RU2089219C1 - Method of treatment of nonspecific ulcer colitis - Google Patents

Abstract

FIELD: medicine, gastroenterology. SUBSTANCE: method involves the use of basic therapy in combination with salazo-derivatives of sulfanylamides and hormones and rectal administration of human donor albumin at the dose 100 ml, 5 times, in 2 days. Method ensures stable clinical effect. EFFECT: decreased dose of hormones, enhanced effectiveness of treatment.

Description

 The invention relates to medicine, namely to gastroenterology, and can be used in the treatment of ulcerative colitis.

 Known methods for treating ulcerative colitis include surgical and conservative methods. The basis of therapy is a set of measures defined as traditional methods: diet, correction of protein, mineral, water metabolism, the use of anti-inflammatory drugs with an individual selection of regimens, doses and routes of administration.

 In severe cases of the disease, replacement therapy involves intravenous administration of protein hydrolysers, amino acid mixtures. However, with the introduction of protein preparations, allergic reactions may occur.

 With prolonged diarrhea, loss of protein, electrolytes, and dehydration, drop transfusions of small doses of red blood cells, protein, albumin, and saline solutions are well recommended.

 Anti-inflammatory therapy for ulcerative colitis includes: derivatives of sulfonamides and glucocorticoid hormones; - cytostatic immunosuppressants. For example, there is a known method for the treatment of ulcerative colitis by the introduction of anti-inflammatory (hormonal), vitamin preparations, in which, to reduce the immunosuppressive effects of anti-inflammatory drugs (hormone therapy), against the background of anti-inflammatory therapy, immunoglobulin is additionally administered in a dose of 5-10 ml 3-5 times day. Although this method reduces the treatment time, it is effective for patients with mild to moderate forms of the process.

 When using anti-inflammatory drugs, the following negative phenomena occur: immunosuppression; when using steroids, hemorrhages in the gastrointestinal tract are detected, bone tissue damage, osteoporosis, osteonecrosis; alkylating substances can cause infertility, baldness, have a carcinogenic effect; azathioprine induces bone marrow depression.

 All of these substances are likely to induce opportunistic infections and the development of colon carcinomas.

 The medical and social significance of the problem of ulcerative colitis is determined not only by a high incidence (according to statistics, most often people of a young, most able-bodied age). Its etiology, many questions of pathogenesis remain unknown, and therefore the treatment is largely empirical.

 Currently known complex treatment, including the use of salase derivatives of sulfonamides, corticosteroids, the use of blood transfusions, transfusion of glucose-salt solutions, plasma, protein preparations, gives satisfactory results only in the treatment of mild and moderate cases and is ineffective in 30-80% of patients with severe forms of diseases .

 The basis of the invention is to propose a method for the treatment of ulcerative colitis, which would be effective in all forms of the disease, including severe.

 This problem is solved by the fact that in the method of treating ulcerative colitis based on basic therapy with the inclusion of salase derivatives of sulfonamides and hormones according to the invention, rectal administration of human donor albumin in a dose of 100 ml is also carried out 5 times in two days.

 The author found a persistent clinical effect when using enemas with albumin against the background of basic therapy, which manifests itself even in patients with a severe form of the disease, namely, they reduced the frequency of stools, the symptoms of hemocolitis disappeared, and the average time for repair of the intestinal mucosa was reduced by 1/3 compared with patients who did not receive albumin rectally.

 In addition, the advantage of the method is the delivery of the drug to the site of the lesion, which unexpectedly allowed to reduce the course dose of hormones and reduce the duration of maintenance hormone therapy.

 The author first discovered that the rectal use of albumin in the basic course of treatment has a normalizing effect on the indicators of the functional activity of phagocytes, helps to coordinate phagocytic activity and oxidative metabolism.

 It can be assumed that the effects achieved are due to the immunomodulating effect of albumin and, possibly, it is able to interfere with intracellular events associated with proliferation.

 The method is as follows. Patients with ulcerative colitis on the background of basic therapy simultaneously with the appointment of salase derivatives of sulfonamides and hormones are prescribed rectal administration of human donor albumin 100 ml five times every two days.

 Example 1. Patient H., 62, was admitted to the hospital with complaints of blood secretion during bowel movements, foamy stools, weakness. According to sigmoidoscopy: the mucosa is swollen and hyperemic, there is no vascular pattern, contact bleeding, single erosion. With coloscopy, proctosigmoiditis. According to bacteriological examination of feces, a sharp decrease in the number of Escherichia coli, an increase in the number of enterococci, hemolytically active staphylococci (up to 60% in relation to all coccal forms) was found. Diagnosed with ulcerative colitis, chronic recurrent form, moderate severity, moderate activity of inflammation. Intestinal dysbiosis. From the first day of treatment against the background of basic therapy, which included: prednisone 60.0 mg orally every other day, salazodimethaxine 6.0 g per day, tranquilizers, biological preparations - bificol; vitamin therapy, for two weeks the patient received rectally albumin, human donor, 100 ml, N 5 after two days. After the second administration of albumin, the symptoms of hemocolitis disappeared. After the fourth injection, the patient noted an improvement in overall health, a decrease in mental asthenia. Repeated sigmoidoscopy was performed one week after the last rectal administration of albumin. The endoscopic picture testified to the beginning of repair processes: the swelling of the mucosa decreased, erosion disappeared, and bleeding of the mucosa stopped. Two weeks after the start of treatment, the daily dose of prednisone was halved, after a month and a half the patient was transferred to maintenance doses of prednisone, which were withdrawn after 4 months.

 Remission for today is 11 months.

 Example 2. Patient N. 34 years. The diagnosis of ulcerative colitis was made 4 years ago. The patient notes the seasonality of exacerbations. I went to the doctor in the month of March. Diagnosis: ulcerative colitis, chronic relapsing form, moderate activity of inflammation. Intestinal dysbiosis.

 A set of measures was carried out, defined as a basic treatment with the inclusion of prednisolone 80.0 mg orally every other day and sulfasalazine 8.0 g per day. Against this background, from the first day of treatment, rectal albumin therapy was carried out (human donor albumin 100 ml 5 times in two days). After the third injection, the patient noted an improvement in overall health, appetite appeared, the frequency of stools decreased, pathological impurities in the feces disappeared. Repeated sigmoidoscopy was performed a week after the last injection of albumin: the swelling of the mucosa decreased, there was no contact bleeding, single ulcers in the epithelization stage. Before starting treatment in a patient with sigmoidoscopy. noted: the mucous membrane of the rectum and sigmoid colon is ulcerated, edematous, bleeds. Two weeks after the start of treatment, the daily dose of hormones was halved, and after two months the patient was transferred to maintenance doses, which were withdrawn after 3.5 months. In autumn, the patient did not have a relapse.

 The duration of remission for today is 7 months.

 It should be noted that in patients who received only basic treatment, the severity of mucosal lesions decreased only on the 40-50th day of treatment, and in 9 out of 14 control individuals who did not receive albumin, autumn relapse was noted.

 Additionally, an immunological examination of patients with ulcerative colitis was carried out. It has been established that with ulcerative colitis, an imbalance in the relationship of cellular and humoral immunity factors is formed, the depth of which directly correlates with the severity of the process. The introduction of albumin had a normalizing effect on the integration of cellular and humoral factors of immunity.

 Thus, the proposed method for the treatment of ulcerative colitis can be successfully used in the treatment of all forms of severity of the process. Moreover, the improvement of the patient's subjective sensations coincides with the normalization of clinical and laboratory data, which allows to reduce the course dose of hormones and reduce the duration of maintenance hormone therapy.

Claims (1)

 A method for the treatment of ulcerative colitis based on basic therapy with the inclusion of salase derivatives of sulfamylamides and hormones, characterized in that they also carry out a rectal administration of human donor albumin in a dose of 100 ml 5 times in two days.