RU2177790C2 - Method to treat duodenal ulcers - Google Patents

Abstract

FIELD: medicine, gastroenterology. SUBSTANCE: inhalations are fulfilled with mineral water for 5-6 min once a day 45-60 min before food intake. Treatment course consists of 10-12 procedures. EFFECT: method removes baltoreaction. 2 ex, 3 tbl _

Description

 The invention relates to medicine and for the treatment of patients with duodenal ulcer (ULC) in a resort.

 A known method of taking drinking treatment of patients in the phase of complete and incomplete remission of the disease using internal intake of mineral water of low and medium mineralization (Ye. B. Vygodner. Physical factors in the treatment and rehabilitation of diseases of the digestive system. In the monograph "Balneology and physiotherapy. Volume 2 . M.: Medicine, 1985. - S. 120-165.). This method involves the internal intake of mineral water of small and medium mineralization of 150-200 ml 1-1.5 hours before a meal.

 The internal intake of mineral water according to the specified method reduces inflammation in the mucous membrane of the stomach and intestines, reduces the factors of aggression of the gastric juice, increases the motility of the biliary tract, improves blood circulation and trophism of the digestive organs.

 However, this method is not effective enough and does not always bring the desired effect. In patients, especially in the presence of severe motor-evacuation disorders of the gastrointestinal tract, an exacerbation of the disease is noted, resulting in a complete rejection of spa treatment and the transition to medication.

 The essence of the invention lies in the fact that the intake of mineral water of small and medium mineralization is prescribed not orally, but in the form of inhalation once a day in the morning.

 The proposed method is as follows. All patients receive diet food - table 5. Morning hygienic and therapeutic exercises are prescribed daily. Reception of mineral baths is carried out according to the traditional method - water temperature 36-37 degrees. Celsius, duration 5-10 minutes after 1-2 days, for a course of 8-10 procedures and internal intake of low-mineralized mineral water in the form of inhalation 1 time per day through the nose for 5-6 minutes 45-60 minutes before meals for course 10 -12 treatments.

 The proposed method is illustrated by the following example.

 Example 1

 Patient P., 45 years old, medical history 1142. The patient was admitted to the sanatorium complaining of pain in the epigastric region that occurs on an empty stomach and at night, heartburn, increased fatigue, and sleep disturbance. He suffers from peptic ulcer for 20 years. Exacerbations occur, as a rule, in the spring season, lasting up to 1-1.5 months, and are stopped by the use of traditional antiulcer drug therapy (type 2 histamine receptor blockers, antacids, antibiotics, and metronidazole). The last exacerbation was 3 weeks ago, was on outpatient treatment, received a course of drug treatment. The patient’s health improved somewhat, and therefore he was allowed to receive spa treatment. However, during the move to the sanatorium (by rail), after errors in the diet, pain and dyspepsia intensified again, weakness and irritability appeared.

 On examination, the pulse is 76 beats. / min HELL - 110/60 mm RT. Art. The tongue is covered with a white coating, tenderness of the abdomen with palpation in the epigastrium is noted. The liver protrudes 1.5-2 cm from under the costal arch, its edge is pointed, the consistency is dense, moderately painful. Clinical blood test - Нb - 118 units, white blood cells - 5.8 thousand, ESR - 4 mm. Radioimmunoassay of blood hormones - insulin 9.5 μE / ml, cortisol - 1289 nmol / ml, triiodothyronine - 3.6 nmol / ml, thyroxine - 122 nmol / ml. An endoscopic examination revealed an ulcer in the duodenal bulb 1 cm in diameter in diameter with the presence of an inflammatory shaft and granulations at the bottom.

 A course of treatment according to the proposed methodology. The patient in the conditions of a gentle regimen of spa treatment received medical nutrition, 8 mineral baths at a temperature of 37 degrees. 10 minutes every other day. Inhalations with low-mineralized mineral water of the spring of Essentuki 4 were prescribed at a temperature of 37 degrees. Celsius once a day in the morning. As a result of spa treatment, the patient completely disappeared complaints, significantly improved health, disappeared increased fatigue, decreased heartburn, increased appetite.

 At the same time, a distinct dynamics in hormonal status was observed - insulin levels increased to 12.3 μE / ml. The content of cortisol in the blood decreased to 827 nmol / ml. The content of triiodothyronine and thyroxine has not changed.

 For comparison with the proposed method provides an example of using the known method of internal intake of mineral water.

 Example 2

 Patient K., 41 years old. Case history 1088. He entered a sanatorium complaining of pain in the epigastric region of a "hungry" nature, heartburn and belching after eating, general weakness and fatigue, stool with a tendency to constipation. A duodenal ulcer was first discovered 16 years ago. The course of the disease is typical, with annual spring-autumn exacerbations for 1 month, the treatment of which is carried out either in a hospital or on an outpatient basis. Last exacerbation 2 months ago.

 Objectively - there is a tongue overlay, a positive symptom of Kera. The abdomen on palpation is moderately painful in the epigastric region, the liver is at the costal margin, its consistency is moderately compacted. Pulse - 76 beats. / min, blood pressure - 125/70 mm RT. Art. An ultrasound examination of the liver and gall bladder revealed no pathology. When fibrogastroduodenoscopy revealed an ulcer of the duodenum in the phase of incomplete scarring.

 Clinical analysis of blood Hb - 129 units, white blood cells - 6.8 thousand, ESR - 12 mm. Eosinophils - 9, stab - 1, segmented - 45, lymphocytes - 43, monocytes - 2. Radioimmunoassay of blood hormones - insulin - 8.55 μE / ml, cortisol - 1036 nmol / ml, triiodothyronine - 4.85 and thyroxine - 135 nmol / ml

 A course of treatment by a known method. The patient in the conditions of a gentle regimen of spa treatment received medical nutrition, 8 mineral baths at a temperature of 37 degrees. 10 minutes every other day. Against this background, an internal intake of low-mineralized mineral water of the spring of Essentuki 4 was prescribed, 100 ml 90 minutes before meals 3 times a day. During the first week of spa treatment, the patient's condition improved, pain and dyspepsia became less disturbed, but on the 8th-9th day the pain intensified again, and the patient began to be disturbed at night, and therefore, drinking treatment was canceled and drug therapy was prescribed, after which the patient's condition improved slightly. The dynamics of hormonal status were almost completely absent. Moreover, the insulin content decreased (up to 3.5 μE / ml), the level of cortisol increased (up to 1368 nmol / ml), which should be regarded as an unfavorable sign, since for patients with exacerbation of UBD, a decrease in insulinemia and an increase in cortisolemia is a rather characteristic symptom . The overall result of the treatment at the resort was regarded as unchanged.

 The proposed method of using inhalation with mineral water as the main treatment method has been tested on the main (36 people) group of patients with UBD in the phase of complete and incomplete remission. The control was patients (21 people), who were identical to the main one by gender, age, disease duration and clinical manifestations. Both groups of patients in the conditions of the sparing regime of the sanatorium received medical nutrition. Mineral baths were prescribed according to the traditional method (temperature 36-37 deg., Duration 8-10 minutes every other day, for a course of 7-8). In addition, all patients underwent rehabilitation of chronic foci of infection. Against the background of this treatment complex, an internal intake of mineral water of the Essentuki 4 spring was prescribed according to the proposed method in the form of inhalation for 5-6 minutes through the nose once a day - 45-60 minutes before meals, for a course of 10-12 procedures.

 In the control group - according to the known method (mineral water of the same composition, the same dosage), 150-200 ml 3 times a day before breakfast, lunch and dinner.

 The tolerance of spa therapy in both groups was not the same. In one third of patients in the control group, balneoreaction was observed on the 8-10th day of drinking treatment, which was manifested in increased symptoms of duodenal ulcer, in connection with which the intake of mineral water was discontinued, and in half of the patients it was not possible to prescribe a course of drinking treatment due to ongoing pain and dyspeptic symptoms.

 In patients of the main group, balneoreaction was not observed in any case. All patients tolerated the inhalation procedure with mineral water.

 After treatment at the resort by the proposed method, a significant improvement in the general condition was noted: in most patients the pain, heartburn, and stool disorders disappeared or significantly decreased in severity. Equally pronounced was the dynamics of asthenic syndrome - increased fatigue and irritability disappeared.

 In the control group of patients, positive changes in clinical symptoms also occurred, however, the severity of these changes was less. So, if in the main group the frequency of pain decreased in 95%, in the control group only in 34% (P <0.05), dyspepsia in 75 and 34%, respectively (P <0.05), frequency and severity asthenoneurotic syndrome - in 78 and 45% (P <0.05). Stool disorders were also most often normalized in patients with mineral water inhalation (respectively, 79 vs. 34% and 83 vs. 63%).

 Therefore, under the influence of the proposed method of internal intake of mineral water (in the form of inhalation with Essentuki 4 mineral water for 5-6 minutes once), the most pronounced favorable dynamics of the clinical symptoms of peptic ulcer (table 1) and endoscopy data (table 2) is noted. In addition, with the inhalation method of administering mineral water, the overall treatment efficiency increases (from 5.2 ± 0.55 to 8.9 ± 0.39 points) and a more significant dynamics of hormonal indicators is noted. So, in patients with mineral water inhalation, the level of insulin in the blood increased by 65.3%, whereas in the control group it practically did not change (table 3).

 Thus, the studies show that in patients of the main group receiving treatment by the proposed method, there was a significant improvement in clinical and hormonal status. At the same time, in the control group, where the internal intake of mineral water was carried out by a known method, positive shifts were less pronounced.

 A more favorable effect of the modified method of internal intake of mineral water is provided due to several factors. Firstly, when inhaled with mineral water, it is possible to avoid the direct irritating effect of the components of mineral water on the mucous membrane of the gastroduodenal zone, where there are inflammatory changes.

 Secondly, inhalation with mineral water also helps to stimulate the secretion of gastrointestinal hormones, which have a pronounced trophic effect on the digestive organs, although to a lesser extent. However, in patients with UBDK in the phase of incomplete remission, an increase in the activity of the intestinal hormonal system due to the pathological process itself is observed, and additional stimulation in this case can lead to its breakdown. In practice, this is manifested by an increase in all the main symptoms of the disease. Doctors-balneologists are so well aware of this feature of patients with UBDK who arrive at the resort in the phase of incomplete remission that they try not to prescribe balneotherapy for such patients at all. Meanwhile, the number of such patients at the resort is very high - up to 20-25% of all patients with peptic ulcer.

 Thirdly, when inhaled with mineral water, there is a more significant decrease in the level of aldosterone in the blood (see Table 3), one of the important pathogenetic factors in ulcer formation.

 Fourth, during inhalation there is no phase of stimulation of the level of gastrin, a hormone that has the most significant acid-stimulating effect on parietal cells of the gastric mucosa.

 The data obtained allow us to draw a conclusion about the advantage of the proposed method of internal intake of low-mineralized mineral water (in the form of inhalation for 5-6 minutes once) over the known method (orally 3 times a day, 150-200 ml) during rehabilitation of patients with peptic ulcer of the duodenum in phase complete and incomplete remission.

Claims (1)

 A method of treating patients with duodenal ulcer, including the use of mineral water, characterized in that the mineral water is used in the form of inhalation and is administered 1 time per day for 5-6 minutes through the nose 45-60 minutes before meals, for a course of 10- 12 treatments.

Images