RU2270662C1 - Method for treating patients with combined pathology of gastroduodenal and bile-excretory systems - Google Patents

Abstract

FIELD: medicine, physiotherapy.

SUBSTANCE: one should prescribe the diet #1, morning exercises, total pearl baths, intake of mineral sulfate-chloride-sodium-magnesium water, manual massage and peloid applications onto area of wide girdle. The impact mentioned should be fulfilled daily at the quantity of 10 procedures. The intake of mineral water mentioned at 6 g/l mineralization should be prescribed thrice daily per 100-150 ml 30 min before meals. Additionally, one should prescribe phytospecies consisting of the following grasses: everlasting, St. John's wort, yarrow, common horsetail and peppermint at the ratio of 3:3:2:2:2, correspondingly per 50 ml thrice daily after meals for 12-14 d. The innovation enables to improve the values of motor-evacuatory function of bile-excretory system, improve biochemical composition of bile, parameters of regional hemodynamics, and, also, improve morphological state of gastric and duodenal mucosa and restore the continuity of mucosal layer.

EFFECT: higher efficiency of therapy.

1 ex, 2 tbl

Description

The invention relates to medicine, namely to gastroenterology and physiotherapy, and relates to methods for treating patients with combined pathology of the gastroduodenal and biliary system.

Known methods of treating diseases of the gastroduodenal region (esophagitis, gastritis, duodenitis, peptic ulcer of the stomach and duodenum) and biliary system (cholecystitis, cholangitis, cholangiocholecystitis, biliary dyskinesia), based on the use of applications peloids, mineral water and 1 internal intake . However, these methods have a long treatment period, since they involve the appointment of peloid applications and baths every other day and the volumetric limitation of peat applications.

Also known is a method of treating patients with peptic ulcer of the stomach and duodenum, which consists in the appointment of: diet No. 1, daily physiotherapy exercises for 15 minutes, common pearl baths with a water temperature of + 37 ° C, for 15 minutes, for a course of 10 procedures; manual massage for 30 min, conducted after 14 hours and applications of peat, which is applied to the wide belt zone, the fascinating epigastric region, the left and right hypochondria and back at the level of Th ₄ -Th ₁₂ , temperature + 40 + 42 ° С, exposure 20 -25 minutes, the treatment course of 10 procedures, and these procedures were prescribed every other day, in combination with daily intake of mineral sulfate-chloride-sodium-magnesium water with a salinity of 6 g / l 3 times a day, 100-150 ml per reception.

However, the described method is not a specific targeted method specifically for the pathogenetic mechanisms of the combined pathology of the gastroduodenal and biliary systems.

The objective of the invention is to develop a differentiated non-drug method of treatment of the combined pathology of the gastroduodenal and biliary system, which allows for more effective and differentiated treatment for these chronic diseases, taking into account the nature and stage of the process, and to extend the duration of remission.

The task is achieved by assigning a diet No. 1, morning exercises, mineral sulfate-chloride-sodium-magnesium water, common pearl baths, a manual massage course and exposure to peloid applications on the wide belt, and these procedures are carried out daily, in the amount of 10 procedures, taking mineral sulfate-chloride-sodium-magnesium water with a salinity of 6 g / l is prescribed 3 times a day, 100-150 ml 30 minutes before meals and an additional phyto-collection containing herb immortelle, St. John's wort, yarrow, field x oscha, peppermint, at a ratio of 3: 3: 2: 2: 2, respectively, 50 ml, 3 times a day after meals for a period of 12-14 days.

The method is as follows: after confirming the clinical diagnosis and the absence of contraindications, the patient is prescribed a diet No. 1, morning exercises, daily for 15 minutes; common pearl baths with a water temperature of + 37 ° C for 15 minutes daily, for a course of 10 procedures; applications of peat, which is applied to the zone of the wide belt, the exciting epigastric region, the left and right hypochondrium and back at the level of Th ₄ -Th ₁₂ , temperature + 40 + 42 ° С, exposure time of 20-25 minutes, for the course of treatment 10 procedures. The treatment complex also includes daily ingestion of highly mineralized, slightly alkaline iodine-bromine-chloride-sodium water with a mineralization of 6 g / l, prescribed according to the generally accepted scheme 3 times a day, 100-150 ml, at a temperature of + 40 + 42 ° С per reception , 30 minutes before eating and phyto-collection, containing immortelle grass, St. John's wort, yarrow, horsetail, peppermint in a ratio of 3: 3: 2: 2: 2, respectively, 50 ml, 3 times a day after meals for 12-14 days.

Peloid therapy is widely used in spa and out-of-resort practice for diseases of the gastroduodenal system. It is a pathogenetic method of treatment, and its main action is to normalize the functions of the central and autonomic nervous system, inhibit the increased activity of the adrenal cortex, decrease the tonus of the vagus nerve and normalize the functional state of the pituitary-adrenal system, as a result of which the aggressiveness of the acid-peptic factor decreases, improves reparative function of the mucous membrane of the stomach and duodenum.

The inclusion in the medical complex of the internal intake of mineral water is based on its ability to exert an adaptogenic, acid-neutralizing, anti-inflammatory effect. It contributes to the normalization of the motor-evacuation function of the gastrointestinal tract, stimulates reparative and metabolic processes, increases the immunological reactivity of the body and improves the function of other digestive organs, to some extent impaired in this disease. The composition of the phyto-collection:

Immortelle - 3 parts (4.5-7.5 g)

St. John's wort - 3 parts (4.5-7.5 g)

Yarrow - 2 parts (3.0-6.0 g)

Horsetail - 2 parts (3.0-6.0 g)

Peppermint - 2 parts (3.0-6.0 g)

Method of preparation: 30 g of the mixture per 1 liter of boiling water, boil for 5-7 minutes, steam for 30-40 minutes, cool, strain.

The choice of the components of gastric collection is based on the use of herbs containing organic acids, mucus, tarry and tannins, trace elements, flavonoids and carotenoids, proteins, saponins, coumarins, vitamins, polysaccharides, mineral salts, pectin, phytoncides, phytosterol, fatty and essential oils , bitterness, sugar, alcohols, stearins, alkaloids, choline, mucus.

The proposed composition has anti-inflammatory, antispasmodic, analgesic, astringent, hemostatic, sedative, diuretic, bactericidal and antibacterial effects, stimulates and activates tissue regeneration and metabolism, improves mineral metabolism and the production of proteolytic enzymes, normalizes the secretion of gastric and pancreatic juice, enhances promotes its thinning, increases the cholesterol-cholesterol coefficient, reduces intragastric pressure and relieves symptoms yl and putrefactive dyspepsia, has a positive effect on the motor-evacuation function of the gastrointestinal tract.

In the clinic of the Tomsk Scientific Research Institute of Balneology and Physiotherapy, 70 patients with combined pathology of the gastroduodenal and biliary system (chronic gastritis, chronic gastroduodenitis, peptic ulcer of the stomach and duodenum) were treated at the stage of decaying exacerbation, which were prescribed treatment in accordance with the claimed method. All observed patients had a concomitant pathology in the form of chronic non-calculous cholecystitis in the stage of incomplete remission with biliary dyskinesia of the hypo-hypermotor or mixed type. As a control, a group of 30 patients with a similar pathology was taken who received traditional treatment with the use of peloids and baths every day with the same T ° C, exposure and internal intake of mineral water, but without taking phyto collection.

The tolerability and effectiveness of the proposed method was evaluated on the basis of the severity of the main clinical symptoms, data of esophagogastroduodenoscopy, indicators of acid-forming function of the stomach, fractionated minute duodenal sounding with a study of the biochemical composition of bile (bilirubin, cholesterol, phospholipids, bile acids, organ cholesterol, ultrasound index, research index abdominal cavity performed with a test breakfast and with the calculation of the volume of the gallbladder, with standing in the circulatory and hepatic portal vein, the fucose content in the gastric juice, the dynamics of the indices of the heart, and Kerdo Hildenbranta characterizing the state of the cardiovascular and autonomic nervous system. Data on the effectiveness of treatment are shown in tables 1, 2.

Table 1
Comparative characteristics of clinical and functional indicators in the treatment of the present method and in the control (in%) Indicator groups The inventive method The control Pain syndrome

Dyspeptic syndrome

Asthenovegetative syndrome

Endoscopic dynamics of the stomach and
dpk

Lithogenic bile:
- Rubens index
- cholecholesterol coefficient

Initially elevated transaminases (ALT, ACT)

Sympathicotonia

Vagotonia

Treatment effectiveness 98.5 86.7 Notes: - in the numerator indicators before treatment;
- in the denominator - after treatment

table 2
Comparative characteristics of laboratory parameters in the treatment of the present method and in control Indicator groups The inventive method The control Acid-forming function of the stomach

The content of fucose in the gastric juice

Gallbladder evacuation function

Dyskinesia of GVP

Note: * - significance of differences relative to control (at P <0.05);
*** - significance of differences (at P <0.001)

From the above tables it is seen that in the group of patients treated by the claimed method, a higher efficiency compared with the control. So, against the background of the treatment, there was a significant improvement in the objective clinical symptoms (relief of pain, asthenovegetative and dyspeptic syndromes, a decrease in local pain in the pyloroduodenal region and in the right hypochondrium). The study of the acid-forming function of the stomach revealed a lack of dynamics of the average values of basal and stimulated secretion, however, in both groups there was no acid-stimulating effect.

According to the fractional mined duodenal sounding, the indicators of the motor-evacuation function of the bile excretory system improved (the volume of cystic bile and the rate of secretion tension were normalized). The biochemical composition and lithogenic properties of bile were significantly improved, and the parameters of regional hemodynamics were positively changed. After the treatment, an increase in the content of fucose in the gastric juice was noted, which indicated an improvement in the morphological state of the mucous membrane of the stomach and duodenum, restoration of the continuity of the mucous layer, decrease in the rate of mucus degradation, restoration of polymer properties and gelability. Clinical tolerance of treatment was noted as good, no negative load on the cardiovascular and autonomic nervous system was noted. In general, the claimed method of treatment avoids the disadvantages of existing methods and improve the quality and immediate results of treatment.

Example

The patient is 45 years old. Diagnosis: Peptic ulcer with localization of the process in the area of the duodenal bulb, in the stage of decaying exacerbation. Chronic non-calculous cholangiocholecystitis in the stage of moderate exacerbation. Chronic opisthorchiasis. Dyskinesia of the biliary tract according to the hypermotor type. Upon admission, the patient complained of severe pain in the epigastric, pyloroduodenal region, arising on an empty stomach (especially at night), belching with air or food eaten, heartburn, loss of appetite, general weakness, sweating, sleep disturbance. Periodically notes aching, pressing pains in the right hypochondrium, a feeling of heaviness (occur when eating fatty, fried foods) bitterness, dry mouth, nausea, low-grade fever. From the anamnesis: Considers himself ill for about 10 years, when for the first time during duodenal fibrogastroduodenoscopy was diagnosed with duodenal ulcer. Deterioration is noted in the last 3 years when a chronic opisthorchiasis was detected. Exacerbations are noted annually, in the spring-autumn period, the duration of the last remission is about 6 months.

The examination revealed endoscopically - the presence in the bulb of the duodenum of a peptic ulcer with a diameter of 0.5 cm on the background of an edematous, hyperemic mucosa. The acidity of the gastric juice was 2.5 units. pH, on the rheohepatogram, a decreased arterial flow was noted. In addition, the presence of hypermotor dyskinesia (according to duodenal sounding, ultrasound examination of the gallbladder) and a violation of the biochemical composition of bile were revealed - the cholecholesterol coefficient was: 7.5, the Rubens index - 0.8.

From the first day the patient was in the clinic, he was prescribed an examination, and from the 3rd day - treatment in accordance with the claimed method, namely: diet No. 1, morning exercises, daily for 15 minutes; common pearl baths, with a water temperature of + 37 ° C for 15 minutes, daily, for a course of 10 procedures; applications of peat, which was applied to the zone of the "wide belt", capturing the epigastric region, the left and right hypochondrium and back at the level of Th ₄ -Th ₁₂ , temperature + 41 ° С, exposure time 25 minutes, daily, in the amount of 10 procedures, daily internal intake 150 ml of iodine-bromide-chloride-sodium water 3 times a day 30 minutes before meals and the intake of the proposed phytobox 50 ml 3 times a day 30 minutes after meals, for 14 days. The patient tolerated the prescribed treatment well, from the 3rd procedure there was a decrease in pain, dyspeptic, asthenovegetative syndromes, and after 6-7 procedures the pain syndrome was completely stopped. During treatment, an increase in the index of cardiac performance (at the 7th procedure) and a transition from vagotonia to sympathicotonia (at the 6th procedure) were noted once. Overall, treatment tolerance was rated as good.

As a result of the treatment, during the control endoscopic examination, complete scarring of the ulcer in the duodenal bulb was noted; the acidity of the gastric juice was 3.0 units. pH on rheohepatogram marked increase in arterial inflow; with repeated ultrasound of the gallbladder and duodenal sounding, an increase in its contractile ability, normalization of the biochemical composition of bile was noted: the cholocholesterol index was 12.0, and the Rubens index was 0.4. The immediate effect is rated at 3.5 points - a significant improvement.

Thus, the proposed method for the treatment of patients with pathology of the gastroduodenal region and biliary system will allow a longer and more effective treatment of this group of patients, to extend the period of remission and to prevent the development of relapses.

In addition, the positive point is that while reducing the cost of treatment, the use of phyto-collection from publicly available raw materials will reduce the undesirable drug load on the patient's body, as well as use plant materials from the region’s natural resources.

Claims (1)

A method of treating patients with combined pathology of the gastroduodenal and biliary system by prescribing a diet No. 1, morning exercises, common pearl baths, mineral sulfate-chloride-sodium-magnesium water, manual massage and exposure to peloid applications on the wide belt, characterized in that these effects are carried out daily in the amount of 10 procedures, the intake of mineral sulfate-chloride-sodium-magnesium water with a mineralization of 6 g / l is prescribed three times a day, 100-150 ml 30 minutes before meals and additionally mean phytosource containing grass of immortelle, St. John's wort, yarrow, horsetail, peppermint in a ratio of 3: 3: 2: 2: 2, respectively, 50 ml three times a day after meals for 12-14 days.