RU2313373C1 - Method for treating chronic diseases of large intestine accompanied with constipation syndrome in children - Google Patents

Abstract

FIELD: medicine, pediatrics, gastroenterology.

SUBSTANCE: it is necessary to carry out complex therapy of the disease in question and ozonotherapy of the lower department of large intestine. Moreover, 2 h before ozonotherapy one should additionally introduce motilac at the dosage of 2.5 mg for 10 kg/d. Ozonotherapy should be carried out with an ozonator "Ultraton-AMP" due to rectal introduction of a gas-discharge cylindrical electrode for the depth of about 4-6 cm. This procedure should be fulfilled daily at power of 3 W. Impact duration should be prolonged from 5 min up to 10 min. The course lasts for 10 d. The innovation in question provides increased circulation of gastro-intestinal tract and enhanced therapeutic impact of motilac and, as a result, rapid interruption of pain syndrome, inflammatory rectal process and the absence of relapses during 6 mo.

EFFECT: higher efficiency of therapy.

2 ex

Description

The invention relates to medicine, namely to pediatrics, in particular to gastroenterology.

The development of methods for treating diseases of the colon in children, especially locally with irritable bowel syndrome, remains relevant. Hypokinesia, heredity and factors acting in the perinatal period, feeding disorders in the first year of life, poor nutritional balance in subsequent age periods lead to an increase in the frequency of intestinal morbidity. The above factors lead to impaired colon motility. There is stagnation of feces in the intestine, which leads to trophic disorders with a violation of the local immune response, with the subsequent development of an inflammatory reaction. The long-term presence of factors supporting the inflammatory process in the colon leads to a chronic process.

However, the modern choice of known methods is rather scarce, includes microclysters, candles, the effectiveness of which is very relative.

A known method of treating colitis in adults using an ozone-oxygen mixture by rectal insufflation, in which there was an increase in pO ₂ in the intestinal wall by 150%, in the venous channel by 130%, in the portal vein by 34%, in the liver parenchyma by 27% (Knox X .G., Klug VL “Therapeutic Archive.” 1990, vol. 62, No. 2, pp. 93-98).

However, this method of ozone therapy was used in adult gastroenterology and does not take into account the anatomical and functional features of the large intestine of children.

The closest is a method of treating diseases of the colon, in particular irritable bowel syndrome, comprising complex therapy and rectal administration of an ozone-oxygen mixture. For rectal administration, an ozone-oxygen mixture in a volume of 100 cm ^{3 is used} with an increase in subsequent procedures to 500-600 cm ³ with an ozone concentration of 6-30 μg / ml, which is selected depending on the type of intestinal motility, while the introduced ozone-oxygen mixture in the intestine is delayed 10 -30 minutes. The procedures are carried out 2-3 times a week, a total of 8-10 procedures (Zmyzgova A.V., Isaeva N.P. and others. Patent of the Russian Federation No. 2178700, BIPM No. 3, 01.27.02., P.227)

However, there is no information about the use of this method in pediatrics, in addition, the method has several disadvantages:

- a long course of therapy, which can cause psychological discomfort in patients, loss of interest in continuing treatment;

- the need for the introduction of large volumes of ozone-oxygen mixture and its retention for 10-30 minutes, which is unacceptable for children.

OBJECT OF THE INVENTION

Improving the effectiveness of the treatment of chronic diseases of the colon, occurring with constipation syndrome in children, due to the rapid relief of the inflammatory process in the mucous membrane of the colon, normalization of bowel movement, and the persistent effect of therapy.

The task is achieved by the fact that in our proposed method for the treatment of chronic diseases of the colon occurring with constipation syndrome in children, they carry out complex therapy of the disease and ozone therapy of the lower part of the colon. 2 hours before ozone therapy, Motilak is additionally prescribed in a dose of 2.5 mg per 10 kg / day. Then ozone therapy is carried out by rectal introduction to a depth of 4-6 cm of a gas-discharge cylindrical electrode of the apparatus of the ozonizer "Ultraton - AMP". Ozone therapy is carried out at a power of 3 W daily for 10 days, increasing the duration of exposure from 5 to 10 minutes.

The novelty of the invention:

- 2 hours before ozone therapy, an additional Motilak is prescribed in a dose of 2.5 mg per 10 kg / day,

- then carry out ozone therapy by rectal introduction to a depth of 4-6 cm of a gas-discharge cylindrical electrode of the apparatus of the ozonizer "Ultraton - AMP",

- ozone therapy is carried out at a power of 3 watts daily for 10 days, increasing the duration of exposure from 5 to 10 minutes.

The method improves blood supply to the tissues of the colon, has a bactericidal effect, improves intestinal motility, which increases the effectiveness of treatment, accelerates the relief of the inflammatory process in the mucous membrane of the colon, normalizes bowel movement.

We have chosen the drug motilak, which is a second-generation prokinetics. The drug contains domperidone. The criteria for the selection of the drug motilak were the properties of this drug. The effect of the drug is due to blockade of the central dopamine receptors. This eliminates the inhibitory effect of dopamine on the motor function of the gastrointestinal tract. For treatment, motilak was used in a dose of 2.5 mg per 10 kg / day 2 hours before ozone therapy, since the maximum concentration of the drug in blood plasma is reached after 1 hour.

The use of ozone therapy in chronic diseases of the colon in children is pathogenetically substantiated. However, in recent years, much attention has been paid to the representative of a new class of regulators of physiological functions - nitric oxide. It was found that nitric oxide can be synthesized in sensitized macrophages from arginine with the participation of oxygen and the enzyme NO synthase. Nitric oxide quickly penetrates bacteria, fungi or tumor cells and inhibits the enzymes of ATP synthesis, Krebs cycle and DNA synthesis, that is, it is the final link of immune damage. We have the idea to connect the mechanism of action of ozone with the formation of nitric oxide. This idea to connect the mechanism of ozone action with the formation of nitric oxide seems quite real: direct synthesis of nitric oxide from atmospheric nitrogen and oxygen was carried out under the influence of an electroionization discharge on a mixture of these gases. When using the ozonizer apparatus, there is a source of a quiet spark discharge and atomic oxygen, which can more easily interact with a vibrationally excited nitrogen molecule. For treatment, the ozonizer "Ultraton - AMP" was used. The time of the procedure, starting from 5 min, bringing the duration to 10 min, the power is weak to 3 W, was worked out during the application of the technique. Reducing the time of the procedure did not allow to achieve a significant clinical effect. Carrying out the procedure for more than 10 minutes did not cause a significant change in clinical indicators (pain syndrome, emptying regimen, dynamics of the endoscopic picture), which were used to evaluate the effectiveness of treatment, which allowed us to choose a maximum procedure time of 10 minutes.

The use of the drug motilak before ozone therapy allowed to obtain a new result:

1. The combined effect of two factors, manifested in synergism, enhances the effect of each, increasing the therapeutic activity of both the drug motilak and ozone therapy.

2. The expansion of blood vessels in the ozone therapy zone increases the blood flow of the gastrointestinal tract, thereby increasing the delivery of the active substance of motilak, thereby enhancing its clinical effects, in particular the effect on gastrointestinal motility.

3. The ability to quickly stop the inflammatory process already by 4-5 procedure.

4. Significantly increase the effectiveness of treatment in the form of the absence of relapse of diseases within 6 months of observation.

Under the supervision were 53 children (boys and girls) aged 5 to 14 years old with a diagnosis of chronic colon disease occurring with constipation syndrome. Each patient underwent general clinical research methods, sigmoidoscopy, colonoscopy - two, irrigography - eight. According to the testimony, ultrasound, EFGDS. The results showed that by the end of the first week of treatment, the majority had a pain syndrome, the correct regime of emptying was established. Positive endoscopic dynamics - in the form of the disappearance of hyperemia and edema of the mucous membrane, restoration of its normal velvety appearance, folding and vascular pattern, the appearance of a brighter color and luster in the presence of subatrophy sites, epithelization of existing erosions - was also significantly more often in the experimental group. The treatment effect in the experimental group was more persistent, as evidenced by the frequency of absence of relapse for 6 months.

The main group included 28 children with chronic diseases of the colon occurring with constipation syndrome, who received treatment according to the claimed method. The control group included 25 children with the same pathology who received treatment according to the prototype. The effectiveness of treatment was evaluated in both groups according to the dynamics of subjective complaints, the main clinical symptoms, and the results of repeated endoscopic examination at the end of the course of treatment and follow-up observation for 6 months.

EXAMPLE 1. Voskoboinikova A., 10 years old.

She complained of: spontaneous abdominal pain, dyspeptic disorders (nausea, heartburn), asthenic syndrome (weakness, malaise, headaches) and constipation. In addition, the girl had pain during a bowel movement. Objectively: pain along the large intestine was determined by palpation. An endoscopic examination revealed superficial distal colitis.

Clinical diagnosis: Irritable bowel syndrome.

They prescribed Motilak at a dose of 2.5 mg per 10 kg / day 2 hours before ozone therapy.

Ozone therapy was performed with the Ultraton-AMP apparatus, a electrode was inserted locally into the rectum, which was injected to a depth of 6 cm with a power of 3 W, sessions were performed daily, starting from 5 minutes, bringing the duration to 10 minutes, for 10 days.

The effectiveness of treatment was evaluated in dynamics according to subjective complaints, the main clinical symptoms and the results of repeated endoscopic examination, which was performed at the end of the course of treatment and follow-up observation for 6 months.

After the end of the course of treatment, the patient's complaints disappeared, with endoscopic examination, the rectal mucosa acquired a healthy shine, pink color. Within 6 months of observation, there were no complaints, with an endoscopic examination of the phenomena of superficial colitis was not observed, the stool returned to normal.

EXAMPLE 2. Gamaleev J., 12 years old.

He complained of: abdominal pain stitching, heartburn, constipation. Objectively: pain along the large intestine was determined by palpation. When sigmoidoscopy revealed superficial distal colitis. Irrigography revealed total colonoptosis of 3 degrees. Clinical diagnosis: Total colonoptosis 3 tbsp. Distal colitis.

They prescribed Motilak at a dose of 2.5 mg per 10 kg / day 2 hours before ozone therapy.

Ozone therapy was performed with the Ultraton-AMP apparatus, locally, an electrode was inserted into the rectum to a depth of 6 cm, with a power of 3 W, sessions were carried out daily, starting from 5 minutes, bringing the duration to 10 minutes, for 10 days.

After the procedure, complaints disappeared, the stool returned to normal, and there was no inflammatory process in the rectal mucosa during proctosigmoidoscopy. Follow-up revealed no relapse within 6 months of follow-up.

Thus, the proposed method allows the treatment of children in a more convenient way that does not cause psychological discomfort in children.

The effect of using the proposed method, consisting in the following:

1. The rapid relief of the inflammatory process in the mucous membrane of the rectum.

2. The absence of relapse within 6 months of observation suggests the presence of persistent remission.

3. Quick relief of pain and setting the correct bowel movement.

Claims (1)

A method of treating chronic colon diseases occurring with constipation syndrome in children, including complex therapy of the disease and ozone therapy of the lower colon, characterized in that 2 hours before ozone therapy, an additional 2.5 mg per 10 kg / day of motilak is prescribed then ozone therapy is carried out by rectal introduction to a depth of 4-6 cm of a gas-discharge cylindrical electrode of the Ultraton-AMP ozonizer apparatus, ozone therapy is carried out at a power of 3 W daily for 10 days, increasing the duration NOSTA impact from 5 to 10 minutes.