; it is not representative, sensitive and convenient, and therefore cannot establish the severity of the condition; it does not reflect the dynamics of the evolution of the disease in the short and long term during treatment, and the psychometric evaluation is limited.
Problema constă în elaborarea unei metode noi exacte, operative, sensibile şi simple de stabilire a gradului de severitate a BRGE, care include completarea unui chestionar din 44 întrebări cu evaluarea punctajelor stabilite pentru fiecare factor analizat, calculul scorului total al tuturor întrebărilor pentru estimarea gradului de severitate a bolii (uşor, moderat, sever) şi monitorizarea eficienţei tratamentului. The problem consists in developing a new accurate, operative, sensitive and simple method for determining the severity of GERD, which includes completing a 44-question questionnaire with the evaluation of the scores established for each factor analyzed, calculating the total score of all questions to estimate the severity of the disease (mild, moderate, severe) and monitoring the effectiveness of treatment.
Avantajele şi noutatea metodei propuse constă în aceea că se stabileşte gradul de severitate a BRGE. Aceasta va permite să fie apreciată mai precis evoluţia BRGE, pentru a indica precoce tratamentul diferenţial în dependenţă de gravitatea maladiei, a monitoriza decurgerea ei pe timp scurt şi lung pe durata medicaţiei şi, prin urmare, a preveni progresarea bolii, apariţia complicaţiilor (ulcere esofagiene, esofagul Barret, adenocarcinom esofagian, stenoza esofagului, stricturi esofagiene, perforaţia esofagului, hemoragie digestivă superioară), reducerea frecvenţei recurenţelor, şi, deci, a ameliora substanţial calitatea vieţii. Metoda propusă prezintă un instrument efectiv, profund, reprezentativ, sensibil şi comod după conţinut, care amplifică esenţial calitatea examinării, informarea medicilor, inclusiv şi de familie, despre bazele de determinare a severităţii BRGE, oferă posibilitatea de a iniţia strategia şi tactica tratamentului, a monitoriza reacţia pacientului la terapie pe timp lung şi, deci, a intensifica măsurile în domeniul profilaxiei secundare a maladiei şi, prin urmare, a ameliora starea bolnavului. The advantages and novelty of the proposed method are that the severity of GERD is established. This will allow for a more precise assessment of the evolution of GERD, in order to indicate early differential treatment depending on the severity of the disease, to monitor its course in the short and long term during the medication and, consequently, to prevent disease progression, the occurrence of complications (esophageal ulcers, Barrett's esophagus, esophageal adenocarcinoma, esophageal stenosis, esophageal strictures, esophageal perforation, upper digestive bleeding), to reduce the frequency of recurrences, and, therefore, to substantially improve the quality of life. The proposed method presents an effective, profound, representative, sensitive and convenient tool in terms of content, which essentially enhances the quality of examination, informing doctors, including family doctors, about the bases for determining the severity of GERD, offers the possibility of initiating the treatment strategy and tactics, monitoring the patient's response to therapy over the long term and, therefore, intensifying measures in the field of secondary prevention of the disease and, consequently, improving the patient's condition.
Esenţa invenţiei care constă în aceea că se efectuează examenul clinic, se estimează simptomele bolii de reflux gastroesofagian cu atribuirea unor puncte pentru fiecare semn clinic înregistrat şi în cazul în care suma punctelor acumulate este de 1…70, se stabileşte un grad uşor de severitate, când este de 71…129 - un grad mediu şi când este de 130...211 se stabileşte un grad sever al bolii de reflux gastroesofagian, totodată pentru semnele clinice înregistrate se atribuie următoarele puncte: The essence of the invention consists in performing a clinical examination, estimating the symptoms of gastroesophageal reflux disease by assigning points for each registered clinical sign and if the sum of the accumulated points is 1...70, a mild degree of severity is established, when it is 71...129 - a medium degree and when it is 130...211 a severe degree of gastroesophageal reflux disease is established, at the same time for the registered clinical signs the following points are assigned:
- arsura retrosternală scade în intensitate: - the retrosternal burning decreases in intensity:
la alimentare cu proteine - 1 when feeding protein - 1
la consum de carne - 1 meat consumption - 1
în timpul foamei - 1; during hunger - 1;
- arsura retrosternală se intensifică la acţiunea următorilor factori: - retrosternal burning is intensified by the action of the following factors:
alcool, băuturi carbogazoase, produse picante (ceapă, usturoi, piper), condimente, citrice, roşii, ciocolată, alimente grase, cafea, ceai, mentă, dulciuri concentrate, arahide, alimente fierbinţi sau reci, suc de fructe acru, după fumat, după flexia anterioară a corpului, după ridicarea greutăţilor, în timpul constipaţiilor, în timpul sarcinii, de la apariţia obezităţii, de la mărirea abdomenului în volum (fiecărui factor i se atribuie câte 1 punct); alcohol, carbonated drinks, spicy products (onion, garlic, pepper), spices, citrus fruits, tomatoes, chocolate, fatty foods, coffee, tea, mint, concentrated sweets, peanuts, hot or cold foods, sour fruit juice, after smoking, after bending forward, after lifting weights, during constipation, during pregnancy, after the onset of obesity, after an increase in abdominal volume (each factor is assigned 1 point);
- arsura retrosternală se intensifică după administrarea de: - retrosternal burning intensifies after administration of:
blocatori ai α1 adrenoreceptorilor, β agonişti, colinolitice, spasmolitice, antidepresante, somnifere (barbiturice), sedative, tranchilizante, neuroleptice, narcotice, opiaţi, nitraţi, cafeină, xantine (aminofilină), dopamină, hinidină, antagonişti de calciu, doxiciclină, estroprogestative, antiinflamatoare nesteroide (fiecărui factor i se atribuie câte 1 punct); α1 adrenoreceptor blockers, β agonists, anticholinergics, antispasmodics, antidepressants, sleeping pills (barbiturates), sedatives, tranquilizers, neuroleptics, narcotics, opiates, nitrates, caffeine, xanthines (aminophylline), dopamine, quinidine, calcium antagonists, doxycycline, estroprogestins, nonsteroidal anti-inflammatory drugs (each factor is assigned 1 point);
- arsura retrosternală după mese scade în intensitate la administrarea de: - retrosternal heartburn after meals decreases in intensity when taking:
antiacide (almagel, maalox, fosfalugel, gelusil-lac), alginate (gaviscon, gaviscon-forte), inhibitori ai pompei de proton (omeprazol, lansoprazol, pantoprazol, rabeprazol, esomeprazol), H2-blocatori (famotidină, nizatidină, roxatidină), domperidonă, metoclopramidă, cizapridă, itomed (itoprid hidroclorid), citoprotectoare (sucralfat, venter), prostaglandine (enprostil, misoprostol, rioprostil), α-adrenomimetice (fiecărui factor i se atribuie câte 1 punct); antacids (almagel, maalox, phosphalugel, gelusil-lac), alginates (gaviscon, gaviscon-forte), proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole), H2-blockers (famotidine, nizatidine, roxatidine), domperidone, metoclopramide, cisapride, itomed (itoprid hydrochloride), cytoprotectors (sucralfate, venter), prostaglandins (enprostil, misoprostol, rioprostil), α-adrenomimetics (each factor is assigned 1 point);
- regurgitaţiile scad în intensitate: - regurgitation decreases in intensity:
la alimentare cu proteine - 1 when feeding protein - 1
la consum de carne - 1 meat consumption - 1
în timpul foamei - 1; during hunger - 1;
- regurgitaţiile se intensifică la acţiunea următorilor factori: - regurgitation intensifies under the action of the following factors:
alcool, băuturi carbogazoase, produse picante (ceapă, usturoi, piper), condimente, citrice, roşii, ciocolată, alimente grase, cafea, ceai, mentă, dulciuri concentrate, arahide, alimente fierbinţi, reci, suc de fructe acru, după fumat, după flexia anterioară a corpului, după ridicarea greutăţilor, în timpul constipaţiilor, în timpul sarcinii, de la apariţia obezităţii, de la mărirea abdomenului în volum (fiecărui factor i se atribuie câte 1 punct); alcohol, carbonated drinks, spicy products (onion, garlic, pepper), spices, citrus fruits, tomatoes, chocolate, fatty foods, coffee, tea, mint, concentrated sweets, peanuts, hot, cold foods, sour fruit juice, after smoking, after bending forward, after lifting weights, during constipation, during pregnancy, after the onset of obesity, after an increase in abdominal volume (each factor is assigned 1 point);
-regurgitaţiile se intensifică după administrarea de: -regurgitation intensifies after administration of:
blocatori ai α1 adrenoreceptorilor, β agonişti, colinolitice, spasmolitice, antidepresante, somnifere (barbiturice), sedative, tranchilizante, neuroleptice, narcotice, opiaţi, nitraţi, cafeină, xantine (aminofilină), dopamină, hinidină, antagonişti de calciu, doxiciclină, estroprogestative, antiinflamatoare nesteroide (fiecărui factor i se atribuie câte 1 punct); α1 adrenoreceptor blockers, β agonists, anticholinergics, antispasmodics, antidepressants, sleeping pills (barbiturates), sedatives, tranquilizers, neuroleptics, narcotics, opiates, nitrates, caffeine, xanthines (aminophylline), dopamine, quinidine, calcium antagonists, doxycycline, estroprogestins, nonsteroidal anti-inflammatory drugs (each factor is assigned 1 point);
- regurgitaţiile scad în intensitate după administrarea de: - regurgitation decreases in intensity after administration of:
antiacide (almagel, maalox, fosfalugel, gelusil-lac), alginate (gaviscon, gaviscon-forte), inhibitori ai pompei de proton (omeprazol, lansoprazol, pantoprazol, rabeprazol, esomeprazol), H2-blocatori (famotidină, nizatidină, roxatidină), domperidonă, metoclopramidă, cizapridă, itomed (itoprid hidroclorid), citoprotectoare (sucralfat, venter), prostaglandine (enprostil, misoprostol, rioprostil), α-adrenomimetice (fiecărui factor i se atribuie câte 1 punct); antacids (almagel, maalox, phosphalugel, gelusil-lac), alginates (gaviscon, gaviscon-forte), proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole), H2-blockers (famotidine, nizatidine, roxatidine), domperidone, metoclopramide, cisapride, itomed (itoprid hydrochloride), cytoprotectors (sucralfate, venter), prostaglandins (enprostil, misoprostol, rioprostil), α-adrenomimetics (each factor is assigned 1 point);
- expresia dificultăţilor la înghiţire (disfagie) în ultimele două săptămâni: - expression of swallowing difficulties (dysphagia) in the last two weeks:
fără senzaţii - 0 no sensations - 0
senzaţii evidente, dar nu neplăcute - 1 obvious but not unpleasant sensations - 1
senzaţii evidente şi neplăcute, dar nu în fiecare zi - 2 obvious and unpleasant sensations, but not every day - 2
senzaţii neplăcute în fiecare zi - 3 unpleasant sensations every day - 3
senzaţii, care afectează activitatea de fiecare zi - 4 sensations that affect everyday activity - 4
senzaţii, care afectează grav activitatea de fiecare zi - 5; sensations that seriously affect daily activity - 5;
- durata dificultăţilor la înghiţire în ultimele şapte zile: - duration of swallowing difficulties in the last seven days:
0 zile - 0, 1 zi - 1 2…3 zile - 2, 4…7 zile - 3;0 days - 0, 1 day - 1 2…3 days - 2, 4…7 days - 3;
- dificultate la înghiţire: - difficulty swallowing:
intermitentă -1, permanentă - 2; intermittent -1, permanent - 2;
- expresia durerilor la înghiţire (odinofagie) în ultimele două săptămâni: - expression of pain when swallowing (odynophagia) in the last two weeks:
fără senzaţii - 0 no sensations - 0
senzaţii evidente, dar nu neplăcute - 1 obvious but not unpleasant sensations - 1
senzaţii evidente şi neplăcute, dar nu în fiecare zi - 2 obvious and unpleasant sensations, but not every day - 2
senzaţii neplăcute în fiecare zi - 3 unpleasant sensations every day - 3
senzaţii, care afectează activitatea de fiecare zi - 4 sensations that affect everyday activity - 4
senzaţii, care afectează grav activitatea de fiecare zi - 5; sensations that seriously affect daily activity - 5;
- durata durerilor la înghiţire în ultimele şapte zile: - duration of pain when swallowing in the last seven days:
0 zile - 0, 1 zi - 1, 2…3 zile - 2, 4…7 zile - 3;0 days - 0, 1 day - 1, 2…3 days - 2, 4…7 days - 3;
- expresia durerilor retrosternale toracice (în epigastru) în ultimele două săptămâni: - expression of retrosternal chest pain (in the epigastrium) in the last two weeks:
fără senzaţii - 0 no sensations - 0
senzaţii evidente, dar nu neplăcute - 1 obvious but not unpleasant sensations - 1
senzaţii evidente şi neplăcute, dar nu în fiecare zi - 2 obvious and unpleasant sensations, but not every day - 2
senzaţii neplăcute în fiecare zi - 3 unpleasant sensations every day - 3
senzaţii, care afectează activitatea de fiecare zi - 4 sensations that affect everyday activity - 4
senzaţii, care afectează grav activitatea de fiecare zi - 5; sensations that seriously affect daily activity - 5;
- durata durerilor retrosternale toracice (în epigastru) în ultimele şapte zile: - duration of retrosternal chest pain (in the epigastrium) in the last seven days:
0 zile - 3, 1 zi - 2, 2…3 zile - 1, 4…7 zile - 0;0 days - 3, 1 day - 2, 2…3 days - 1, 4…7 days - 0;
- iradierea durerilor epigastrice în: - radiating epigastric pain in:
mandibulă -1 mandible -1
baza gâtului - 1 base of the neck - 1
regiunea interscapulară - 1 interscapular region - 1
braţe - 1; arms - 1;
- expresia greţurilor în ultimele două săptămâni: - expression of nausea in the last two weeks:
fără senzaţii - 0 no sensations - 0
senzaţii evidente, dar nu neplăcute - 1 obvious but not unpleasant sensations - 1
senzaţii evidente şi neplăcute, dar nu în fiecare zi - 2 obvious and unpleasant sensations, but not every day - 2
senzaţii neplăcute în fiecare zi - 3 unpleasant sensations every day - 3
senzaţii, care afectează activitatea de fiecare zi - 4 sensations that affect everyday activity - 4
senzaţii, care afectează grav activitatea de fiecare zi - 5; sensations that seriously affect daily activity - 5;
- durata greţurilor în ultimele şapte zile: - duration of nausea in the last seven days:
0 zile - 3, 1 zi - 2, 2…3 zile - 1, 4…7 zile - 0;0 days - 3, 1 day - 2, 2…3 days - 1, 4…7 days - 0;
- sialoree (ptialism, salivaţie abundentă, secreţie exagerată de salivă): - sialorrhea (ptyalism, profuse salivation, excessive saliva secretion):
nu - 0, da - 1;no - 0, yes - 1;
- gust metalic în gură: - metallic taste in the mouth:
nu - 0, da -1;no - 0, yes -1;
- eructaţii (eliminarea din stomac de gaze sau suc gastric): - belching (elimination of gas or gastric juice from the stomach):
nu - 0, da - 1;no - 0, yes - 1;
- vome: - vomit:
nu - 0, da - 1;no - 0, yes - 1;
- senzaţie de plenitudine în abdomen: - feeling of fullness in the abdomen:
nu - 0, da - 1;no - 0, yes - 1;
- meteorism: - flatulence:
nu - 0, da - 1;no - 0, yes - 1;
- disfonie (răguşeală, voce răguşită, alterarea şi/sau tulburarea vorbirii, modificarea timbrului şi intensităţii vocii): - dysphonia (hoarseness, hoarse voice, alteration and/or disturbance of speech, change in timbre and intensity of the voice):
nu - 0, da - 1;no - 0, yes - 1;
- hemoptizie (eliminare de sânge prin tuse pe gură, cauzată de unele leziuni ale căilor respiratorii): - hemoptysis (coughing up blood through the mouth, caused by some airway injuries):
nu - 0, da - 1;no - 0, yes - 1;
- dereglări de ritm cardiac: - heart rhythm disorders:
nu - 0, da - 1;no - 0, yes - 1;
- otalgie ( durere în urechi): - otalgia (ear pain):
nu - 0, da -1;no - 0, yes -1;
- dureri cervicale, paracervicale: - cervical, paracervical pain:
nu - 0, da - 1; no - 0, yes - 1;
- miros neplăcut din gură (halenă; halitoză): - unpleasant smell from the mouth (halitosis):
nu - 0, da - 1; no - 0, yes - 1;
- senzaţie de arsură pe limbă: - burning sensation on the tongue:
nu - 0, da - 1; no - 0, yes - 1;
- tuse cronică, preponderent nocturnă: - chronic cough, mainly nocturnal:
nu - 0, da - 1; no - 0, yes - 1;
- accese de sufocare (dispnee; asfixie): - attacks of suffocation (dyspnea; asphyxia):
nu - 0, da - 1; no - 0, yes - 1;
- dureri în gât recurente: - recurring sore throats:
nu - 0, da - 1; no - 0, yes - 1;
- pierdere de smalţ dentar (eroziuni dentare): - loss of tooth enamel (dental erosion):
nu - 0, da - 1; no - 0, yes - 1;
- stridor (zgomot şuierător al respiraţiei, cauzat de spasm sau obstrucţie a laringelui): - stridor (whistling breathing noise caused by spasm or obstruction of the larynx):
nu - 0, da - 1; no - 0, yes - 1;
- senzaţie de glob (nod) în gât: - sensation of a lump in the throat:
nu - 0, da - 1; no - 0, yes - 1;
- hemoragie gastrointestinală în antecedente: - history of gastrointestinal bleeding:
nu - 0 no - 0
până la 6 luni în urmă - 1 up to 6 months ago - 1
6…11 luni în urmă - 1 6…11 months ago - 1
12…23 luni în urmă - 1 12…23 months ago - 1
24…35 luni în urmă - 1 24…35 months ago - 1
36…47 luni în urmă - 1 36…47 months ago - 1
48…59 luni în urmă - 1 48…59 months ago - 1
5…9 ani în urmă - 1 5…9 years ago - 1
mai mult de 10 ani în urmă - 1; more than 10 years ago - 1;
- scădere ponderală neexplicabilă: - unexplained weight loss:
nu - 0, până la 5% - 1, no - 0, up to 5% - 1,
cu 5…9% - 2, mai mult de 10% - 3; by 5…9% - 2, more than 10% - 3;
- scădere ponderală neexplicabilă: - unexplained weight loss:
nu - 0 no - 0
până la 6 luni în urmă - 1 up to 6 months ago - 1
6…11 luni în urmă - 1 6…11 months ago - 1
12…23 luni în urmă - 1 12…23 months ago - 1
24…35 luni în urmă - 1 24…35 months ago - 1
36…47 luni în urmă - 1 36…47 months ago - 1
48…59 luni în urmă - 1 48…59 months ago - 1
5…9 ani în urmă - 1 5…9 years ago - 1
mai mult de 10 ani în urmă - 1; more than 10 years ago - 1;
- patologii concomitente în anamneză: - concomitant pathologies in the anamnesis:
pneumonii recurente, bronşită cronică (BPOC), astm bronşic, abces pulmonar, bronşectazie, emfizem pulmonar, atelectazie pulmonară, fibroză pulmonară, faringită, laringită, otită, sinuzită, eroziuni ale smalţului dentar; anemie ferodeficitară, hernie hiatală, deformări ale cutiei toracice (coloanei vertebrale) (fiecărui factor i se atribuie câte 1 punct); recurrent pneumonia, chronic bronchitis (COPD), bronchial asthma, lung abscess, bronchiectasis, pulmonary emphysema, pulmonary atelectasis, pulmonary fibrosis, pharyngitis, laryngitis, otitis, sinusitis, erosions of dental enamel; iron deficiency anemia, hiatal hernia, deformities of the rib cage (spine) (each factor is assigned 1 point);
- frecvenţa senzaţiilor de pirozis, regurgitaţii pe săptămână: - frequency of heartburn, regurgitation per week:
până la 2 ori - 1, mai mult de 2 ori - 2; up to 2 times - 1, more than 2 times - 2;
- durata senzaţiilor de pirozis, regurgitaţii: - duration of heartburn, regurgitation sensations:
până la 6 luni - 1, mai mult de 6 luni - 2; up to 6 months - 1, more than 6 months - 2;
- indicele masei corporale: - body mass index:
18…25 - 0 18…25 - 0
26…30 - 1 26…30 - 1
31…35 - 2 31…35 - 2
36…40 - 3 36…40 - 3
41…45 - 4. 41…45 - 4.
Rezultatul tehnic obţinut constă în determinarea operativă, exactă, completă, simplă, necostisitoare, atraumatică, noninvazivă a gradului de severitate a BRGE. Metoda nu necesită examinare instrumentală, poate fi realizată în orice edificiu medical şi în condiţii de ambulatoriu. The technical result obtained consists in the operative, accurate, complete, simple, inexpensive, atraumatic, noninvasive determination of the severity of GERD. The method does not require instrumental examination, it can be performed in any medical building and in outpatient conditions.
Exemplu Example
Pacientul A., 44 ani, s-a adresat la Spitalul Clinic Republican la medicul gastrolog cu acuze periodice (mai mult de 2 ori pe săptămână) de pirozis, regurgităţi acide, tuse, dureri în cutia toracică. Se consideră bolnav 6 ani cu exacerbări la erori de regim şi produse alimentare. La medicul de familie şi medicul specialist gastroenterolog nu s-a adresat. Tratamentul consta în automedicaţia sporadică de antiacide la apariţia pirozisului cu ameliorare nesemnificativă pe timp scurt. Bolnavul a fost examinat conform invenţiei şi s-a stabilit un scor total de 77 puncte. Patient A., 44 years old, went to the Republican Clinical Hospital to see a gastroenterologist with periodic complaints (more than 2 times a week) of heartburn, acid regurgitation, cough, pain in the chest. He is considered ill for 6 years with exacerbations due to errors in diet and food products. He did not go to the family doctor and the gastroenterologist specialist. The treatment consisted of sporadic self-medication with antacids when heartburn appeared with insignificant improvement in a short time. The patient was examined according to the invention and a total score of 77 points was established.
- Arsura retrosternală scade în intensitate: - The retrosternal burning decreases in intensity:
la consum de carne - 1; for meat consumption - 1;
- arsura retrosternală se intensifică la acţiunea următorilor factori: - retrosternal burning is intensified by the action of the following factors:
alcool, băuturi carbogazoase, produse picante (ceapă, usturoi, piper), condimente, citrice, roşii, ciocolată, alimente grase, cafea, dulciuri concentrate, suc de fructe acru, după flexia anterioară a corpului, după ridicarea greutăţilor (fiecărui factor i se atribuie câte 1 punct); alcohol, carbonated drinks, spicy products (onion, garlic, pepper), spices, citrus fruits, tomatoes, chocolate, fatty foods, coffee, concentrated sweets, sour fruit juice, after bending forward, after lifting weights (each factor is assigned 1 point);
- arsura retrosternală se intensifică după administrarea de: - retrosternal burning intensifies after administration of:
colinolitice, spasmolitice, somnifere (barbiturice), sedative, tranchilizante, antiinflamatoare nesteroide (fiecărui factor i se atribuie câte 1 punct); cholinolytics, spasmolytics, sleeping pills (barbiturates), sedatives, tranquilizers, nonsteroidal anti-inflammatory drugs (each factor is assigned 1 point);
- arsura retrosternală după mese scade în intensitate la administrarea de: - retrosternal heartburn after meals decreases in intensity when taking:
antiacide (almagel, maalox, fosfalugel, gelusil-lac), inhibitori ai pompei de protoni (omeprazol, lansoprazol, pantoprazol, rabeprazol, esomeprazol), H2-blocatori (famotidină, nizatidină, roxatidină), domperidonă, metoclopramidă, (fiecărui factor i se atribuie câte 1 punct); antacids (almagel, maalox, phosphalugel, gelusil-lac), proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole), H2-blockers (famotidine, nizatidine, roxatidine), domperidone, metoclopramide, (each factor is assigned 1 point);
- regurgitaţiile scad în intensitate: - regurgitation decreases in intensity:
la consum de carne - 1 meat consumption - 1
în timpul foamei - 1; during hunger - 1;
- regurgitaţiile se intensifică la acţiunea următorilor factori: - regurgitation intensifies under the action of the following factors:
alcool, băuturi carbogazoase, produse picante (ceapă, usturoi, piper), condimente, citrice, roşii, ciocolată, alimente grase, cafea, dulciuri concentrate, alimente fierbinţi, reci, suc de fructe acru, după flexia anterioară a corpului, după ridicarea greutăţilor, (fiecărui factor i se atribuie câte 1 punct); alcohol, carbonated drinks, spicy products (onion, garlic, pepper), spices, citrus fruits, tomatoes, chocolate, fatty foods, coffee, concentrated sweets, hot, cold foods, sour fruit juice, after bending forward, after lifting weights, (each factor is assigned 1 point);
- regurgitaţiile se intensifică după administrarea de: - regurgitation intensifies after administration of:
colinolitice, spasmolitice, somnifere (barbiturice), sedative, tranchilizante, antiinflamatoare nesteroide (fiecărui factor i se atribuie câte 1 punct); cholinolytics, spasmolytics, sleeping pills (barbiturates), sedatives, tranquilizers, nonsteroidal anti-inflammatory drugs (each factor is assigned 1 point);
- regurgitaţiile scad în intensitate după administrarea de: - regurgitation decreases in intensity after administration of:
antiacide (almagel, maalox, fosfalugel, gelusil-lac), inhibitori ai pompei de protoni (omeprazol, lansoprazol, pantoprazol, rabeprazol, esomeprazol), H2-blocatori (famotidină, nizatidină, roxatidină), domperidonă, metoclopramidă, (fiecărui factor i se atribuie câte 1 punct); antacids (almagel, maalox, phosphalugel, gelusil-lac), proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole), H2-blockers (famotidine, nizatidine, roxatidine), domperidone, metoclopramide, (each factor is assigned 1 point);
- expresia dificultăţilor la înghiţire (disfagie) în ultimele două săptămâni: - expression of swallowing difficulties (dysphagia) in the last two weeks:
fără senzaţii - 0; no sensations - 0;
- durata dificultăţilor la înghiţire în ultimele şapte zile: - duration of swallowing difficulties in the last seven days:
0 zile - 0; 0 days - 0;
- dificultate la înghiţire: - difficulty swallowing:
nu are - 0; does not have - 0;
- expresia durerilor la înghiţire (odinofagie) în ultimele două săptămâni: - expression of pain when swallowing (odynophagia) in the last two weeks:
fără senzaţii - 0; no sensations - 0;
- durata durerilor la înghiţire în ultimele şapte zile: - duration of pain when swallowing in the last seven days:
0 zile - 0; 0 days - 0;
- expresia durerilor retrosternale toracice (în epigastru) în ultimele două săptămâni: - expression of retrosternal chest pain (in the epigastrium) in the last two weeks:
senzaţii, care afectează activitatea de fiecare zi - 4; sensations that affect daily activity - 4;
- durata durerilor retrosternale toracice (în epigastru) în ultimele şapte zile: - duration of retrosternal chest pain (in the epigastrium) in the last seven days:
4…7 zile - 0; 4…7 days - 0;
- iradierea durerilor epigastrice în: - radiating epigastric pain into:
nu iradiază - 0; does not irradiate - 0;
- expresia greţurilor în ultimele două săptămâni: - expression of nausea in the last two weeks:
senzaţii, care afectează grav activitatea de fiecare zi - 5; sensations that seriously affect daily activity - 5;
- durata greţurilor în ultimele şapte zile: - duration of nausea in the last seven days:
0 zile - 3; 0 days - 3;
- sialoree (ptialism, salivaţie abundentă, secreţie exagerată de salivă): - sialorrhea (ptyalism, profuse salivation, excessive saliva secretion):
da - 1; yes - 1;
- gust metalic în gură: - metallic taste in the mouth:
nu - 0; no - 0;
- eructaţii (eliminarea din stomac de gaze sau suc gastric): - belching (elimination of gas or gastric juice from the stomach):
da - 1; yes - 1;
- vome: - vomit:
nu - 0; no - 0;
- senzaţie de plenitudine în abdomen: - feeling of fullness in the abdomen:
da - 1; yes - 1;
- meteorism: - flatulence:
da - 1; yes - 1;
- disfonie (răguşeală, voce răguşită, alterarea şi/sau tulburarea vorbirii, modificarea timbrului şi intensităţii vocii): - dysphonia (hoarseness, hoarse voice, alteration and/or disturbance of speech, change in timbre and intensity of the voice):
da - 1; yes - 1;
- hemoptizie (eliminare de sânge prin tuse pe gură, cauzată de unele leziuni ale căilor respiratorii): - hemoptysis (coughing up blood through the mouth, caused by some airway injuries):
nu - 0; no - 0;
- dereglări de ritm cardiac: - heart rhythm disorders:
nu - 0; no - 0;
- otalgie ( durere în urechi): - otalgia (ear pain):
nu - 0; no - 0;
- dureri cervicale, paracervicale: - cervical, paracervical pain:
da - 1; yes - 1;
- miros neplăcut din gură (halenă; halitoză): - unpleasant smell from the mouth (halitosis):
da - 1; yes - 1;
- senzaţie de arsură pe limbă: - burning sensation on the tongue:
nu - 0; no - 0;
- tuse cronică, preponderent nocturnă: - chronic cough, mainly nocturnal:
da - 1; yes - 1;
- accese de sufocare (dispnee; asfixie): - attacks of suffocation (dyspnea; asphyxia):
nu - 0; no - 0;
- dureri în gât recurente: - recurring sore throats:
nu - 0; no - 0;
- pierdere de smalţ dentar (eroziuni dentare): - loss of tooth enamel (dental erosion):
nu - 0; no - 0;
- stridor (zgomot şuierător al respiraţiei, cauzat de spasm sau obstrucţie a laringelui): - stridor (whistling breathing noise caused by spasm or obstruction of the larynx):
nu - 0; no - 0;
- senzaţie de glob (nod) în gât: - sensation of a lump in the throat:
nu - 0; no - 0;
- hemoragie gastrointestinală în antecedente: - history of gastrointestinal bleeding:
nu - 0; no - 0;
- scădere ponderală neexplicabilă: - unexplained weight loss:
nu - 0; no - 0;
- scădere ponderală neexplicabilă: - unexplained weight loss:
nu - 0; no - 0;
- patologii concomitente în anamneză: - concomitant pathologies in the anamnesis:
nu suferă de patologii concomitente -0; does not suffer from concomitant pathologies -0;
- frecvenţa senzaţiilor de pirozis, regurgitaţii pe săptămână: - frequency of heartburn, regurgitation per week:
mai mult de 2 ori - 2; more than 2 times - 2;
- durata senzaţiilor de pirozis, regurgitaţii: - duration of heartburn, regurgitation sensations:
mai mult de 6 luni - 2; more than 6 months - 2;
- indicele masei corporale: - body mass index:
26…30 - 1. 26…30 - 1.
Astfel, în baza calculelor efectuate, s-a constatat că bolnavul suferă de BRGE, grad moderat de severitate. Ulterior, pacientului i s-a efectuat FEGDS şi s-a determinat diagnosticul endoscopic de esofagită de reflux gradul B (eroziuni unice ale mucoasei esofagului de dimensiuni mai mari de 5 mm, care nu se extind între pliurile mucoasei esofagului). Examenul histologic al mucoasei esofagiene a depistat hiperplazia stratului bazal, alungirea papilelor, celule polimorfonucleare neutrofile şi eozinofile în lamina propria, mitoze în număr mare în epiteliu, congestia şi dilatarea vaselor sangvine. În concluzie, diagnosticul clinic a fost confirmat endoscopic şi histologic. Thus, based on the calculations performed, it was found that the patient suffers from GERD, moderate severity. Subsequently, the patient underwent FEGDS and the endoscopic diagnosis of reflux esophagitis grade B was determined (single erosions of the esophageal mucosa larger than 5 mm, which do not extend between the folds of the esophageal mucosa). Histological examination of the esophageal mucosa revealed hyperplasia of the basal layer, elongation of the papillae, polymorphonuclear neutrophils and eosinophils in the lamina propria, large numbers of mitoses in the epithelium, congestion and dilation of blood vessels. In conclusion, the clinical diagnosis was confirmed endoscopically and histologically.
Aşadar, ca rezultat al studiului pe un lot de 15 bolnavi cu BRGE a fost elaborată metoda de stabilire a gradului de severitate a BRGE, care include un chestionar din 44 întrebări cu evaluarea punctajului stabilit pentru fiecare factor analizat, apoi se calculează suma totală a punctajului tuturor întrebărilor pentru estimarea gradului de severitate a bolii (uşor, moderat, sever) şi monitorizarea eficienţei tratamentului. Aceste repere permit determinarea exactă şi operativă a gradului de severitate a BRGE, selectarea programului terapeutic în dependenţă de gravitatea maladiei şi supravegherea dinamică a maladiei pe parcursul tratamentului şi controlului veridic al medicaţiei. Therefore, as a result of the study on a group of 15 patients with GERD, a method for determining the severity of GERD was developed, which includes a questionnaire of 44 questions with an assessment of the score established for each factor analyzed, then the total sum of the scores of all questions is calculated to estimate the severity of the disease (mild, moderate, severe) and monitor the effectiveness of the treatment. These benchmarks allow for the accurate and operative determination of the severity of GERD, the selection of the therapeutic program depending on the severity of the disease and the dynamic monitoring of the disease during treatment and truthful control of medication.
Metoda propusă a fost aplicată în Clinica Medicală nr. 4 Gastroenterologie şi Hepatologie, departamentul Medicină Internă, laboratorul Gastroenterologie al IP USMF ”Nicolae Testemiţanu” şi secţiile Hepatologie, Gastroenterologie ale IP Spitalul Clinic Republican. The proposed method was applied in Medical Clinic No. 4 Gastroenterology and Hepatology, the Internal Medicine Department, the Gastroenterology Laboratory of the "Nicolae Testemiţanu" USMF IP and the Hepatology and Gastroenterology sections of the Republican Clinical Hospital IP.
1. Katz P. O., Gerson L.B., Vela M.F. Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am. J. Gastroenterol., 2013, nr. 108, p. 308-328 1. Katz P.O., Gerson L.B., Vela M.F. Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. I have. J. Gastroenterol., 2013, no. 108, p. 308-328
2. Hunter J.G., Trus T.L., Branum G.D., Waring J.P., Wood W.C. A physiologic approach to laparoscopic fundoplication for gastroesophagel reflux disease. Ann. surg., 1996, nr. 223, p. 673-685 2. Hunter J.G., Trus T.L., Branum G.D., Waring J.P., Wood W.C. A physiological approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann. surg., 1996, no. 223, p. 673-685
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Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU1304804A1 (en) * | 1984-09-25 | 1987-04-23 | Минский государственный медицинский институт | Method of diagnosis of gastroesophageal reflux |
| SU1364347A1 (en) * | 1985-12-10 | 1988-01-07 | Латвийский Научно-Исследовательский Институт Экспериментальной И Клинической Медицины | Method of diagnosis of gastroesophageal reflux |
| SU1380731A1 (en) * | 1986-02-27 | 1988-03-15 | Днепропетровский Научно-Исследовательский Институт Гастроэнтерологии | Method of determining the degree of manifestation of gastroesophageal reflux by means of ph-probing of stomach |
| SU1421307A1 (en) * | 1985-05-27 | 1988-09-07 | Минский государственный медицинский институт | Method of diagnosis of gastroesophageal reflux of children |
| MD202G2 (en) * | 1993-05-05 | 1996-01-31 | Государственный Университет Молд0 | Method of active gamma-MnO2 preparing |
| MD2160G2 (en) * | 2003-01-23 | 2003-11-30 | СКОРПАН Анатолие | Method of diagnosis of the reflux esophagitis gravity degree |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| SU1304804A1 (en) * | 1984-09-25 | 1987-04-23 | Минский государственный медицинский институт | Method of diagnosis of gastroesophageal reflux |
| SU1421307A1 (en) * | 1985-05-27 | 1988-09-07 | Минский государственный медицинский институт | Method of diagnosis of gastroesophageal reflux of children |
| SU1364347A1 (en) * | 1985-12-10 | 1988-01-07 | Латвийский Научно-Исследовательский Институт Экспериментальной И Клинической Медицины | Method of diagnosis of gastroesophageal reflux |
| SU1380731A1 (en) * | 1986-02-27 | 1988-03-15 | Днепропетровский Научно-Исследовательский Институт Гастроэнтерологии | Method of determining the degree of manifestation of gastroesophageal reflux by means of ph-probing of stomach |
| MD202G2 (en) * | 1993-05-05 | 1996-01-31 | Государственный Университет Молд0 | Method of active gamma-MnO2 preparing |
| MD2160G2 (en) * | 2003-01-23 | 2003-11-30 | СКОРПАН Анатолие | Method of diagnosis of the reflux esophagitis gravity degree |
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| Title |
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| American gastroenterological association. Medical Position Statement: Guidelines on the Use of Esophageal pH. Gastroenterology, 1996, vol.110, p.1981-1996 * |
| Hunter J.G., Trus T.L., Branum G.D., Waring J.P., Wood W.C. A physiologic approach to laparoscopic fundoplication for gastroesophagel reflux disease. Ann. surg., 1996, nr. 223, p. 673-685 * |
| Katz P. O., Gerson L.B., Vela M.F. Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am. J. Gastroenterol., 2013, nr. 108, p. 308-328 * |
| Position Statement: Guidelines on the Use of Esophageal pH. Gastroenterology, 1996, vol.110, p.1981-1996. * |
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