RU2097048C1 - Method for treating gastroduodenal peptic ulcers - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves cleaning ulcer surface from fibrin film by means of 3% solution of hydrogen peroxide, washing with water, blowing down with air, delivering autofibronectin-containing preparation warmed to patient body temperature in aimed mode. Preparation concentration is 2-2.5 mg/l in solution. The preparation is introduced in the amount of 5-15 ml per one endoscopy procedure. EFFECT: enhanced effectiveness in preventing recidivations and complications. 1 tbl

Description

 The invention relates to endoscopic methods of treating gastroduodenal ulcers. In recent years, methods of local treatment of this complex disease by administering drugs through an endoscope have become more widespread. There is an endoscopic method for treating gastroduodenal ulcers with pankipsin and karatalin (Gumerov A.A. et al. Comparative evaluation of treatment results for gastric and duodenal ulcers in children: abstracts of the All-Union Scientific and Practical Conference Topical issues of endoscopy in pediatrics Gorky, 1990. p.169 170 ) The essence of this method is that the ulcer is treated with pankypsin at a dose of 25 mg, then it is irradiated with low-intensity red light for 2 3 minutes, then it is irrigated with 10 ml of caratalin. The disadvantage of this method is its complexity, longer duration of the procedure and course of treatment due to exposure to low-intensity red light, as well as the healing of ulcers (up to 30 days) and the preservation of pain (up to 10 days).

 The prototype of the invention is an endoscopic method for treating gastroduodenal ulcers with solcoseryl and sea buckthorn oil (Akhmetova R.A. et al. Endoscopic method in the complex treatment of peptic ulcer and erosive gastroduodenitis in children Pediatrics, 1990, pp. 79-80). The essence of this method is that the preparation of sea buckthorn oil through the catheter of the endoscope biopsy channel irrigated the ulcer and near ulcer surfaces in a radius of 3 5 cm (single dose of 5 ml) with preliminary application of solcoseryl (single dose of 2 ml). The procedure was carried out every other day. Depending on the size and depth of ulcerative defects, the course of treatment included from 5 to 11 endoscopic irrigation with solcoseryl and sea buckthorn oil. Ulcer healing was assessed by a combination of subjective and objective data and endoscopy results. The disadvantage of this method is that there is a longer healing period for ulcerative defects (23 25 days), patient stay in the hospital (30 45 days), pain preservation (up to 10 days), as well as scar formation.

 The aim of the invention is the prevention of complications and relapses, reducing the duration of treatment and the presence of pain.

A method of treating gastroduodenal ulcers is as follows: for treatment, patients were taken with a clearly established diagnosis of gastroduodenal ulcer, in which conventional conservative therapy was ineffective. The diagnosis was made on the basis of fibroesophagogastroduodenoscopy (PEGF) with biopsy and histological examination of the biopsy, clinical and biochemical blood tests, blood tests for the Australian antigen and HIV. The patient was sampled from 100 to 250 ml in a hemacon container, depending on age, simultaneously. Then the container was centrifuged in a PC-6 centrifuge (operating time 15 min, revolutions 2250 per minute), the separated erythromass was returned to the patient intravenously, and the platelet-poor plasma was extracted and incubated with heparin at a rate of 15 Units / ml at a temperature of 4 ^o C in for 16-18 hours, after this period, the precipitate was separated by centrifugation (operating time 20 min, speed 3300 rpm), the supernatant was removed with an extractor, the isolated heparin precipitate was used as a source of autofibronec tin (AFN), the concentration of which in the plasma precipitate was determined by the solid-phase immuno-enzyme method using purified antibodies to human autofibronectin. The final concentration of autofibronectin in the preparation was 2 2.5 mg / ml. Plasma replacement was performed with 0.9% saline in a ratio of 1: 1 with the volume of blood taken into the container. A patient with a stomach ulcer or (and) duodenal ulcer was subjected to standard FEGDS. Then, through the catheter of the endoscope’s biopsy channel (equipment and instruments of the Japanese company Olympus were used), the ulcer surface was preliminarily cleared of fibrinous plaque using a 3% hydrogen peroxide solution, washed with water, purged with air, and the patient was heated up to 37 ^° C while aiming at it. a preparation containing autofibronectin, the concentration of which was 2 2.5 mg / ml of solution. For one endoscopic procedure, 5 to 15 ml of the drug was administered. This amount is enough to treat the ulcer surface. The duration of the course was determined by the healing time of the ulcer. The procedure was carried out daily for 5 to 8 days. After 2 3 procedures, there was a decrease in fibrinous plaque on the ulcer, relief of the inflammatory process and a decrease in the size of the ulcer surface by 1.5 2 times. At the end of the full course of treatment (5–8 days), the patients were undergoing conservative therapy and follow-up with follow-up FEGDS after 1.3 and 6 months. In the control biopsy sample after 6 months, the absence of inflammatory processes, restoration of the glandular epithelium, and the absence of dystrophic changes were determined.

 The healing factor of autofibronectin is the activation of wound healing - stimulation and vascularization on the ulcer surface. Autofibronectin concentrates on its surface neutrophils, macrophages, cells of the connective tissue skeleton (fibroblasts) that actively produce collagen (see Clark RA Quinn JH Winn HI et al. // J. exp. Med. 1982.- Vol. 156. P . 646-651).

 Endoscopic autofibronectin treatment was carried out for 68 patients under the age of 14 years, with various ulcerative history (acute and chronic). A positive endoscopic and clinical effect was obtained in all 68 patients, i.e., in 100% of cases. Follow-up observations over three years showed that in 64 patients the healing effect was persistent, four patients required a second course of endoscopic treatment with autofibronectin after 1.5 years, which is associated with the refusal of supportive conservative therapy, violation of diet and diet.

We give observations:
1. Patient A. V. born in 1993 N source illness 10829, was admitted to the RCCH 5.01.94 with complaints of abdominal pain, repeated vomiting, weakness, periodic anxiety. From the anamnesis it is known that in the neonatal period he was operated on in the RCCH for septic peritonitis. The postoperative period is difficult, intensive therapy was carried out, was discharged after one month. Six months after discharge, anxiety appeared, sharp pains in the epigastric region of the abdomen, vomiting after eating, belching, heartburn, the child lagged behind in physical development. He was again hospitalized in the Russian Children's Clinical Hospital with a suspicion of adhesive intestinal obstruction, which was excluded during clinical and laboratory examination. 8. 01.94 performed FEGDS, revealed an ulcer of the stomach angle, rhomboid shape, 10x18 mm, deep, with severe periulcerinous inflammation, the bottom is covered with loose fibrinous deposits, increased contact bleeding of the gastric mucosa and 12 duodenal ulcer with symptoms of hypertrophic inflammation; the pylorus for the endoscope tube (D 7.9 mm) is difficult to pass due to edema. With contrast radiography, the passage of barium from the stomach is reduced. The patient underwent a course of generally accepted conservative therapy and 6 courses (10 procedures each) of endoscopic treatment (solcoseryl 2.0 and sea buckthorn oil 5.0), which did not lead to an effect. From 04/27/94 to 05/02/94, a course of endoscopic treatment of AFS was carried out according to the proposed scheme (7 procedures). With FEGDS from 05/12/94, the angle of the stomach has a completely healed ulcer, there are no inflammation phenomena, the pylorus passes freely. With endoscopic control after 1.3 and 6 months, data for a relapse of the disease were not detected. Transferred to supportive conservative therapy. There are currently no complaints; body weight meets age standards.

2. Patient S. I. b. 1986 N source disease 7700, sought medical help at the RCCH 12.05.92 six hours after the onset of the disease. Upon admission, he complained of abdominal pain of paroxysmal nature, double vomiting, low-grade fever. In the blood test at admission, moderate leukocytosis up to 12.0 • 10 ⁹ / ml. A history of such pain was noted two days ago. Hospitalized in the surgical department with suspected acute appendicitis. During dynamic observation, acute appendicitis was not possible to exclude and a typical appendectomy was performed on 05/12/92, in which a catarrhally altered vermiform appendix was removed. In the postoperative period, pain remained in the epigastric region of the abdomen, nausea. 05.21. 92 pain intensified, repeated vomiting, "tarry" stools appeared. 05.22. 92 produced FEGDS: in the lumen of the stomach and duodenum, blood in moderation; in the duodenum bulb along the anterior and posterior walls there are two “specular” ulcers, round in shape, 1.0 cm in diameter each, deep, with periulcerous reaction, with hemorrhagic-fibrinous plaque, easily bleeding on contact with the endoscope. Conservative hemostatic therapy has begun, hemorrhagic syndrome has been stopped. A course of endoscopic treatment of AFS has begun (8 procedures). After the third treatment procedure, sharply positive dynamics of the ulcer was completely cleared of fibrin, and halved. A positive endoscopic and clinical effect was obtained. Transferred to supportive conservative therapy. In the control FEGDS, after one month, the ulcers are in the healing stage. When dynamic endoscopic observation after 3.6 and 12 months of relapse was not observed. Currently no complaints.

3. Patient B. Century, born in 1980 N source illness 4209, was admitted to the Republican Children's Clinical Hospital March 16, 1992 with complaints of abdominal pain, belching, heartburn. Previously examined and treated repeatedly for ulcers of the pyloric stomach. An ulcerative history of three years, exacerbation of the disease on average 1 time per year. Hospitalized, examined. In the blood test, moderate leukocytosis up to 9.0 • 10 ⁹ / ml, ESR 2 mm / h, other indicators without features. When FEGDS revealed an ulcer of the pyloric department of a large curvature of the stomach, 12 • 8 mm, with severe inflammatory phenomena, the bottom is covered with loose fibrin. Due to the ineffectiveness of conventional conservative therapy, from March 20, 92 to March 25, 92, endoscopic treatment of AFS was carried out, a course of 6 procedures was conducted. During the control FEGDS after 1.3 and 6 months, no ulcer was found. Repeatedly sought medical help on 11/21/92, with complaints of abdominal pain that appeared one month ago after eating spicy and fatty foods. The prescribed conservative therapy was not carried out. 11/27/92 launched the second course of endoscopic treatment of AFS, consisting of six procedures, which led to a persistent healing effect. When the control FEGDS after 1, 3, 6 and 12 months of data for the recurrence of the disease was not detected, post-ulcer scar was not found. There are currently no complaints, healthy.

 4. Patient Yu. R. b. 1982 N source disease 381, appealed to the RCCH 3.07.94 with complaints of paroxysmal abdominal pain, weakness, nausea, lack of appetite. Acute pains appeared one day ago during sleep. When FEGDS revealed ulcerative defect of the anterior wall of the bulb 12 p. K. 6 • 6 mm, the bottom is shallow with a slight loose fibrinous coating. 07/06/94 endoscopic treatment using AFS, a course of 5 procedures. After three treatment procedures, the ulcer was completely cleansed of plaque and the ulcer was reduced in size. With FEGDS 07/15/94 complete healing of ulcers. Conservative maintenance therapy has been prescribed. Examined after 1, 3 and 5 months of data for recurrence of the disease was not detected.

More clearly examples are shown in the table.
The advantages of the invention, the method is organ-preserving (excludes severe surgical intervention, leading to disability); healing of the ulcer surface occurs without the formation of deforming organ scars. In addition, significantly reduced treatment time compared with the prototype (in the proposed method 10 12 days, in the prototype up to 30 days, ie 2 3 times). After two or three treatment procedures, the disappearance of pain and other symptoms accompanying the disease are noted. Significantly reduced drug consumption.

Claims (1)

 A method for the treatment of gastroduodenal ulcers, including endoscopic administration of a drug, characterized in that the ulcer surface is preliminarily cleaned of fibrinous plaque with a 3% hydrogen peroxide solution, washed with water, rinsed with air, 5-15 ml of the patient is heated up to body temperature with autofibronectin concentration 2.0 2.5 mg / ml solution daily.

Images