RU1796198C - Method for treatment of erosive reflux esophagitis - Google Patents

Abstract

The invention relates to medicine, in particular to gastroenterology. The goal is to shorten the duration of treatment. The lesion is affected by defocused laser radiation with a wavelength of 632 nm, a power density of 0.66 mW / cm2 for 10 min with a total dose of 7.2 J using a light guide probe with a light distribution indicator of 6 cm. The method allows to reduce the time of hospital treatment by 2 times and to achieve complete epithelialization of erosion in 93.8% of patients. 1 tab.

Description

The invention relates to medicine, in particular to methods for treating erosive reflux eosophagitis.

A method of treating chronic eosophagitis is known. which consists in the fact that a solution of a regeneration stimulant, methyluryl, is introduced into the cavity of the esophagus under conditions of rotation of the body through an elastic catheter.

The technique is not without drawbacks, which significantly reduces its value. Thus, the main clinical manifestations of the disease disappear only on the 15-16th day, and the percentage of patients with complete epithelization of erosion does not exceed 65.2 with 30 days of treatment in a hospital.

Recently, a helium-neon laser has been widely used in gastroenterological practice, in particular in the treatment of gastric ulcer and duodenal ulcer. However, there is no technological development of the use of this type of laser in the treatment of erosive reflux eosophagitis, which is characterized by a number of distinguishing features.

Esophagus erosion, as a rule, occurs against the background of a diffuse inflammatory process of the mucous membrane. Unlike gastric and duodenal ulcers, they are characterized by multiplicity and a greater prevalence associated with it, which complicates the use of targeted irradiation of defects through a fiber inserted into the biopsy channel of the fiberscope. In addition, during fibroscopy, there is a risk of trauma to the esophagus mucosa.

At the same time, the anatomical features of the esophagus are a tubular structure; small dimensions are extremely convenient for conducting probe irradiation.

The purpose of the invention is to reduce the treatment time for erosive reflux eosophagitis by diffusing irradiation of erosion of the esophagus mucosa with defocused laser radiation at a wavelength of 632 nm with a power density of 0.66 mW / cm2 for 10 minutes with a total dose of 7.2 J using a special fiber guide.

The goal is realized as follows.

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Laser radiation is delivered to the erosion of the mucous membrane of the esophagus by a light guide probe with a light distribution indicatrix at the distal end in the form of a cylinder with a length of 6 cm.

The location and size of the eroded area are determined visually from the marking of the apparatus during preliminary endoscopy. Subsequently, irradiation of the lesion is carried out without a fiberscope.

The fiber is inserted to the required depth after local anesthesia of the pharyngeal mucosa with 10% lidocaine solution. Probe progress is monitored by the centimeter markings on it. With extensive mucosal lesions, irradiation is carried out in two stages by sequentially moving the light guide.

The light guide device consists of an external PVC tube with a diameter of 0.5 cm, a length of 2.5 m and an internal fiber with a cross section of 0.1 cm. A metal reflector of a cylindrical shape with a concave working surface of 0.3x0.5 cm is placed in the cavity of the distal end of the tube The output end of the internal fiber is 6 cm away from the reflector. The distal part of the tube is filled with polymer fixing the output end of the fiber and the reflector.

The optical properties and elasticity of the polymer contribute to the laser beam from the fiber to the reflector when the shape of the probe changes.

The proposed method of laser therapy makes possible diffuse uniform irradiation of the mucous organ of a cylindrical shape (esophagus).

Example 1. Patient B, 43 years old, medical history No. 4509. Diagnosis: erosive reflux eosophagitis with partial cardiac insufficiency, Algic form, moderate severity, in the acute phase.

Complaints of pain along the esophagus, constant heartburn, belching, burping food.

Sick for 3 years, treatment was carried out twice in the hospital for 24 and 28 days, respectively. It was prescribed without healing of erosion with a slight subjective improvement. On admission, pain in the epigastrium was noted.

X-ray conclusion: reflux eosophagitis. Indirect signs of cardia failure. Chronic gastritis.

With endoscopy in the lower third of the esophagus at a distance of 37-40 cm from the edge of the upper

incisors against the background of hyperemic mucosa revealed 4 linear erosion 2.5-3.0 cm long, 0.2-0.3 cm wide covered with fibrin,

Using a light guide probe, diffuse irradiation of the lower third of the esophagus with defocused laser radiation at a wavelength of 632 nm was performed daily for a power density of 0.66 mW / cm2 for 10 min with a total dose of 7.2 joules.

After 3 sessions, the main manifestations of the disease disappeared, after 5 sessions, healing of erosion began.

Thus, in a patient with long-term non-cicatricial erosion of the esophagus after laser irradiation, their complete epithelization was achieved.

Example 2. Patient A., 58 years old, medical history N 4912. Diagnosis: erosive reflux eosophagitis with complete insufficiency of cardia. Chronic gastritis with reduced secretory function.

Complaints of pain behind the sternum, in the epigastrium, in the interscapular region, aggravated after eating hot food, heartburn,

burping air. Sick for about 5 years. A year ago, he was treated in a hospital for 30 days. Was discharged with a decrease in clinical manifestations and partial epithelization of erosion.

An X-ray examination revealed small areas of barium retention, gaping of the cardia, absence of a gas bubble, an increase in the angle of His, and barium reflux from the stomach to the esophagus in a horizontal position in the lower third of the esophagus. Conclusion: signs of cardia failure. Erosion of the lower third of the esophagus, chronic gastritis.

Endoscopically in the lower third of the esophagus, at a distance of 36–40 cm from the anterior incisors, 5 longitudinal tape-shaped erosions 0.2–0.3 cm wide, covered with fibrin plaque, yaw of cardia, hyperemia and swelling of the esophageal mucosa were found

and stomach.

A light guide probe was used to daily irradiate lesions with defocused laser radiation at a wavelength of 632 nm and a power density of 0.66 mW / cm2 for 10 min with a total dose of 7.2 J.

After 4 sessions, pain, heartburn disappeared and belching decreased. After 6 sessions, control endoscopy revealed healing

zrozium and reduction in the size of the zi or cardia.

In this patient with erosion resistant to drug treatment, after 6 sessions of probe laser therapy, their epithelization was complete.

Example 3. Patient J., 44 years old, medical history N 5479. Diagnosis: erosive reflux eosophagitis with indirect signs of cardia failure in the acute stage. Chronic gastritis with reduced secretory function. Chronic duodenitis.

Complaints of pain behind the sternum, dysphagia that occur after eating solid foods, heartburn in a horizontal position, regurgitation when the body is tilted forward.

When endoscopy revealed erosion of the esophagus. Treated on an outpatient basis. Due to the lack of effect, hospitalized.

An X-ray examination revealed indirect signs of cardia failure, erosive reflux eosophagitis with the effects of moderate narrowing of the lumen in the abdominal part, and chronic gastritis.

Endoscopically in the lower third of the esophagus, at a distance of 37–40 cm from the anterior incisors, 4 ribbon-like erosions and narrowing of the lumen due to swelling of the mucosa were found.

Using a light guide probe, daily irradiation with a defocused laser radiation of 632 nm wavelength and a power density of about bb mW / cm for 10 min with a total dose of 7.2 J was performed.

After 4 sessions, pain, heartburn disappeared and the symptoms of dysphagia significantly decreased. After 7 sessions, control endoscopy revealed the healing of erosion and the expansion of the lumen to normal sizes.

The average duration of inpatient treatment of patients using laser therapy averaged 15 days, and with local use of methyluracil 30 days.

Thus, laser therapy of erosive reflux eosophagitis allows halving the time of inpatient treatment of patients and significantly increasing its effectiveness.

Probe diffuse laser irradiation of esophageal erosion was performed in 32 patients. As a result of therapy with defocused diffuse laser radiation according to the proposed method, complete epithelization of erosion was observed in 93.8% of patients, and the disappearance of the main clinical symptoms of the disease occurred 4 times faster compared to the direct exposure to erosive mucosa with 0.7% methyluracil solution (see . table).

SUMMARY OF THE INVENTION A method for treating erosive reflux eosophagitis by topically treating a lesion after insertion of a probe into the esophagus, characterized in

that, in order to shorten the treatment period, the exposure is carried out by defocused laser radiation by means of a light probe with an indicatrix of light distribution in the form of a cylinder 6 cm long.