RU2159125C1 - Method for treating gastroduodenal peptic ulcers - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making a series of injections around ulcer defect periphery in four points under fibrogastroduodenoscopy control. 2 ml (100 mcg) of Sandostin diluted with 8 ml of 0.25% novocaine solution is applied for this purpose. The injections are made during 14 days once in two days. EFFECT: reduced secretory activity; accelerated ulcer cicatrization. 2 cl, 2 tbl

Description

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

 The problem of peptic ulcer is central to modern gastroenterology. This is due to both its prevalence and social significance. If from the mid-70s monographs devoted to peptic ulcer were published with a frequency of one monograph in 10 years, then in the next 20 years - with a frequency of one monograph in 2-3 years. This is due, first of all, to technological progress, which significantly accelerates the period of accumulation of knowledge and obtaining new data, allowing to put forward new concepts and revise existing ones (O.N. Minushkin, I.V. Zverkov, G.A. Elizavetina, L. .V. Maslovsky "Peptic ulcer", M., 1995).

 Peptic ulcer of the stomach and duodenum is observed in 0.4 - 10% of the population. According to A.L. Grebenev (Modern advances in the diagnosis and treatment of diseases of the digestive system. In the book. New in gastroenterology. M., 1995), in the territory of the former USSR in 1989, only registered patients with peptic ulcer and duodenal ulcer there were about 10 million intestines. Growing incidence, which reaches 5.7 per 1000 population, chronic relapsing course, prolonged scarring, frequent development of complications requiring complex surgical interventions, long periods of disability and disability flax, allows to attribute this pathology to a number of important medical and social problems. So for the period from 1971 to 1985, the incidence of ulcer increased 1.8 times, mortality increased by 11.4%, and, according to forecasts for the period from 1986 to 2010, a further increase in the incidence is expected to be 1.8 times.

 This paper is devoted to the practical issues of peptic ulcer. Basically, today, conservative treatment of peptic ulcer is associated with drug therapy. Modern ideas about the etiology and pathogenesis suggest that the appointment of drugs should ensure the achievement of the following goals: the elimination of pain and dyspeptic phenomena; ulcer healing; elimination of signs of exacerbation of gastritis and duodenitis (meaning, first of all, forms caused by pyloric helicobacter); normalization of gastroduodenal motility; prevention of exacerbation or prolongation of the period of remission.

 Gastroduodenoscopy, having direct access to the ulcer, has opened up new possibilities in the treatment of this pathology. This method allows the introduction or application of a drug for a peptic ulcer, while with the parenteral route of administration, access to the ulcer is limited by the inflammatory shaft, granulation tissue, and microcirculation disorders in the periulcerous zone.

There are several ways of local exposure to an ulcer using endoscopy (O. N. Minushkin, I. V. Zverkov, G. A. Elizavetina, L. V. Maslovsky “Peptic ulcer”, M., 1995):
1. Mechanical treatment of an ulcerative crater using biopsy forceps, a special brush, or rinsing with a strong stream of fluid through a catheter.

 2. Treatment of peptic ulcer with liquid substances through a catheter. It is suggested to wash the ulcer with alcohol, collargol, 5-10% silver nitrate solution, rosehip oil, sea buckthorn oil, solcoseryl, ventrisol, aminocaproic acid.

 3. Application of drugs of a thick consistency (dibunol, solcoseryl on a gel basis).

 4. Application of film-forming substances. Aerosol preparations (Lifusol, Gastrosol, Statisol) and medical adhesives (BF-6, MK-6, MK-7, MK-8, KL-3, polar glue) are used.

 5. Treatment of ulcerative crater and periulcerosis using high frequency currents.

 6. Phototherapy with low and high energy laser radiation.

 7. Transendoscopic ultrasound therapy.

 8. Chipping of a ulcerative defect, periulcerous zone, gastroduodenal region with drugs. This method introduces drugs that have anti-inflammatory effects (hydrocortisone, heparin), which improve regeneration (methyluracil, solcoseryl, oxyferriskarbon, dalargin, etc.). According to most authors who use local methods of exposure to an ulcer through an endoscope, such treatment tactics can significantly reduce the time of scarring of stomach and duodenal ulcers.

 The closest proposed local topical treatment for ulcers is chipping of a ulcer defect with Dalargin (O.A. Kargina, Local application of Dalargin and electrical stimulation for endoscopic treatment of hard-to-heal ulcers of the stomach and duodenum, M., 1996). The latter improves regeneration, but the formation of a rough scar is not excluded, the drug does not affect the level of secretion of hydrochloric acid, on the acceleration of the healing time.

 The objective of the invention is to increase the effectiveness of treatment of gastroduodenal ulcers with the introduction of a drug that provides a comprehensive effect on the ulcer by reducing the secretory activity of the mucosa, by enhancing regenerative activity, due to the possible effect on the HP factor.

 Our data suggest that such a drug is Sandostatin, which is introduced according to this invention in the area of a peptic ulcer.

 The method is as follows. The patient undergoes fibrogastroduodenoscopy in the supine position on the left side. After examining the stomach and duodenum, assessing the condition and size of the ulcer defect, using an endoscopic injector conducted through the instrument channel of the endoscope, the ulcer defect is chipped at 4 points around the perimeter, 1 cm from the edge of the ulcer, with the addition of Sandostatin solution into the submucosal layer. Manipulations are performed every two days. Only 7 sessions. For chipping, the standard release form of Sandostatin solution (100 μg, volume 2.0 ml) is used in a 1: 4 dilution with 0.25% novocaine solution, i.e. 2 ml Sandostatin is diluted in 8 ml of novocaine.

Clinical example 1
Patient V., 36 years old, was admitted to the hospital with complaints of pain in the epigastric region without a clear connection with food intake, nausea. For 11 years, suffers from gastric ulcer with annual exacerbations. The described complaints arose two days ago. Upon admission to the hospital, the general condition is closer to satisfactory, blood pressure 120/75 mm RT. Art., heart rate - 80 beats per minute, blood hemoglobin 125 g / l. Esophagogastroduodenoscopy revealed a mucosal defect along the front wall of the antrum, up to 0.8 cm in diameter, surrounded by an inflammatory shaft with perifocal mucosal hyperemia, performed by fibrin plaque. Local treatment has been started according to the proposed methodology. After the first session on the second day, relief of pain, dyspepsia was achieved. On the third day, when repeating the procedure, the absence of perifocal hyperemia of the mucosa was noted. When conducting the next session of local treatment, a reduction in the size of the ulcer defect to 0.4 cm in diameter, the beginning of marginal epithelization, and the surface location of the ulcer defect were endoscopically observed. On the ninth day, the endoscopic picture corresponds to complete ulcer epithelization.

Clinical example 2
Patient S., 27 years old. An history of peptic ulcer of the duodenal bulb for 3 years. Complaints upon receipt of aching pains in the epigastric region, left hypochondrium with radiation to the lumbar region, nausea, lack of appetite, loose stools. General condition of moderate severity: body temperature up to 37.8 ^o C, hyperemia of the face, abdomen moderately swollen, with palpation, pain in the epigastrium is noted. In the blood, leukocytosis - 10.2 thousand. A moderate increase in the level of diastase in the urine. In conclusion, ultrasound - reactive pancreatitis. When esophagogastroduodenoscopy along the front wall of the duodenal bulb revealed a rounded ulcer: deep, up to 1.0 cm in size, the bottom of which is covered with a coating of fibrin and necrotic masses. When conducting local treatment by 6 days, peeling, a decrease in the depth of the ulcer defect was recorded, and on the 9th day - pronounced marginal epithelization, reduction in size to 0.3 cm. Clinically - the absence of pain, subsidence of the pancreatitis clinic, ultrasound - pronounced positive dynamics in condition pancreas. On the 12th day, endoscopically indicated complete epithelialization of the ulcer.

 To assess the effectiveness of the developed method, we conducted comparative studies of three groups of patients. The main group included patients who underwent treatment according to the developed method (n1 = 12). The first control group included patients who underwent treatment using the prototype method - endoscopic chipping of a peptic ulcer with Dalargin solution (n2 = 12). The second control group consisted of patients who underwent an ulceration of the ulcer with a 0.25% solution of novocaine, without Sandostatin, according to the method and in the amounts provided for in the treatment developed by the proposed method (n3 = 10).

 In all groups, patients were prescribed diet food, recommendations on diet were given. Patients in all groups are comparable in age, gender, ulcerative history, ulcer size. The average age of patients in group 1 was 42 years old, in the first control group - 41.5 years, in the second control group - 42 years. The ratio of men and women in all groups is 3: 1. The average duration of ulcerative history in the main group was 7.5 years, in the first control group - 6.9 years, in the second control group - 7.6 years. Patients in all groups had no history of complications. The sizes of a peptic ulcer upon admission in all groups are from 0.7 cm to 1.3 cm (Table 1).

 We have analyzed the results of treatment in the main and control groups. At the same time, earlier periods of reducing the area of the ulcer defect by 50% were revealed in the main group by the 6th day, in the first control group by the 9th day, in the second by the 12th day, respectively. The terms of ulcer healing were 100% in the main group - on the 9th day, in the 1st control - on the 12th day, and in the 2nd control group, the periods exceeded 15 days. In addition, an earlier decrease in perifocal inflammation, lymphoplasmacytic infiltration in the main group was revealed compared with the control ones. In the main group, the beginning of marginal epithelization was also recorded on the 6th day, while in the 1st and 2nd control groups - on the 9th and 12th days, respectively. Relief of pain, dyspepsia in the main group - up to 3 days, in the control - up to 6-9 days. According to a cytological study, a sanitizing effect was noted in the main group in relation to HP. The results of the comparative studies are shown in table. 2).

 Thus, the local use of sandostatin in the treatment of gastroduodenal ulcers according to the developed method has a pronounced reparative and clinical effect.

Claims (2)

 1. A method of treating gastroduodenal ulcers, including chipping of the submucosal layer along the perimeter of a peptic ulcer with a drug solution during therapeutic fibrogastroduodenoscopy, characterized in that 2 ml of Sandostatin solution containing 100 μg of the drug in dilution with 8 ml of 0.25% is used as a drug novocaine solution.  2. The method according to p. 1, characterized in that the chipping is performed at 4 points along the perimeter of the ulcer, with a frequency of 1 time in 2 days, for 14 days.

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