RU2150277C1 - Method for treating the cases of constipation by applying intestinal lavage - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering enteroclysis with salt solution having composition identical to that of chyme and taken in the volume of 3-6 l in 200-500 ml large portions with 5-10 min long pauses. Enterosorbent is given during the pauses at a dose of 2-3 g/kg of body weight. Microenema is done containing 3-5 therapeutic doses of eubiotic agent. the procedures are repeated 3-8 days later until therapeutic efficiency is achieved. EFFECT: enhanced effectiveness of treatment; enterocyte regeneration; repaired barrier function of intestinal wall.

Description

 The invention relates to medicine, more specifically to gastroenterology, and can be used to treat patients suffering from constipation (constipation) and as an improvement of the body.

 There is a comprehensive method for treating constipation using a special diet, the use of plant and pharmacological preparations that regulate intestinal motility, laxative oil and salt preparations, physiotherapeutic procedures, acupuncture, enemas (A.V. Frolkis, 1979; V.G.Smagin et al., 1989 )

 The disadvantage of this method is that the diet, for example, is effective only for mild disorders. To drugs that affect intestinal motility, addiction eventually develops (tachyphylaxis) and they cease to work even with a constant increase in their doses. In this case, a kind of substance abuse may develop, staining of the intestinal mucosa (melanosis) with the danger of its malignant degeneration. Large doses of them can cause damage to the kidneys and liver, neuroendocrine disorders, allergic reactions. Oil laxatives are contraindicated in pancreatic insufficiency (V.G. Smagin et al., 1989). Frequent and prolonged use of salt laxatives can cause disturbances in water-electrolyte metabolism, malabsorption syndrome, exudative enteropathy, colon atony (A.V. Frolkis, 1979). The main disadvantage of this method, as A.V. Frolkis (1979) admits, is that it has a symptomatic character rather than a pathogenetic one.

 There is a method of treating moderate to severe constipation with surgical operations: periarterial neurectomy of the superior mesenteric artery, bauginoplasty, bypass intestinal anastomoses, sigmoid colon resection, left-sided hemicolectomy, subtotal colectomy with ileosigmoid anastomavosom (C.X. 1988).

 The disadvantage of this method is that, as the author himself admits, the desired result is not always achieved, while the surgical intervention itself is associated with well-known complications: failure of sutures, anastomoses, infection of the abdominal cavity, bleeding, adhesive disease.

 There is a method of eliminating colonic stasis and healing the body by probe transrectal washing of the colon with various solutions with the addition of enterosorbents (V.A. Mikhailovich et al., 1995). This method is also used for chronic colitis, inflammatory bronchopulmonary, skin, allergic diseases, exo- and endotoxemia, as a preoperative preparation of patients, treatment of postoperative intestinal paresis.

 The disadvantage of this method is that washing only the colon does not eliminate the pathological processes occurring in the small intestine, which are the result of constipation, limits the possibilities of therapeutic and health-improving effects on the body as a whole. In addition, the disadvantage of this method is that washing the intestine with saline or a solution of a randomly prepared prescription and, especially, just water, can cause disturbances in water-electrolyte metabolism and metabolism (Yu.M. Halperin, TS Popova, 1976; N.M. Baklykova, 1986).

 There is a method of washing the entire intestine (intestinal lavage) through a naso-ejunal probe using an enteral solution, with an ionic composition identical to the composition of the chyme (N.M. Baklykova, 1986), used to detoxify the body during acute oral poisoning. In this case, 30-120 or more liters of this solution are used without causing any disturbances in the metabolic rate and the water-electrolyte balance of the body (V.A. Matkevich, 1988; E.A. Luzhnikov, L.G. Kostomarova, 1992).

 However, this method due to its methodological complexity (the need to introduce a special probe into the duodenum using a gastroduodenoscope) is not applicable in patients with constipation.

 The closest technical solution to the proposed invention is a method of cleansing the body by washing the intestines, used by Indian yogis (Shankh-Prakshalan). To implement this method, use a hypertonic solution of sodium chloride. The patient drinks 200 ml of warm solution, then performs special physical exercises. As a result of the alternation of these procedures, he develops diarrhea. The total volume of solution drunk is approximately 3 liters. Thus, bowel lavage occurs.

 The disadvantage of this method is that the mismatch of the ionic composition of this solution with the composition of the chyme inevitably leads to disruption of the electrolyte balance between the enteral and internal environment of the body, metabolic disorders of homeostasis. Hypertonic sodium chloride solution acts by analogy with salt laxatives and diarrhea occurs due to the attraction of fluid from the bloodstream. Taking into account the fact that a rather large volume of solution is used during this procedure, the transport of water from the bloodstream to the intestines may be sufficient for the development of hypovolemia, which carries the risk of lowering blood pressure, increasing blood concentration, blood viscosity with all the ensuing consequences ( myocardial ischemia, brain). Physical exercises, which are an integral part of this method, can contribute to the development of these complications. This method is most dangerous for the elderly and those suffering from cardiovascular and renal diseases. In addition, the disadvantages of this method include the patient’s discomfort during and after the procedure: thirst, soreness in the anus (due to irritation of the rectal mucosa with saline). Weakened and elderly people find it difficult to perform a set of physical exercises.

 The aim of the present invention is to restore the rhythmic work of the intestines in people suffering from constipation, the normalization of the function of the organs of the gastrointestinal tract in other pathological conditions, which results in the improvement of the body.

 This goal is achieved by the fact that the patient is subjected to repeated washing of the intestine at intervals of 3-8 days with a saline solution identical in chemical composition to the chyme, giving enterosorbent inside, and after washing make microclysters with eubiotics.

For washing the intestines using a saline solution containing 1 l of the following ingredients,
Sodium - 2.2
Potassium - 0.8
Calcium - 0.3
Magnesium - 0.16
Phosphorus - 0.5
Chlorine - 3.51
Sulfur - 0.34
Distilled water - Up to 1 L
The proposed method is as follows.

 A patient on an empty stomach is allowed to drink heated or cooled saline solution of 200-500 ml every 5-10 minutes. In between, enterosorbent is given in portions in a total amount of 2-3 g per 1 kg of body weight. As a result of taking the solution in a volume of 3-6 l, the patient develops diarrhea. The procedure is carried out until clean translucent yellowish discharge from the rectum. After the discharge is stopped, the patient is given a microclyster with an eubiotic in a therapeutic dose (bifidocolibacterin, etc.). To prevent possible nausea and vomiting during washing, the patient is prescribed 1-2 therapeutic doses of cerucal or a similar drug 15-20 minutes before the procedure. An intestinal lavage session is repeated after 3-8 days until a clinical effect is obtained. As a result of applying the proposed method in patients, in some cases, after 1 procedure, daily stool is restored. The duration of the effect is from two weeks to two to three months. If there is a failure of the rhythmic function of the intestine, the procedure is repeated. The duration of the effect then increases to several months. Depending on the severity of constipation, to achieve the effect, it is necessary to carry out 1 to 7 sessions of CR.

 Positive effect.

Constipation is characterized by the following symptoms: rare bowel movements, obstructed by the act of defecation, a small amount of feces of increased hardness and dryness (less than 300 g in 72 hours), lack of a feeling of complete bowel movement after defecation. Most people with constipation have all of these symptoms, but some may be absent. The presence of even one of these symptoms indicates constipation. For most people, chronic delayed bowel movements for more than 48 hours should be considered constipation. S.Kh. Ravanduzi (1988) identified four degrees of severity of chronic constipation:
I degree - stool delay up to three days. The predominant complaint is pain in various parts of the abdomen. The general condition of the patient is satisfactory, the mental status is not impaired. Patients are professionally and socially adapted.

 II degree - stool retention from 4 to 6 days. Pain is expressed, the act of defecation is painful, symptoms of general intoxication are noted in the form of decreased performance, increased fatigue. Mental changes characteristic of asthenic and asthenoneurotic syndrome are detected.

 III degree - stool retention from 7 to 15 days. Marked pain syndrome leading to a sharp decrease in disability is noted, partial loss of professional fitness, social adaptation may occur, severe neurasthenic, hysteroid and depressive syndromes may develop.

 IV degree - stool retention for more than 15 days. There is a constant pain syndrome, pronounced mental disorders such as hypochondria or depression. Professionally and socially maladaptive, these patients eventually become disabled.

 Constipation is classified by duration: acute, chronic; by etiology and pathogenesis: alimentary, neurogenic, reflex, hypodynamic, inflammatory, proctogenic, mechanical (tumors and other causes of an organic nature), toxic, drug, endocrine, dishydro-electrolyte, cholestatic. Often there is constipation of mixed genesis.

 Regardless of the causes of constipation, similar pathological processes occur in the patient’s organism to a greater or lesser extent, characterized by impaired gastrointestinal motility, impaired digestion and absorption, secretory and excretory functions, and disorders of the immune system (A.V. Frolkis, 1989). Disruption of the gastrointestinal tract results in a delay in the intestine of its contents, accumulation of metabolic products, biologically active substances, and bacterial toxins. Due to the slowdown of the passage of intestinal contents with constipation, excessive colonization of the small intestine (ICC) develops - its pathological colonization by bacteria of the colon and feces (Bjorneklett A., 1983), a change in the spectrum of normal flora and the appearance of pathogenic. In this case, there is an increase in the phenomena of atrophy and damage to the intestinal mucosa and, as a result, a decrease in its barrier function, which leads to the absorption and portal translocation of microbes and toxins, substances with antigenic properties, damage to the liver parenchyma, and a systemic inflammatory reaction (A.L. Kostyuchenko , E.D. Kostin, A.A. Kurygin, 1996). According to V.A. Mikhailovich et al. (1995), the permeability of the intestinal wall can pathologically increase by 5 times. At the same time, intestinal toxins were found in the blood and accumulated most intensively in the tissues of the liver, lungs and kidneys. These processes can be complicated by enteric insufficiency, manifested by malabsorption - a violation of the absorption of one or more food substrates: proteins, carbohydrates, fats, as well as water, electrolytes, vitamins, which can lead to disorders of the trophic status of the body, vitamin deficiency, anemia, immunodeficiency, etc. . (Simon G. L., Gorbach S. L. 1984; Bjorneklett A. et al, 1985).

 According to A.V. Frolkis (1979), constipation can be complicated by secondary colitis, reflux enteritis, anorectal diseases, hepatitis, pathology of the bile ducts, and the formation of fecal stones, which, in turn, can cause intestinal obstruction. Increased intestinal pressure contributes to the formation of diverticulosis of the colon. With an increase in the concentration of carcinogenic substances produced by certain bacteria in the intestine with stasis, the development of colon cancer is associated.

 As a result of intestinal lavage, according to the proposed method, the entire intestinal contents are removed, including toxic substances, microbial toxins, IKK syndrome is eliminated, the water-electrolyte balance in the cells of the gastrointestinal mucosa and the body as a whole is restored, which helps to improve blood circulation in the vessels of the intestinal wall. An important point is that as a result of repeated washing of the intestinal mucosa, enterocytes are regenerated and their pool replenished, which, in turn, restores the intestinal barrier function (A.L. Kostyuchenko, E.D. Kostin, A.A. Kurygin, 1996). The duration of the intervals of 3-8 days between washes is due to the period of complete renewal of enterocytes of various parts of the intestine (V. A. Mikhailovich et al., 1995; A. L. Kostyuchenko, E. D. Kostin, A. A. Kurygin, 1996). The restoration of the barrier function of the intestinal wall stops the entry of microbial bodies, their toxins, medium and long chain amino acids, and other substances with antigenic properties into the portal and lymphatic systems, which reduces the functional "load" on the detoxification and secretion organs (liver, kidneys, lungs, skin integuments, the immune system). As a result, the function of not only the gastrointestinal tract, but also the respiratory system, nervous system, skin, improves, the metabolic processes of the body as a whole are normalized, and immunity increases. The presence in the solution of magnesium sulfate improves bile secretion (dubbing), as evidenced by the presence of bile in the washings. This means that the hepatobiliary system is “unloaded”, the content of bile acids in the intestinal contents increases, which contribute to the restoration of intestinal propulsive function (A. L. Kostyuchenko et al., 1996). Morphologically complete intestinal mucosa provides normal secretory, excretory functions, which helps to normalize digestion processes. The synthesis and metabolism of serotonin, a biogenic amine produced by enterochromaffin cells, depends on improving bowel function. Serotonin is involved not only in digestion and regulation of intestinal motor activity, but also in other complex regulatory processes outside the gastrointestinal tract (I.N. Pidevich, 1977; A.P. Simonenkov et al., 1994).

 The elimination of CIC syndrome as a result of CL and the subsequent colonization of normal microflora in the colon (enemas) eliminate dysbiosis, which is associated with constipation in 80%. The introduction of eubiotics into the rectum is more effective than oral administration, since in the second embodiment, under the influence of hydrochloric acid, bile, pancreatic juice and other digestive enzymes, the bacterial culture may die or become less active.

Taking into account the commonality of some pathogenetic mechanisms in gastrointestinal tract disorders and their influence, in turn, on the development of pathological processes outside this system, as well as the mechanism of therapeutic action of CR in these disorders, we can recommend this treatment for the following diseases and conditions:
1. Constipation I-III severity of various etiologies.

2. As a wellness procedure, CL is indicated for persons:
- after the error in the diet,
- eating small-slag refined food,
- having erratic nutrition,
- leading a sedentary lifestyle,
- prone to obesity,
- prone to frequent colds,
- professions which are associated with frequent stressful, conflict situations, mental stress,
- with harmful production.

 3. Spastic and nonspecific ulcerative enterocolitis, gastritis.

 4. Intestinal dysbiosis.

 5. Acute and chronic hepatitis.

 6. Chronic pancreatitis.

 7. Biliary dyskinesia.

8. Skin diseases:
- atopic dermatitis,
- neurodermatitis,
psoriasis
- eczema.

 9. Acute and chronic allergic diseases.

 10. Bronchial asthma, inflammatory nonspecific bronchopulmonary diseases.

 11. Alcoholic hangover syndrome, binge, withdrawal symptoms, including alcoholic intestinal fermentopathy.

 12. Acute poisoning, including by mushrooms.

 13. Foodborne diseases, other intestinal infectious diseases.

 14. As a preoperative preparation of elective patients, endoscopic examinations.

Contraindications to the use of CL:
1. Constipation of mechanical etiology (intestinal tumors, narrowing of the colon of cicatricial origin, mechanical compression of the rectum from the outside, etc.), gastrointestinal bleeding.

 Relative contraindications are cholelithiasis and urolithiasis, hemorrhoids during exacerbation.

 Clinical example.

 Patient Kis-va E.A. 30 years suffered from constipation for 12 years. Constipation appeared in the postpartum period. The stool delay was up to 6 days (II severity according to Ravanduzi S.Kh., 1988). Concerned about periodic abdominal pain, a feeling of heaviness, discomfort. The bowel movement was difficult, sometimes painful. She noted increased fatigue, often arising general weakness. As a treatment, I took laxative tea, Senade tablets. The effect was unexpressed and unstable.

 In December 1996, she accepted the procedure of intestinal lavage by the proposed method. Bowel washing was carried out in a volume of 3 l of saline in portions of 200 ml. After 2 liters of the drunk solution, a stool appeared, at first a fecal character, then liquid. During the procedure, which lasted 2 hours, the chair was 7 times. The last portion of the discharge was translucent light yellow. The procedure was easily transferred, at the end of which she noted improvement in well-being, a feeling of lightness and health. There were no reactions or complications. A regular daily stool was established on the second day after the procedure, and had this character for 2-3 months. After errors in the food, a malfunction appeared: the stool became irregular with interruptions of 2-3 days.

 After a repeated CR session in a volume of 3 l, the daily stool has recovered and remains so until now. Overall health has improved.

Bibliography
1. Baklykova N.M. Composition and preparation of media for intraintestinal administration with peritonitis / Methodological recommendations. - Moscow, - 1986. 19 S.

 2. Halperin Yu.M., Popova TS In the book: Ways of correction of metabolic disorders in emergency and planned surgery. - M., M., 1976.

 3. Kostyuchenko A.L., Kostin E.D., Kurygin A.A. Enteral artificial nutrition in intensive care. - St. Petersburg, Special Literature. - 1996.330 p.

Claims (1)

 A method of treating constipation, including filling the intestines by oral administration of saline and then emptying it, characterized in that the intestines are washed with saline, identical in chemical composition to the chyme, in a volume of 3-6 l in portions of 200-500 ml at intervals of 5-10 min, during which enterosorbent is given orally in portions in a total amount of 2–3 g per 1 kg of body weight, and at the end of the procedure, microclyster is administered with 3–5 therapeutic doses of eubiotics, the procedure is repeated after 3–8 days until clinical effect.