RU2348405C2 - Method of treatment of chronic cholecystitis exacerbation - Google Patents

Abstract

FIELD: medicine; gastroenterology.

SUBSTANCE: treatment of chronic noncalculous cholecystitis exacerbation is ensured by introduction of Celebrex dosed 100 mg twice a day. Course of medical treatment is 3-5 days.

EFFECT: pathogenetic action on inflammatory process of gallbladder wall with reduced treatment time, prolonged disease remission without medical by-effects.

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Description

The present invention relates to medicine, namely to gastroenterology in the treatment of exacerbation of patients with chronic cholecystitis.

There is a method of treating exacerbation of acute chronic cholecystitis by prescribing antibacterial treatment, for example, ciprofloxacin 500-750 mg 2 times a day or clarithromycin 250-500 mg 2 times a day. The course of treatment is 10-21 days (see Cholecystitis under the editorship of P.Y. Grigoriev // Practicing physician. Gastroenterology, 2002 - No. 1. - P.22).

The closest is the treatment method, in which when prescribing antibacterial drugs for exacerbation of chronic cholecystitis, their ability to penetrate into bile is taken into account, for example, doxycyline with 200 mg on the first day and 100 mg on the following days for 3 weeks. The use of antibacterial agents must be combined with drugs with a choleretic effect (nicodine, cyclonal) (see Mayev I.V. Diagnosis and treatment of diseases of the biliary tract. M., GOU VUNMTS MZ RF. - 2003. - P.84).

The technical result of the proposed method is to shorten the treatment time and lengthen the remission of the disease.

New in achieving the technical result is that a non-steroidal anti-inflammatory drug is prescribed, for example, celebrex 100 mg 2 times a day for 3-5 days.

Celebrex is a non-steroidal anti-inflammatory drug. The appointment of celebrex provides a quick relief of the symptom of the disease, reduces the treatment time for chronic cholecystitis from 3-4 weeks to 3-5 days, and also to prolong the remission of the disease from 6 months to 1-2 years. Celebrex is a selective inhibitor of the oxygenase-2 cycle and has minimal side effects on the gastric mucosa. Celebrex has no contraindications and side effects, and also has a pathogenetic effect on the inflammatory process of the gallbladder wall.

Comparative analysis with the prototype shows that the proposed method of treatment differs from the known one in that a non-steroidal anti-inflammatory drug is prescribed, for example, celebrex 100 mg 2 times a day for 3-5 days, which meets the criterion of “novelty”.

A new set of features allows to reduce the treatment time and to extend the remission of the disease, and also allows to provide a pathogenetic effect on the inflammatory process of the gallbladder wall, which meets the criterion of “industrial applicability”.

The method is as follows.

Before and after treatment, all patients undergo laboratory blood tests, as well as ultrasound of the abdominal organs, dynamic gamma scintigraphy of the liver and gall bladder, as well as FGDS. Celebrex is prescribed 100 mg 2 times a day. The course of treatment is 3-5 days. The pain syndrome stops for 3-4 days. Against the background of celebrex treatment, other drugs are not prescribed.

The proposed method was treated 10 patients with exacerbation of chronic cholecystitis. The average age of patients is 49.6 ± 4.4 years. Everyone was prescribed celebrex 100 mg 2 times a day for 5 days. The pain syndrome was stopped on average in 4.1 ± 0.2 days. Remission of the disease was up to 1-2 years.

For comparison, 6 patients with exacerbation of chronic cholecystitis were treated with antibiotics and choleretic drugs. Doxicillin 200 mg was prescribed on the first day and 100 mg on the following days for 2 weeks and nicodine 0.5 g 3-4 times a day for 3 weeks. The pain syndrome was stopped on average by 10.2 ± 0.5 days. The duration of remission has not changed.

The proposed method is illustrated by the following clinical examples.

Example 1. Patient S., 65 years old. Complaints of pain in the right hypochondrium of a aching character, which are aggravated by errors in the diet, nausea. Objectively: the tongue is dry, coated with a white coating. The abdomen is soft, painful at the point of the gallbladder, the symptoms of Kera, Vasilenko are positive. General blood test: red blood cells - 5.2 × 10 ¹² / l; HB - 163.0 g / l; color item - 1.1; ESR - 16 mm per hour; leukocyte formula: leukocytes - 4.4 × 10 ⁹ / l; stab neutrophils - 1%, segmented - 67%, eosinophils - 3%, monocytes - 4%, lymphocytes - 25%. Blood biochemistry: cholesterol - 4.4 mmol / l, bilirubin - 12.6 μmol / l, indirect bilirubin - no, ALT - 0.16 μmol / (h / ml), AST - 0.26 μmol / (h / ml ), thymol test - 3.5 units. Ultrasound of the abdominal organs: liver of normal size, smooth contours, homogeneous structure. The gall bladder is 76 × 36 mm, is deformed by two incomplete constrictions in the lower third of the body and in the neck, the contents are uniform, without reflective inclusions. Wall - 4 mm, uneven. Hepaticholedoch - 5 mm. The portal vein is 11 mm in diameter, the blood flow through it is correctly directed, it is associated with breathing: V blood flow cf. - 40.6 cm / sec, total blood flow V - 2103 ml / min. The pancreas with smooth contours, moderately increased echogenicity, head - 21 mm, body - 17 mm, tail is not visualized due to artifacts. Conclusion: Chronic cholecystitis. Deformed gall bladder. Moderate diffuse changes in the pancreas.

Dynamic gamma scintigraphy of the liver and gallbladder with Tc: moderate violations of the absorption and excretory function of the liver, disabled gall bladder.

FGDS: superficial gastroduodenitis. Distal reflux esophagitis 1 degree. Gatekeeper insufficiency.

Against the background of treatment with celebrex, the pain was stopped after 4 days. Objectively: the tongue is moist, coated with a white coating at the root. The abdomen is soft, painless on palpation. Symptoms of Kera, Vasilenko, Ortner are negative. In the general analysis of blood ESR - 12 mm per hour. On the control ultrasound, the wall of the gallbladder is 3 mm, sealed. On the control dynamic gamma scintigraphy of the liver and gallbladder: signs of hypomotor dyskinesia of the gallbladder. Within 2 years of observation of the patient exacerbation of the disease was not observed.

Example 2. Patient X., 24 years old. Complained of pain in the right hypochondrium stitching and aching in nature, which intensifies after ingestion of fatty foods, bitterness in the mouth. Objectively: the tongue is dry, covered with a white-yellow coating. The abdomen is soft, painful on palpation at the point of Roger, the symptoms of Kera, Ortner, Vasilenko are positive. Complete blood count: er. - 3.8 × 10 ¹² / l; HB - 124 g / l, color - 0.98; ESR - 18 mm per hour, leukocyte formula: l. - 5.3 × 10 ⁹ / l; stab neutrophils - 2%, segmented - 48%, eosinophils - 2%, monocytes - 4%, lymphonites - 44%. Blood biochemistry: cholesterol - 4.2 mmol / l, bilirubin - 14.8 mmol / l; indirect bilirubin - no, ALT - 0.30 μmol / (h / ml); AST - 0.62 μmol / (h / ml), thymol sample - 0.7 units.

Ultrasound of the abdominal organs: liver of normal sizes, smooth contours, homogeneous structure. The gall bladder is 45 × 23 mm, the contents are not uniform enough, in the lumen there is a minimal level of sedimentary structures along the lower wall, mainly in the neck region. Wall - 4 mm, sealed. Hepaticholedoch - 5 mm. The portal vein is 9 mm in diameter, the blood flow in it is associated with breathing, it is correctly directed: V blood flow cf. - 19.0 cm / sec, V blood flow about. - 648 ml / min. The pancreas with smooth contours, normal echogenicity, the structure is homogeneous. Head - 20 mm, body - 14 mm, tail - 15 mm. Conclusion: Chronic cholecystitis.

Dynamic gamma scintigraphy of the liver and gallbladder with Tc: signs of hypomotor dyskinesia of the gallbladder.

FGDS: superficial widespread gastritis.

Against the background of treatment with celebrex, the pain was stopped after 3 days. Objectively: the tongue is moist, lined with a slight white coating at the root. The abdomen is soft, painless on palpation. Symptoms of Kera, Vasilenko, Ortner are negative. In the general analysis of blood ESR - 14 mm per hour. On the control ultrasound, the gallbladder wall is 2.7 mm, uneven. On the control dynamic GHA of the liver and gallbladder: signs of hypomotor dyskinesia of the gallbladder. Within 1 year of observation of the patient exacerbation of the disease was not noted.

Claims (1)

A method of treating exacerbation of chronic non-calculous cholecystitis, characterized in that a selective cyclooxygenase-2 Celebrex inhibitor (celecoxib) is administered as a medicine at 100 mg 2 times a day for 3-5 days.