RU2082413C1 - Method of duodenum ulcer disease treatment - Google Patents

Abstract

FIELD: medicine, gastroenterology. SUBSTANCE: ulcer defect is pricked about with lysozyme at dose 100-150 mg and then with solcoseryl or actovegin at dose 4-5 ml and ulcer is sprayed with sea-buckthorn oil. Administration points were changed at the following procedure. Procedure is carried out each other day, 3-5 procedures for treatment course. EFFECT: decreased period of treatment. 3 cl

Description

 The invention relates to medicine, namely to gastroenterology and can be used to treat duodenal ulcers.

 Treatment of long-term non-healing duodenal ulcers is a complex and unresolved problem of modern gastroenterology. Therefore, the search for methods and drugs for the treatment of duodenal ulcers is an urgent problem in the treatment of this disease.

 A known method of endoscopic treatment using the drug "Proposol" in the treatment of duodenal ulcers [1] The drug contains propolis and is administered through an endoscope on an empty stomach three times a week, every other day. Through a teflon catheter conducted through a biopsy channel of the endoscope, 3 ml of the drug is applied to the surface of the ulcer. Conduct conventional antiulcer therapy at the same time. In 84.3% of patients, a peptic ulcer is epithelized up to 18 days, for which 6 8 treatment endoscopies were required. Ineffective treatment was found in 6.1% of patients.

A known method of treating peptic ulcer using film-forming drugs. From a large number of adhesive substances N.S. Fokin et al. (1980) [2] focused on MK-6 glue, which has antimicrobial activity, is non-toxic, biologically compatible and quickly polymerizes upon contact with tissues. During an endoscopic examination, a teflon catheter is placed above the ulcer. A peptic ulcer and mucous membrane around the ulcer is treated with 8 10 ml of 96 ^o , ethyl alcohol. On the ulcer, including 0.5 cm of the mucous membrane around it, 1-2 ml of glue is applied, depending on the size of the defect. Subsequent adhesive applications are made with an interval of 4 -5 days. In total, there are 8 10 applications for the course. The terms of ulcer scarring when using adhesive applications in combination with the general therapy of peptic ulcer with duodenal ulcers amounted to 33.2 ± 3.2 days.

A known method of treating gastric ulcer and duodenal ulcer using the aerosol film-forming preparation "Statizol", which affects the metabolic processes in the mucous membrane of the digestive tract, providing a prolonged, reparative effect in the area of the pathological focus, protecting the ulcer from further exposure to acid-resistant gastric contents the environment of the stomach. "Statisol" is applied to the ulcer through a catheter conducted through the biopsy channel of the endoscope during fibrogastroduodenoscopy after preliminary "drying" of the mucosa with 96 ^o alcohol (3 5 ml), glue was applied to the ulcer and up to 1 cm around it. 10 applications were used for the course of treatment. As a result of complex therapy of peptic ulcer with the use of the film-forming drug “Statizol”, ulcer healing is observed after 2 3 weeks. With duodenal ulcer, the healing time was 20.7 ± 2.4 days [3]
The disadvantages of all the methods described are the rapid removal of any drugs from the surface of the ulcer, through gastric juice and food, and the impossibility of prolonged exposure when applied topically to the ulcer.

 Closest to the proposed method and adopted as a prototype is a known method for the treatment of duodenal ulcer by chipping an ulcer with oxypherisorbone sodium and amiglouracil, followed by applying film-forming drugs to the ulcer: MK 6, MK 7 glue [4] Sodium oxyfericorbone has reparative and anti-inflammatory decongestant action. Amigluracil, a preparation made on the basis of methyluracil, belonging to the group of pyrimidine derivatives, has a reparative, anti-inflammatory and proteolytic effect. In case of fibrogastroduodenoscopy with a special needle, an injection of 2 to 3 points at a distance of 0.5 0.8 cm from the edges of the ulcer submucosally injects 15 30 mg of hydroxyferisorbone sodium, and 0.25 0.5 mg of amigluracil into its bottom (1-2 points). Then, after “drying” (0.8-1 ml of acetone), 1-2 ml of MK-6 or MK-7 medical glue is applied to the ulcer, with 0.5 to 0.8 cm of the surrounding mucous membrane being captured through a teflon catheter. Repeated fibrogastroduodenoscopy for therapeutic purposes is performed with an interval of 4 to 5 days, an average of 3 6 times per treatment course. In 1/3 of patients with a duodenal ulcer treated with this method, the healing time of the ulcer is 12–15 days. In 2/3 patients, the healing time is from 16 to 48 days. Clinical recovery occurred in 97.4% of patients.

 The disadvantage of the prototype is the duration of treatment of patients. The healing time of ulcers is close to the treatment of duodenal ulcers with other methods of complex exposure. In 2/3 patients, the healing time is from 16 to 48 days, which does not satisfy modern gastroenterology.

 The objective of the invention is the reduction of treatment time.

 This is achieved by the fact that in the known method of treating duodenal ulcer by chipping an ulcer with drugs, lysozyme and reparant are injected into the edges and under the ulcer defect at different points and irrigate the surface of the ulcer with sea buckthorn oil, while the injection points are changed with the following procedure. The procedure is carried out every other day, for the course of treatment 3 5 procedures. A single dose of lysozyme 100 150 mg. reparant 4 5 ml of sea buckthorn oil 5 ml. Solcoseryl or Actovegin is used as a repair agent.

 Lysozyme is an enzyme of protein nature. Get it from chicken egg protein. This is an antibacterial drug that has the ability to stimulate non-specific immunity. Lysozyme in surgery is used to treat severe surgical infections, while stimulating the body's immune forces. Lysozyme stimulates phagocytosis, proliferation of T and B lymphocytes. Without stimulation of the body's immune forces, it is impossible to enhance reparative processes in the mucosa in case of duodenal ulcer with the help of only oxypherisorbone sodium or other reparants. 100 150 mg of the drug per injection, this dose, which is administered to patients intramuscularly with severe, purulent infection of the abdominal cavity (purulent appendicitis, peritonitis) with a single injection. Creating a depot of lysozyme in the submucosal layer of the ulcer, and then chipping the ulcer with a solution of solcoseryl or actovegin stimulate local immunity processes and enhance reparative processes in the ulcer area, thereby conducting pathogenetic treatment of duodenal ulcer.

The method is as follows:
On an empty stomach in the position on the left side after irrigation of the pharynx with 1% dicaine solution, fibrogastroduodenoscopy is performed in which it reveals a duodenal ulcer. The bottom of the ulcer is cleaned with a brush of food debris and plaque of fibrin. After that, bringing the injector to the ulcer, a 0.5 - 0.8 cm needle is released from it. By injecting into the edge of the ulcer so that when the medicine is introduced, an infiltration shaft from the mucous membrane is formed. Injection injected lysozyme in a dose of 100 to 150 mg at one point, solcoseryl or actovegin in a dose of 4 to 5 ml is administered at another point on the border of a healthy and affected mucous ulcer. With the introduction of lysozyme, local immunity is stimulated, with the introduction of the reparant, regeneration processes are activated. Creating a submucosal infiltration shaft from drugs, they are deposited for a longer period, which increases their therapeutic effect, and also brings the edges of the mucosa closer together mechanically, thereby accelerating the adhesion of the edges of the ulcer and its healing. After injection of lysozyme and solcoseryl or actovegin, sea buckthorn oil is applied to the ulcer through a fluoroplastic catheter. When applying oil, they capture the mucous membrane surrounding the ulcer. The procedure is repeated every other day. In the course of treatment 3 5 procedures. Each subsequent procedure is performed at a new point along the perimeter of the ulcer. Treatment is stopped after scarring the ulcer to a tender red scar, sometimes by contracting the mucosa at the site of the ulcer crater, depending on its depth.

 Examples of specific performance are given in the form of extracts from medical records.

 Patient A.I. Vodopyanov, 56 years old, source N 588, suffers from duodenal ulcer for 5 years. In February 1993, the patient had another exacerbation of peptic ulcer of the duodenum, which is manifested by pain in the epigastrium, aching, skinny character. With fibrogastroduodenoscopy from 02.20.1993, the detection of exacerbation of duodenal ulcer. He entered the therapeutic department for conservative treatment. The patient underwent treatment: vicalin, gastrofarm 1 tablet x 3 times a day, almagel 1 dl x 3 times a day HBO therapy. 02/19/93 produced 1 session of therapeutic endoscopy. After irrigation of the pharyngeal ring with 1% solution of dicain, fibrogastroduodenoscopy was performed. The esophagus and cardia are freely passable. There is a lot of mucus in the stomach on an empty stomach, the mucous membrane is hyperiminated, the folds are thickened, and swollen. There are many surface erosions in the antrum. The gatekeeper is symmetrical, closed. In the bulb of the duodenum on the anteromedial wall there is a deep ulcer, measuring 1.5 x 1.0 cm. Its bottom is filled with fibrin, the walls around it are infiltrated, the folds are thickened, swollen. The bottom of the ulcer is brushed from fibrin. An ulcer was chipped with the creation of an infiltrative shaft with a 100 mg solution of lysozyme. from one point. From the second point on the border of the healthy and mutable healthy mucosa, the ulcer was chipped with 5 ml of solcoseryl solution. After that, 5 ml of buckthorn oil was irrigated through a teflon catheter. The patient underwent 5 sessions of therapeutic endoscopy according to the described technique. After the second session, the patient disappeared pain in the epigastrium. During the 3rd session, a decrease in the size of the ulcer, as well as its depth, was diagnosed, the bottom was cleansed of fibrin. During the 5th session revealed: on the anterior-medial wall of the bulb 12 of the duodenal ulcer pink ulcer, 0.6 x 0.8 cm. Pink mucous around. Swelling of the folds and deformity of the bulb was not noted.

 Patient Semenova N.P. East. N 889, 61 years old, suffers from duodenal ulcer for 3 years, when an ulcer was first detected. Pain in the epigastrium of a seasonal, skinny nature bothered the patient before. With an exacerbation of peptic ulcer of the duodenum 12, the patient was hospitalized in the therapeutic department of hospital No. 28, where she underwent conservative treatment: vikalin, gastrofarm 1 tablet. x 3 times a day, 1 dl almagel x 3 times a day. Antispasmodics / m 02.25.1993 with fibrogastroduodenoscopy revealed that the esophagus and cardia are freely passable. There is no contents in the stomach on an empty stomach, pink mucosa, folds are not thickened. The gatekeeper is symmetrical, closed. There are two ulcers in the bulb of the duodenum 12 on the anterior and posterior walls, 0.8 x 0.5 cm in size, their bottom is covered with a fibron, and the folds are somewhat thickened. The mucosa is hyperemic. Diagnosis: duodenal ulcer in art. exacerbations. Kissing ulcers of the duodenal bulb 12. Medical endoscopy was performed: an injector was inserted under the ulcer on the posterior wall of the bulb, and the ulcer was chipped with 150 mg lysozyme solution. On the opposite side of the ulcer, the ulcer was chipped off at the border of the healthy and affected 4 ml solcoseryl solution. After that, the ulcer was irrigated with a solution of sea buckthorn oil 5 ml. The patient produced 5 sessions of therapeutic endoscopy. During the second session, an improvement was noted in the form of a decrease in the size of ulcers and beginning scarring at the edges. The pain syndrome disappeared by the 3rd procedure. By procedure 5, ulceration is diagnosed.

Comparison of the proposed method with the prototype revealed the following positive effect:
Chipping an ulcer with a solution of lysozyme and creating its depot in the submucosal layer, increases local immunity.

 Subsequent stabbing of the ulcer with a reparant, against the background of lysozyme injected, creates the most favorable conditions for ulcer healing, reducing the number of procedures to 3 5 per treatment course.

 Thus, the treatment time was reduced to 6 10 days.

 The described method treated 12 patients. All marked clinical endoscopic positive dynamics during the ulcerative process. In all patients, ulcer scarring was observed after 3 5 endoscopic chipping.

 Excellent results were obtained in 92.31% of patients. Satisfactory in 7.6% of patients, which allows us to recommend a method for implementation in widespread practice.

Bibliography
1. Kabanov A.N. Suvorov A.M. Therapeutic endoscopy in the selection of patients with duodenal ulcer, subject to surgical treatment // Klin. chir. 1986. -N8.-p. 39 41.

 2. Fokin N.S. Bastatsky V.G. Ponomarev V.G. et al. The use of MK-6 glue in the treatment of gastroduodenal ulcers with a fiber microscope // Sov. honey.-1980-N2. - p. 61 63.

 3. Tsarev N.I. Krasnykh A.M. The use of the film-forming glue "Statizol" in the treatment of gastric and duodenal ulcers // Tomsk State University Journal. chir. -1986.-N1. -FROM. 14 17.

 4. The prototype. Berezov Yu.E. Fokin N.S. Bastatsky V.G. et al. Local treatment of long-term non-healing gastroduodenal ulcers through a fibroscope // Sov.med. -1981.-N2.-C.26 30.

Claims (3)

 1. A method of treating duodenal ulcer by chipping an ulcer with drugs, characterized in that lysozyme and reparant are injected into the edges and under the ulcer defect at different points and the surface of the ulcer is irrigated with sea buckthorn oil, the injection points are changed with each subsequent procedure, the procedure is carried out every other day, on a course of treatment 3 5 procedures.  2. The method according to p. 1, characterized in that a single dose of lysozyme 100 - 150 mg, reparant 4 5 ml, sea buckthorn oil 5 ml.  3. The method according to PP. 1 and 2, characterized in that as a repair using solcoseryl or actovegin.