RU2302004C1 - Method for predicting pylorostenosis development - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves determining duodenal juice acidity, duodenum bulbary and postbulbary department insemination degree with H.pylori. Ulcer edge and pyloric canal area bioptates are subjected to immunological and histological examination. Duodenal juice acidity being equal to or higher than 6.5 mmole/h and duodenal mucous membrane insemination degree being equal to or higher than 100 bacteria in vision field, IgG antibodies to H.pylori diluted in 1:160 proportion and higher, gastric metaplasia being detected in pyloric canal bioptates of ulcer edges among hypertrophied smooth muscle cells of separate groups of atrophied and deformed smooth muscle cells divided by layers of loose connecting tissue having blood vessels, fibroblasts, lymphocytes and macrophages, and anisochromia being detected when staining hypertrophied smooth muscle cells, pylorostenosis development is to be predicted.

EFFECT: high accuracy in predicting pylorostenosis development clinical course.

Description

The invention relates to medicine, and more particularly to gastroenterology, and can be applied in predicting the development of pyloric stenosis.

A known method for predicting giant gastric ulcers and complications by immunological, pathophysiological and pathomorphological studies with subsequent surgical intervention (Nesterov A.O. et al. Giant gastric ulcers: clinical features, course, diagnostic difficulties. Expert. And wedge. Gastroenterology. 2003 No. 1, P.177). This method is taken as an analog.

A known method for predicting complications of duodenal ulcers and choosing the method of operation by taking into account the individual location of each ulcer defect, pyloric pulp condition, and duodenal function (Zhernov G.K. et al. Our experience in the surgical treatment of duodenal ulcers. Expert. And wedge. Gastroenterol 2003 No. 1, P.175-176). This method is adopted as a prototype.

However, this method does not provide sufficient accuracy for predicting the development of pyloric stenosis.

The aim of the invention is to improve the accuracy of predicting the development of pyloric stenosis.

The technical result is achieved by determining the acidity of the duodenal juice, the seeding of the bulbar and postbulbar sections of the duodenum of H. pylori, conducting an immunological and histological examination of biopsy samples of the ulcer margin and the pyloric canal and with acidity of the duodenal juice 6.5 mmol / hour or more, mucosal colonization the duodenum of 100 bacteria in the field of view and above, the content of antibodies of the IgG class against H. pylori at a dilution of 1: 160 and above, the detection of gastric metaplasia ulcer in the biopsy specimens; detection in biopsy specimens of the pyloric canal among hypertrophied smooth muscle cells of individual groups of atrophied and deformed smooth muscle cells separated by layers of loose connective tissue with blood vessels, fibroblasts, lymphocytes and macrophages, and upon detection of anisochromia when staining hypertrophied smooth muscle cells, the development of pilogram is predicted.

The method is as follows.

The patient suffers for a long time from peptic ulcer of the duodenum (20-25 years). From the anamnesis it is known that the patient did not pay due attention to the treatment of the disease.

The patient complains of a feeling of fullness, heaviness in the epigastric region after eating, periodic vomiting, sometimes acidic belching worries, periodically there are pains in the epigastric region.

During the subcompensated phase, the feeling of heaviness in the epigastric region becomes constant, belching increases, vomiting becomes frequent and profuse. After eating, the apparent peristalsis in the epigastric region is determined. Clinical-motor insufficiency of the stomach develops, the manifestations of which the patient reduces, causing artificial vomiting, which brings a short-term improvement in well-being. The patient gradually loses weight. Constant tachycardia.

In the compensation phase, the stomach is normal or slightly enlarged. Evacuation of the contents of the stomach is carried out for no more than 8-12 hours. Enhanced high-amplitude peristalsis is noted.

In the phase of subcompensation, the stomach is enlarged and on an empty stomach contains fluid with weakened peristalsis and delayed evacuation of the contrast mass up to 24 hours.

An endoscopic examination reveals the presence of fluid in the stomach, the stomach is enlarged, a narrowing of the pyloric canal is manifested to varying degrees of at least 0.5 cm - subcompensated stenosis and less than 0.5 cm - decompensated.

The skin is dry, earthy in color, tissue turgor is reduced. The tongue and oral mucosa are dry with the effects of glossitis and stomatitis. Diuresis is reduced.

In an X-ray examination, the contours of the narrowing are even, the mucous smooth, narrowed area in a series of images changes, in contrast to its rigid picture with a tumorous character of narrowing.

The acidity of the duodenal juice, the colonization of the bulbar and postbulbar sections of the duodenum of H. pylori are determined, immunological and histological studies of biopsy specimens of the ulcer margin and the pyloric canal are performed.

The acidity of duodenal juice is 6.5 mmol / hour and above. The colonization of the duodenal mucosa is 100 bacteria in the field of view and above. The content of IgG antibodies to H. pylori at a dilution of 1: 160 and higher. In biopsy specimens of the edge of the ulcer, gastric metaplasia was detected. Separate groups of atrophied and deformed smooth muscle cells, separated by layers of loose connective tissue with blood vessels, fibroblasts, lymphocytes and macrophages, were found in biopsy specimens of the pyloric canal among hypertrophied smooth muscle cells. When staining hypertrophied smooth muscle cells with methylene blue, anisochromia was detected.

The combination of distinctive and restrictive signs allows us to predict the development of pyloric stenosis in a patient.

As a result of surgical treatment, the passage of gastric contents into the duodenum was restored. Subsequent follow-up observation confirmed the correctness of the prognosis of the development of the disease and its subsequent surgical correction.

The method is confirmed by the following examples.

Example 1

Patient Bn, 37 years old, for 18 years suffering from peptic ulcer of the duodenum. From the anamnesis it is known that the patient treated his disease on demand until pain relief was achieved. I did not conduct an annual spring-autumn preventive course of treatment.

Upon admission, the patient complains of a feeling of heaviness and pain in the epigastric region after eating, periodic vomiting. Vomiting brings a short-term improvement in well-being. The patient gradually loses weight.

An endoscopic examination reveals the presence of fluid in the stomach, the stomach is enlarged, a narrowing of the pyloric canal, manifested to varying degrees, of at least 0.5 cm is detected - subcompensated stenosis.

The skin is dry, pale, tissue turgor is reduced.

During X-ray examination: the contours of the pyloric canal are even, the mucous membrane is smooth, the narrowed area in a series of images changes.

The acidity of the duodenal juice is 6.5 mmol / hour. Seeding of the duodenal mucosa is 100 bacteria in the field of view. The content of antibodies of the IgG class against H. pylori at a dilution of 1: 160. In biopsy specimens of the edge of the ulcer, gastric metaplasia was detected. Separate groups of atrophied and deformed smooth muscle cells, separated by layers of loose connective tissue with blood vessels, fibroblasts, lymphocytes and macrophages, were found in biopsy specimens of the pyloric canal among hypertrophied smooth muscle cells. When staining hypertrophied smooth muscle cells with methylene blue, anisochromia was detected.

The combination of immunological, morphological, endoscopic signs allows us to predict the development of a patient subcompensated pyloric stenosis.

As a result of the treatment, the passage of gastric contents into the duodenum was restored. Subsequent follow-up observation confirmed the correctness of the prognosis of the development of the disease.

Example 2

Patient Iv, 52 years old, suffers from peptic ulcer of the duodenum for 25 years. Upon admission, the patient complains of a feeling of fullness, heaviness in the epigastric region after eating, frequent and profuse vomiting, which brings relief; sour burp. Weight loss over the past four years is 12 kg.

From the anamnesis it is known that the patient was hospitalized twice for exacerbation of peptic ulcer.

After eating, the apparent peristalsis in the epigastric region is determined with the development of clinical and motor insufficiency of the stomach. The heart rate is 92-96 beats / min.

During an X-ray examination, the stomach is enlarged and on an empty stomach contains fluid, peristalsis is weakened, the delay in the evacuation of the contrast mass is up to 24 hours.

With an endoscopic examination: fluid is detected in the stomach, the stomach is dilated, a narrowing of the pyloric canal is detected - less than 0.5 cm.

The skin is dry, earthy in color, tissue turgor is reduced. The tongue and oral mucosa are dry with the effects of glossitis and stomatitis. Diuresis is reduced.

The acidity of the duodenal juice, the seeding of the bulbar and postbulbar sections of the duodenum of H. pylori are determined, immunological and histological studies of biopsy specimens of the ulcer margin and the pyloric canal are performed.

The acidity of duodenal juice is 7.5 mmol / hour. The colonization of the duodenal mucosa is 150 bacteria. The content of IgG antibodies to I. pylori at a dilution of 1: 200. In biopsy specimens of the edge of the ulcer, gastric metaplasia was detected. Separate groups of atrophied and deformed smooth muscle cells, separated by layers of loose connective tissue with blood vessels, fibroblasts, lymphocytes and macrophages, were found in biopsy specimens of the pyloric canal among hypertrophied smooth muscle cells. Methylene blue staining of hypertrophied smooth muscle cells reveals anisochromia.

Based on the results of the examination, the diagnosis was made: decompensated pyloric stenosis. Surgical treatment was performed.

As a result of surgical treatment, the passage of gastric contents into the duodenum was restored. Subsequent follow-up observation confirmed the correctness of the prognosis of the development of the disease.

Example 3. Patient K., 44 years old, suffers from peptic ulcer of the duodenum for 23 years. From the anamnesis it is known that the patient did not pay due attention to the treatment of the disease.

Upon admission, the patient complains of a feeling of fullness, heaviness in the epigastric region after eating, pain in the epigastric region.

With an X-ray examination, the stomach is slightly enlarged. Evacuation of the contents of the stomach is carried out for 8 hours. Enhanced high-amplitude peristalsis is noted. Rigidity of the pyloric canal is noted.

Endoscopically: the presence of fluid in the stomach, the stomach is expanded.

The acidity of the duodenal juice, the colonization of the bulbar and postbulbar sections of the duodenum of H. pylori are determined, immunological and histological studies of biopsy specimens of the ulcer margin and the pyloric canal are performed.

The acidity of duodenal juice is 5.7 mmol / hour. The colonization of the duodenal mucosa is 70 bacteria in the field of view. The content of antibodies of the IgG class against H. pylori at a dilution of 1: 120. In biopsy specimens of the edge of the ulcer, gastric metaplasia was detected. Hypertrophic smooth muscle cells were found in biopsies of the pyloric canal. When staining hypertrophied smooth muscle cells with methylene blue, anisochromia was detected.

The results of the anamnesis and data of an objective examination do not allow to predict the development of a patient with pylorosteiosis. To address the etiology of changes in the pyloric canal, detected radiologically, a diagnostic laparotomy was performed; a pancreatic tumor was found, growing in the region of lesser curvature of the stomach and the pyloric canal.

The examination of the patient did not reveal those quantitative and qualitative characteristics of the pathological process that are declared as diagnostic in the development of pyloric stenosis.

Prediction of the development of pyloric stenosis according to the claimed method in 21 patients was carried out. Subsequent surgical treatment confirmed the prognosis.

Claims (1)

A method for predicting the development of pyloric stenosis by immunological, pathophysiological and morphological studies, characterized in that they determine the acidity of the duodenal juice, the colonization of the bulbar and postbulbar sections of the duodenal H. pylori, conduct immunological and histological studies of biopsy specimens of the ulcer margin and the area of the pyloric canal and venous acidity 6 , 5 mmol / h and above, colonization of the duodenal mucosa of 100 bacteria in the field of view and above, the content of the antibody l IgG class to H. pylori at a dilution of 1: 160 and higher, detection in biopsy specimens of gastric metaplasia ulcer margin; detection in biopsy specimens of the pyloric canal among hypertrophied smooth muscle cells of individual groups of atrophied and deformed smooth muscle cells separated by layers of loose connective tissue with blood vessels, fibroblasts, lymphocytes and macrophages, and upon detection of anisochromia when staining hypertrophied smooth muscle cells, the development of pilogram is predicted.