RU2449787C1 - Method of treating erosions and ulcers of gastric mucosa - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and aims at treating erosions and ulcers of gastric mucosa. Esomeprazole 20 mg is prescribed once a day before meals. It is added with prescribing a mixture of lyophilised culture Lactobacterium plantarum 8P -A3 4×10⁹ in 1 ml of suspension and almagel in ratio 1:1. The mixture is prepared before use. The dose is 25 ml 3 times a day 30-40 minutes after meal. The course is 21 days.

EFFECT: method provides epithelised defects, reduced inflammations and dystrophic changes of the mucosa.

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Description

The invention relates to medicine, namely to gastroenterology, and can be used to treat acute erosion and stomach ulcers.

Currently, one of the most significant pathogenetic factors for erosive and ulcerative lesions of the gastric mucosa is the microbial flora (V. V. Chernin, Diseases of the esophagus, stomach and duodenum: a guide for doctors / V.V. Chernin // M .: OOO “ Medical Information Agency ”, 2010. - 528 p.). A known method of treating erosive and ulcerative lesions of the gastric mucosa using a combination of antisecretory and antibacterial drugs, the most effective of which can be considered a "triple" scheme: de-nol + amoxicillin + metronidazole in combination with a proton pump blocker for 2-3 weeks. Epithelization of erosion and ulcers after the course of treatment was determined in 90% of the examined, a decrease in gastritis activity from II-III to I degree in 85% (Zimmerman Y.S. Comparative evaluation of the eradication and morphological effectiveness of alternative triple antibiotic therapy regimens for Nr - associated gastroduodenal diseases / I .S. Zimmerman, G.G. Freind, V.E. Vedernikov, M.R. Zinnatulin II Russian gastroenterol. Journal - 1998. - No. 4. - P.70-71).

The disadvantages of the method are: a significant number of contraindications for the appointment of drugs (more than 20% of the examined); high toxicity of all components; development or aggravation of intestinal dysbiosis; the high cost of drugs (an average of more than 4 thousand rubles for a course of treatment).

Effect: increasing the effectiveness of the method, reducing contraindications.

The result is achieved by using a combination of an esomeprazole proton pump inhibitor with a lyophilized form of the antagonistically active culture of Lactobacterium plantarum 8P-A3 (FSP 42 - 0504729805) mixed with 1: 1 almagel, which has enveloping properties.

The novelty of the method lies in the combined use of esomeprazole (an antisecretory drug) and an antagonistically active culture of Lactobacterium plantarum 8P-A3 mixed with almagel (enveloping preparation).

The method is as follows:

After a reliable diagnosis of erosive or ulcerative lesions of the gastric mucosa (clinical, endoscopic and histological studies) is established, the patient receives esomeprazole 20 mg before meals, and then during the day a mixture of lyophilized culture Lacto bacterium plantarum 8P-A3 (4 × 10 ⁹ ) prepared before use in 1 ml of suspension) with almagel in a ratio of 1: 1 in the amount of 25 ml 3 times a day 30-40 minutes after a moderate meal. The course of treatment is 21 days. The effectiveness of treatment is assessed using clinical, endoscopic and histological studies.

The method is illustrated by the following clinical examples:

1. Patient Sh., 73 years old. The main diagnosis: Chronic gastroduodenitis (erosive antrum - gastritis, erosive bulbitis), in the acute phase. Concomitant diagnosis: Chronic secondary pancreatitis, moderate, with dyspeptic syndrome, stage of exacerbation.

Complaints upon admission to the hospital for pain in the upper abdomen, aching in nature, occurring both on an empty stomach and after eating after 1 hour, belching, bloating.

From the anamnesis it is known that periodic pain in the upper abdomen disturbed the patient for two years. Not surveyed. Deterioration of health two weeks ago, when there were constant aching pains in the upper abdomen. I did not receive treatment.

Hospitalized in hospital.

The following therapy was carried out: esomeprazole 20 mg in the morning 30 minutes before a meal and a mixture of a resuspended culture of Lactobacterium plantarum 8P-A3 (4 × 10 ⁹ in 1 ml of suspension) with almagel in a ratio of 1: 1, 25 ml 3 times a day every 30 minutes after eating for 21 days.

Against the background of the therapy, the pain abdominal syndrome disappeared on the 5th day, dyspeptic syndrome - on the 7th day.

The dynamics of instrumental examination and analysis are shown in table 1.

FGDS at admission FGDS after treatment Entrance to the esophagus is free, its mucosa is practically unchanged, the cardiac pulp closes. The mucous membrane of the antrum is thickened, swollen, hyperemic, there are multiple small (2-3 mm) surface defects, with a corolla of hyperemia, covered with fibrin. Forceps biopsy. Pyloric pulp closes. The mucous membrane of the duodenal bulb is pale pink, swollen, there are several small (2-3 mm) surface defects, with a corolla of hyperemia, covered with fibrin. Entrance to the esophagus is free, its mucosa is not changed, the cardiac pulp closes. The mucous membrane of the stomach is pale pink, clean, folds are not thickened, there is no secret in the lumen. Pyloric pulp closes. The duodenal mucosa of the duodenum is gray-pink, clean, folds are smoothed by air. Conclusion: Pathology was not detected. Conclusion: Erosive antrum - gastritis, erosive bulbitis. Histological examination of the biopsy sample upon admission Histological examination of the biopsy specimen after treatment Severe edema, dystrophic changes in the integumentary epithelium, sometimes with signs of desquamation. No foci of destruction and desquamation of the epithelium were detected, dystrophy of the epithelial cells is absent. Minimal focal lymphohistiocytic infiltration is maintained.

2. Patient B., 46 years old. The main diagnosis: Chronic gastroduodenitis (erosive antrum - gastritis, bulbitis), exacerbation phase. Concomitant diagnosis: Chronic secondary pancreatitis, moderate, with dyspeptic syndrome, stage of exacerbation. Chronic cholecystitis, stage of exacerbation.

Complaints upon admission to the hospital for pains of a burning character in the epigastric region that arise between meals, radiating to the left hypochondrium, belching air, nausea in the morning, periodic bloating and increased gas formation.

From the anamnesis of the disease it is known that two weeks ago I began to notice the appearance of burning pains in the epigastric region, arising on an empty stomach, nausea, belching with air. I did not receive treatment. Hospitalized in a hospital.

The following therapy was carried out: esomeprazole 20 mg in the morning 30 minutes before a meal and a mixture of a resuspended culture of Lactobacterium plantarum 8P-A3 (4 × 10 ⁹ in 1 ml of suspension) with almagel in a 1: 1 ratio of 25 ml 3 times a day after 40 minutes after eating for 21 days.

Against the background of the therapy, the pain abdominal syndrome disappeared on the 5th day, dyspeptic syndrome - on the 6th day.

The dynamics of instrumental examination and analysis are shown in table 2.

FGDS at admission FGDS after treatment The esophagus passes, the cardia closes. There is a small amount of clear secretion in the stomach. The folds are longitudinal, the mucosa of the proximal part of the stomach is practically unchanged. In the antrum, there is bright hyperemia and swelling of the mucosa, there are at least a dozen erosions - papules with hematin and fibrinous deposits. The gatekeeper closes. The duodenum is passable, the mucous membrane of the bulb is moderately swollen and hyperemic, in some places there are fibrin patches on the folds. At the control examination - positive dynamics. Mucosal defects were completely epithelized. The mucous membrane of the antrum of the stomach with areas of hyperemia and atrophy. Focal hyperemia of the duodenal mucosa of the duodenum. Bookmark: Chronic focal antrum - gastritis, superficial bulbitis. Zakl .: Erosive antrum - gastritis, bulbitis. Histological examination of the biopsy sample upon admission Histological examination of the biopsy specimen after treatment The biopsy specimen of the mucous membrane contains small superficial defects, mainly without fibrin, in isolated areas fibrin. In the stroma - edema and plethora of blood vessels, moderate infiltration by lymphocytes, macrophages by neutrophilic granulocytes. Manifestations of gastritis activity decreased. The structure of the mucous membrane is not broken; distinct picture of cushions and pits. Epithelium with signs of regenerative activity - large nuclei located basally. There are no dystrophic changes. Mucus formation is pronounced. Vessels without signs of plethora. Lympho-histiocytic infiltration without the presence of neutrophils is moderate. Conclusion: Acute erosion, chronic gastritis with moderate activity.

3. Patient G., 71 years old. The diagnosis of the main: Acute ulcer of the antrum, erosive gastritis. Concomitant diagnosis: Diverticulum of the esophagus.

Complaints at admission to the hospital for high-intensity pains in the epigastric region that occur 15 minutes after eating, nausea, heartburn after eating.

From the anamnesis it is known that suffers from chronic gastritis for several years, exacerbation 1 time per year. Deterioration of well-being within 1 week, when there were pains in the epigastric region, heartburn, nausea. I did not receive treatment. Hospitalized in a hospital.

The following therapy was carried out: esomeprazole 20 mg in the morning 30 minutes before a meal and a mixture of a resuspended culture of Lactobacterium plantarum 8P-A3 (4 × 10 ⁹ in 1 ml of suspension) with almagel in a ratio of 1: 1 in an amount of 25 ml 3 times a day every 30 minutes after eating for 21 days.

Against the background of the therapy, the pain abdominal syndrome was stopped on the 6th day, dyspeptic syndrome - on the 6th day.

The dynamics of instrumental examination and analysis are shown in table 3.

FGDS at admission FGDS after treatment We pass the esophagus, at the level of 35 cm in the right semicircle there are large Entrance to the esophagus is free, its mucosa is practically unchanged, on the right

sizes (2-2.5 cm) diverticulum, with a wide neck, without diverticulitis. The cardia closes. There is a small amount of unclear secretion in the stomach. The folds are longitudinal. Mucous with areas of bright hyperemia, in the antrum there are many surface defects, 2-3 mm in size, covered with fibrin. According to the lesser curvature of the antrum, there is a deeper defect, 5 mm in diameter, with fuzzy edges and pronounced perifocal inflammation. The gatekeeper closes. KDP is passable, the mucosa of the bulb without visible pathology. semicircle in the abdominal region there is a true diverticulum, 2 cm, without signs of inflammation. Cardiac pulp closes. The mucous membrane of the stomach is pink, somewhat swollen, the folds are not thickened, there is no secret in the lumen. Pyloric pulp and bulb of the duodenum are not changed. Conclusion: Superficial gastritis (minimal manifestations), diverticulum of the esophagus. Conclusion: Antrum ulcer, erosive antrum - gastritis, diverticulum of the esophagus. Histological examination of the biopsy sample upon admission Histological examination of the biopsy specimen after treatment The material from the bottom of the ulcer defect contains a focus of fibrinoid necrosis and a fragment of necrosis with leukocyte-macrophage infiltration. There is a plot of the mucous membrane with severe dystrophic changes. H.pylori +++ There are no sites of fibrinoid necrosis from the ulcer defect, no erosion. The activity of chronic gastritis decreased, there were no dystrophic changes in the integumentary-fossa epithelium, the nuclei were located basally, mucus formation was restored. H. pylori not detected.

The described method was used to treat erosive gastritis in 19 and acute stomach ulcers in 7 patients (ICD-10 code - K 25.3). Erosions in all our patients were visualized in the form of superficial mucosal defects, from 1 to 5 mm, covered with fibrin or a dark blood clot, which was confirmed by histological examination, which also showed the presence of moderate or severe gastritis. Peptic ulcers were visualized in the form of round or irregular shape of the surface or medium depth of defects, from 5 to 8 mm, covered with dense detritus. Histological examination determined the foci of fibrinoid necrosis, leukocyte and macrophage infiltration, as well as signs of moderate to severe gastritis. Patients did not receive treatment before admission to the hospital.

As a result of the treatment, from 3-6 days the clinical signs of the disease disappeared, after the end of the course of treatment, all patients showed complete epithelization of defects, a decrease in the signs of gastritis activity. There are no contraindications to the prescription of drugs. The cost of treatment averaged 1800 rubles.

Claims (1)

A method of treating erosive and ulcerative lesions of the gastric mucosa by using a proton pump inhibitor, characterized in that the patient is prescribed esomeprazole at a dose of 20 mg per day as a proton pump inhibitor before meals in combination with a mixture of lyophilized culture Lactobacterium plantamm 8P-A3 prepared before use at a dose of 4 × 10 ⁹ in 1 ml of suspension and almagel in a ratio of 1: 1, in an amount of 25 ml 3 times a day 30-40 minutes after eating, course 21 days.