RU2146934C1 - Method for complex treatment of gastric illness in sanatoriums and health resorts - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves treatment by mineral water and curative mud combined with specific agent. During first 5-7 days, method involves taking the agent in adaptive dose, which consists of 0.4 g/kg for children younger than 10 years, 0.5 g/kg for children older than 10 years, and 25 g for adults. For subsequent days, method involves curing treatment, which consists of 0.3 g/kg for children and 15.0 g for adults. The agent is taken once a day on an empty stomach. If necessary, treatment may be continued at home. EFFECT: prevention of worsening of pathological process, decreased frequency of decease relapses by factor of 1.5-2. 5 tbl, 3 ex, 4 cl

Description

 The invention relates to medicine, in particular to pediatrics, therapy, balneology, and can be used in the treatment of a wide range of diseases, the pathogenetic treatment of which requires the use of natural physical effects that have anti-inflammatory, antioxidant, regenerative, antispasmodic, immunostimulating, desensitizing effects.

 Digestive apparatus diseases in childhood are perhaps the most common. In all regions of the country, without exception, they occupy a leading place in the structure of child morbidity. Over the past 10 years, the number of patients with a severely occurring pathology of the digestive system has increased by 3 times. The number of patients with peptic ulcer increased by 56%, gastritis and duodenitis - by 74%, diseases of the hepatobiliary system - by 54%. The combination of gastroenterological pathology with other diseases reaches 70-90%. The origins of severe forms of adult diseases are in childhood.

 This necessitates increased attention to all types of treatment of diseases of the digestive system, including the sanatorium-resort phase of rehabilitation.

 Treatment with individual natural factors, such as mineral water, peloids, aerophytions, therapeutic physical culture, is aimed at individual links in the pathogenetic chain of the process that occurs in the body during the development of the disease.

 These circumstances determine the necessity and relevance of the search for integrated methods of natural exposure, which have a wide spectrum of action and ensure high efficiency of recovery.

 Analogues of the proposed method is the treatment of gastroenterological diseases at the sanatorium stage using drinking mineral waters (1), in combination with the internal intake of mineral water and baths of various mineral composition (2), the use of mud treatment (3).

 R.N.Yamoldinov (1993) prescribed to children in the rehabilitation therapy of digestive diseases weakly alkaline, medium mineralized, sulphate-sodium-calcium mineral water "Uvinskaya" based on a single dose of water at a dose of 3 ml / kg 3 times a day before meals on a diet nutrition. Found a normalizing effect of this water on the acid-forming function of the stomach, the motor activity of the gallbladder. The author notes the positive dynamics of clinical symptoms.

 The disadvantage of the internal use of mineral waters is the lack of systemic effects on the body.

 X. Akhmat (1994), in the process of rehabilitation of children with chronic gastroduodenitis at the resort, used the simultaneous administration of Goryachiy Klyuch mineral water at the rate of 3 ml / kg 3 times a day before meals and hydrosulfide baths. The author of cytochemical research methods proved that the above balneotherapy is an effective method of restoring the functions of the gastroduodenal system. The vast majority of children complete the course of spa treatment with improvement. But at the same time, moderate pain during palpation of the abdomen in the epigastrium persists for discharge from the sanatorium in 3.3% of children, tongue is coated in gray in 6.6% of patients, and appetite in 3.3% of patients is reduced.

LI Baklykov et al. (1983) applied mud therapy to sick children with chronic diseases of the digestive system. Mud applications are applied to the gastroduodenal region of the abdomen every other day at a temperature of 38-40 ^{o for a} duration of up to 10 minutes, for a course of treatment of 8-10 procedures. Mud treatment has a choleretic, antispasmodic, anti-inflammatory effect.

 The disadvantages include the lack of influence of the natural factor directly on the mucous membrane of the gastrointestinal tract, which is the reason for the insufficient treatment efficiency.

The prototype of the proposed method is the rehabilitation of diseases of the digestive system by the simultaneous appointment of mineral water for external and internal use, sulphide silt mud (4). This combination of natural healing factors was applied by R.A. Akhmetova et al. (1991). Krasnousolsky mineral water was administered to patients for oral administration at a rate of 3-5 ml / kg of weight 3 times a day, taking into account the acid-forming function of the stomach, general mineral baths N 10, alternating with silt sulfide mud imposed on the epigastric zone and the right hypochondrium at a temperature of 38 -40 ^o , lasting 10 minutes, for a course of 10 procedures. As a result of the treatment, the general condition improved in patients, the functional indices of the gastrointestinal tract returned to normal, favorable shifts occurred in the immunobiological and hormonal indices of the child’s body.

 In the long-term follow-up, the clinical efficacy of therapy for children with chronic gastroduodenitis was 98%, while, according to endoscopic studies, it was lower (87%), which was the cause of further relapse of the disease.

 The aim of the proposed method of treatment is to increase the efficiency of the recovery of patients with diseases of the digestive system at the spa stage of rehabilitation using natural factors.

Tasks:
1) reduce the recurrence rate of the disease;
2) to prevent the progression of the pathological process;
3) lengthen periods of remission;
4) to reduce in the future the length of hospital stay of patients;
5) normalize immune homeostasis;
6) to restore the altered secretory and acid-forming functions of the stomach.

 The essence of the invention lies in the fact that against the background of a gentle-training regimen, diet, drinking mineral water for external and internal use, sulphide silt mud, the drug MIGI-K LP, developed by VNI RO and recommended by the Institute of Nutrition of the Academy of Medical Sciences of the Russian Federation, is simultaneously prescribed.

 In the adaptation period of spa treatment (first 5-7 days), MIGI-K LP is calculated according to the scheme: for children under 10 years of age per 0.4 kg of body weight, for children after 10 years of age per 0.5 g of body weight, and later to the end stay in the sanatorium - 0.3 g per kg of mass. The drug is prescribed 1 time per day, in the morning, on an empty stomach. For adults, the drug MIGI-K LP is recommended to be taken in the adaptation period of 0.25 g, starting from the 8th day until the end of the stay in the sanatorium - 15.0 g once a day, in the morning, on an empty stomach.

 The new domestic drug MIGI-K LP, related to food supplements, is a concentrate of biologically active components of marine hydrobionts, obtained from mussels and consisting of bioglycans (25.6 - 33.0%), glycopeptides (5.8% -8.8 %), insulin-like substances (19.4 - 25.8%), acid polysaccharides (5.5-8.2%), glyconucleopeptides (2.0-3.1%), hexoazines (4.7% -5, 4%), free amino acids (20.1-26.0%).

 MIGI-K LP is a salty, dark brown liquid with the smell of dried mushrooms or fried potatoes, with a pleasant taste.

 A clinical study of the method of complex therapy of gastroenterological diseases, which is a combination of a sparing-training regimen, diet, balneotherapy, peloid, aerophytotherapy and MIGI-K LP, confirmed that the simultaneous effect of several natural factors and MIGI-K LP on the body has immunostimulating action, reduces the degree of sensitization, normalizes the secretory and acid-forming functions of the stomach, enhances the antioxidant protection of gastric juice, improves regeneration the mucous membrane of the organs of the gastroduodenal zone.

 Such a wide spectrum of action is due to the multicomponent action of natural factors and MIGI-K LP.

 The indicated method of complex therapy of diseases has been successfully used for the treatment of gastroenterological diseases, but can also be used for other pathologies where anti-inflammatory, antioxidant, antispasmodic, immunostimulating, desensitizing, and regenerative effects of the applied natural factors are necessary.

A clinical trial of the method of complex therapy included the following appointments:
1) treatment regimen - sparing in the first 5-7 days of stay in the sanatorium, then sparingly-training;
2) medical nutrition - diet N 1;
3) the internal intake of mineral water "Semigorsk-6", heated to 38 ^o C, at the rate of 3 ml per kg of body weight of the child, 3 times a day for 60-90 minutes before meals with high acidity, for 40-50 minutes - at normal acidity, in 20-30 minutes - with reduced acidity of gastric juice;
4) mineral or sea baths with a temperature of 34 ^o - 37 ^o C, lasting from 8 to 12 minutes, every other day, for a course of 8-10 procedures;
5) peloid therapy in the form of mud applications of silt sulfide mud on the epigastrium, right hypochondrium and lower thoracic spine, heated to 39-40 ^o C, exposure time 10-15 minutes, every other day, for a course of 8-10 procedures;
6) aerophytotherapy in the form of inhalations of essential oils (mint, lavender, fennel, fir, sage, eucalyptus) in an aesthetically equipped room against the background of sounding musical melodies or tales for 30 minutes, for a course of 15-20 sessions;
7) MIGI-K LP in the adaptation period (first 5-7 days) for children under 10 years of age at 0.4 g per kg of weight, after 10 years - at 0.5 g per kg of weight, subsequently 0.3 g / per kg of weight 1 time per day, in the morning, on an empty stomach, The course of treatment is 4-5 weeks. Adults in the adaptation period, 1 tablespoon (25.0 g), and then 1 dessert spoon (15.0 g) once a day, in the morning, on an empty stomach.

 The above method of complex therapy of diseases was used in the conditions of spa treatment in sick children aged 4 to 14 years and adults with the following indications: peptic ulcer of the stomach and duodenum in the remission phase, chronic, superficial, widespread gastroduodenitis in the remission phase.

 In the clinical application of the complex therapy method at the sanatorium-resort stage of rehabilitation in patients with chronic gastroduodenitis and peptic ulcer of the stomach and duodenum, the generally accepted methods of clinical research were used: assessment of the general condition of the patient, clinical tests of blood and urine, determination of sector and acid-forming functions of the stomach, the dynamics of the geometric mean titer of antibodies to the gastric mucosa, as well as indicators of the activity of humoral and cellular immunity.

 Patients with chronic gastroduodenitis (group I - 122 people) and patients with peptic ulcer of the stomach and duodenum (group II - 52 people) were divided into subgroups: "A", who received complex spa therapy without MIGI-K LP, and "B", receiving complex spa therapy with the drug MIGI-K LP.

 The studied groups were homogeneous by age, sex, clinical manifestations of chronic gastroduodenitis and peptic ulcer.

 Analysis of changes in disease symptoms (Table 1) shows the pronounced clinical effect of complex spa therapy of gastroenterological pathology with the use of the MIGI-K drug from marine hydrobionts, which consists in a more rapid disappearance of subjective and objective signs of inflammation in the gastrointestinal tract.

 When studying the sector and acid-forming functions of the stomach (Table 2), significant quantitative changes in their indices were revealed in patients receiving a new treatment method.

 From the table. Figure 3 shows that the geometric mean titer of antibodies to the gastric mucosa during the treatment of diseases tended to decrease, and more significantly in patients of group I "B", which indicates a decrease in the degree of sensitization of the body.

 From the data presented in table. 4 and 5, it follows that there is a more significant immunostimulating effect of the proposed complex spa therapy of diseases with the inclusion of the MIGI-K drug, which is confirmed by the complete restoration of the total T-lymphocytes and the correction of their subpopulations, as well as a pronounced approximation of the concentration of serum immunoglobulins to healthy children.

 Thus, based on the foregoing, it is seen that the method of complex spa treatment of diseases, including the use of balneotherapy and the MIGI-K drug from marine hydrobionts, which has anti-inflammatory, immunostimulating, desensitizing effects, reduces signs of intoxication, and helps restore the sector and acid-forming functions of the stomach, effective treatment for gastroenterological diseases.

 The proposed method of complex therapy of gastroenterological diseases allows to prevent the progression of the pathological process, to reduce the frequency of disease recurrence by 1.5 - 2 times, to avoid polypharmacy, to reduce the length of hospital stay.

 Examples.

 1. Nastya P., 11 years old. I came for treatment at the resort of Anapa from the city of Belorechensk, Krasnodar Territory. Diagnosis: chronic widespread superficial gastroduodenitis with increased sectorial function of the stomach, phase of incomplete remission.

 Complaints of intermittent abdominal pain, nausea, periodic headaches, heartburn. Objectively: the tongue is covered with a white coating at the root. Visible mucous membranes and skin are pink. Respiratory rate - 20 in 1 minute. Percussion above the lungs determines a clear pulmonary sound, auscultation - vesicular breathing. Heart sounds are clear, pure. Heart rate is 78 in 1 minute. The abdomen is soft, painful on palpation in the epigastric region. Bubble symptoms are negative. The liver and spleen are not enlarged. The chair is regular, decorated. Urination is not impaired.

Immunogram upon admission: the number of leukocytes - 8.5 • 10 ⁹ g / l, stab leukocytes - 5, segmented leukocytes - 47, lymphocytes - 39, monocytes - 7, eosinophils - 1, TE-ROCK - 46%, pE - POK - 39 %, bE-POK - 22%, B-lymphocytes - 9%, O - lymphocytes - 30%, pE-POK / bE-POK- 1.7, IgA - 1.05 g / l, IgM - 1.67 g / l, IgG - 17.3 g / l. Fractional study of the stomach: the amount of gastric secretion on an empty stomach - 40 ml, in the first phase - 50 ml, the second phase - 90 ml; flow rate - HCl in phase I - 40.5 mg / h, in phase II - 150.4 mg / h; the titer of antibodies to the gastric mucosa is 1:80.

The treatment was prescribed for the child:
- sparing mode of 7 days, then sparingly-training until the end of stay in the sanatorium;
- diet table N 1;
- A set of physical exercises N 1 daily at 7.00 in the morning:
- intake of mineral water Semigorsk - 6 at 100.0 x 3 times a day 60 minutes before meals, without gas, in the form of heat (t = 38 ^o C);
- common sea baths at t = 34 ^o C, lasting 10 minutes every other day, for a course of 10 baths;
- mud applications on the epigastric region, the right hypochondrium and lower thoracic spine at t = 39 ^o C, duration 12 minutes, alternating with baths, for a course of 10 procedures;
- the drug MIGI-K LP in the first 7 days, 1 dessert spoon (16.0 g), from the 8th day until the end of the stay - 1 teaspoon (10.0 g) once a day, in the morning, on an empty stomach;
- phyto-inhalation with combined oils in a special room amid the sound of music for 30 minutes, daily, for a course of 20 procedures.

At the end of the course of treatment, a follow-up examination was conducted: immunogram - white blood cell count - 7.9 • 10 ⁹ g / l, stab leukocytes - 3, segmented-49, lymphocytes-42, monocytes-6, eosinophils-1, tE-POK-58 %, pE-POK-22%, bE-POK-26%. B-lymphocytes - 25%, O-lymphocytes - 18%, pE-POK / bE-POK-0.9, IgA - 2.0 g / l, IgM - 0.9 g / l, IgG - 11.0 g / l Fractional study of the stomach: fasting secretion volume - 28 ml, in the I phase - 31.5 ml, in the II phase - 90 mg / h. The titer of antibodies to the gastric mucosa is 1:30.

 The general condition of the girl has improved, she has no complaints. An objective study of pathology is not detected. Follow-up observation for 2 years showed the absence of exacerbations of the disease.

 2. Dima S., 5 years old. He arrived for treatment at the resort of Anapa from Art. Red Army Krasnodar Territory. Diagnosis: chronic erosive gastroduodenitis with increased sectorial function of the stomach, remission phase. Comprehensive treatment was prescribed to the patient, including MIGI-K LP in the first 7 days of stay in the sanatorium, 1 teaspoon (≈ 8.0 g) from the 8th day of stay until the end of the sanatorium treatment period, 1/2 teaspoon (≈ 5.0 g), 1 time per day, in the morning, on an empty stomach.

 The patient was discharged with significant improvement, which was expressed in the absence of complaints, satisfactory condition, positive dynamics of laboratory and functional indicators. Observation of the patient for 2 years revealed the absence of exacerbations of the disease.

 3. Nina P., 32 years old. I arrived at the resort of Anapa from the city of Slavyansk, Krasnodar Territory. Diagnosis: peptic ulcer of the duodenum.

 The patient was prescribed a comprehensive spa treatment, including MIGI-K LP in the first 7 days of stay in the sanatorium, 1 tablespoon (25.0 g), and later, until the end of the stay in the sanatorium, 1 dessert spoon (15.0 g) Once a day, in the morning, on an empty stomach.

 The patient went home in satisfactory condition, without complaints, with a positive dynamics of objective data and functional indicators. Observation of the patient in follow-up for 2 years showed the absence of exacerbations of peptic ulcer.

 Medical and social effectiveness consists in restoring the secretory and acid-forming functions of the stomach; normalization of immune homeostasis; decreased sensitization of the body; lengthening periods of remission; a further reduction in the length of hospital stay of patients; preventing the progression of the pathological process; halving the frequency of relapses.

Claims (4)

 1. The method of complex therapy of gastroenterological diseases in the conditions of spa treatment, including the use of mineral waters and peloids, characterized in that the patient is simultaneously given the drug MIGI-K in the first 5 to 7 days of spa treatment in an adaptive dose, hereinafter in therapeutic dose.  2. The method according to claim 1, characterized in that the adaptive dose of the MIGI-K preparation is 0.4 g per 1 kg of weight for children under 10 years old, 0.5 g per 1 kg of weight for children after 10 years of age, and therapeutic dose - 0.3 g per 1 kg of weight; the drug is administered 1 time per day in the morning, on an empty stomach.  3. The method according to p. 1, characterized in that the adaptation dose of the drug MIGI-K for adults is 25 g, and the therapeutic dose is 15 g; the drug is administered 1 time per day in the morning, on an empty stomach.  4. The method according to claim 1, characterized in that it is possible to extend the intake of the drug MIGI-K according to indications in an outpatient setting.

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