RU2477633C2 - Method of treating secondary lactase deficiency - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly gastroenterology, and may be applied in treating secondary lactase deficiency. For this purpose, with underlying diet and drug-induced therapy, bifiform 1 tablet 2-3 times a day and No-spa 1-2 tablets 3 times a day are additionally administered. The therapeutic course makes 14 days.

EFFECT: method enables higher clinical effectiveness in secondary lactase deficiency.

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Description

The invention relates to medicine, and can be used in the treatment of secondary lactase deficiency.

A known method of treating lactase deficiency using enzymes in the background of diet therapy (1 - A.I. Chubarova, V.P. Geraskina., M.V. Kyshtymov and others. The effectiveness of enzyme therapy and diet therapy for lactase deficiency in newborns. Questions of child nutrition, 2003, vol. 1, No. 4, 21-25). The method adopted as an analogue.

A known method of treating lactase deficiency, which consists in the fact that the treatment was carried out by prescribing the drug Lactase Enzyme in a dose of 7 mg (700 units). (1 capsule of infant form) for every 100 ml of expressed breast milk (or 350 units per 50 ml); the drug interfered with milk at each feeding (2 - A.I. Chubarova, N.V. Stepanova. Use of the drug Lactase Baby for the treatment of lactase deficiency in newborns. Found: Google http://www.lactase.ru/publications/using- lactase-baby.html). This method is adopted as a prototype.

However, the effectiveness of the prototype method is limited.

The aim of the present invention is to increase the effectiveness of the treatment of secondary lactase deficiency.

The technical result is achieved by the fact that in the treatment regimen of patients with secondary lactase deficiency, 1 table is added as a daily dose of bifiform. 2-3 times and no-spa - 1-2 tablets. 3 times a course of treatment for 14 days.

The method is implemented as follows.

Patients with a diagnosis of secondary lactase deficiency come with complaints of bloating, rumbling, periodic aching pains in the abdomen, moderate intensity, without irradiation, not associated with eating; constipation up to 2-4 days, which are regulated by diet. The chair is decorated, not plentiful without admixture of mucus and blood. Appetite saved. Weight is stable.

From the anamnesis it is known that patients suffer from epigastric pain after eating for a long time, spring / autumn exacerbations were noted.

Objectively: satisfactory condition, blood pressure 110-130 / 70-90 mm RT. Art. Heart rate 60-80 per min. BH 16-18 in a minute. Heart sounds are muffled, the rhythm is correct. There are no wheezing in the lungs, vesicular breathing. The tongue is wet, coated with a white coating. The abdomen is soft, moderately painful in the umbilical region. Survey Results:

ECG: semi-vertical position of the EOS. Sinus rhythm, correct. Weakly expressed diffuse changes in the myocardium.

EGDS: We pass the esophagus. The mucous membrane of the esophagus is pink, the cardia closes. In the cavity of the stomach, a moderate amount of mucous contents; pink mucosa, moderately thinned. The folds are medium sized, elastic. Peristalsis can be traced in all departments. The angle of the stomach is not changed. The gatekeeper will close, we pass. The duodenal bulb is medium in size, not deformed. The mucous membrane of the duodenal bulb and the mucosa of the postbulbar section are pink. The folds are medium sized, elastic. The jejunum is b / o. The urease test is negative. The lactase test is positive.

Biopsy: fragments of the mucous membrane of the duodenum from the proximal sections: in the submucosal layer Brunner's glands, intestinal villi of normal height, crypts are shallow. The number of MEL is within normal limits. In their own plate there is a small lymphoplasmocytic infiltration. The mucous membrane of the duodenum of the usual structure.

According to the respiratory hydrogen test, excessive bacterial growth was detected.

Ultrasound of the abdominal cavity: The liver protrudes from under the edge of the costal arch. The edge is smoothed, the surface is flat, the outline is clear, the capsule is not thickened. The size of the liver is not increased. The structure is homogeneous. The total echogenicity of the parenchyma is average. The diameter of the portal vein and inferior vena cava is normal, the lumen is uniform. Vascular pattern saved. The gall bladder is irregular in shape, dimensions are not enlarged. The walls of the bubble are thin, even, of a homogeneous structure. In the cavity of the bubble, homogeneous content is determined, there are no calculi. Intrahepatic ducts are not dilated, the walls are smooth, segmental and lobar not significantly expanded, the lumen is homogeneous. The common bile duct is not expanded, the walls are even, the lumen is uniform. The pancreas is visualized satisfactorily, the contour is fuzzy, the surface is even. The structure is homogeneous, average echogenicity. Pancreatic duct is not expanded, the walls are sealed. Volumetric formations are not identified. The spleen is adequately visualized, the contour is clear, the surface is even. There is no free fluid in the abdominal cavity. Conclusion: gallbladder deformity.

Sigmoidoscopy: with external examination, finger examination, anoscopy - internal hemorrhoidal nodes are not expressed. The sphincter tone is saved. The rectoscope tube was inserted 25 cm. The mucous pink, smooth, shiny. The vascular pattern is distinct. No ulcers, polyps, tumors were detected. Conclusion: no organic pathology was detected.

Endocrinologist consultation: goiter of the thyroid gland 1 tbsp. Euthyroidism.

EMA GIT: hypermotor dyskinesia of the stomach, hypomotor dyskinesia of the ascending colon.

Hydrogen Breath Test with Lactulose (Dufalac): Excessive bacterial growth is periodically detected.

Secondary lactase deficiency was treated, including a lactose-free diet. As medications used daily as a daily dose of mezim forte 1 table. × 2-3 times, bifiform 1 table. 2-3 times and no-spa - 1-2 tablets. 3 times a course of treatment for 14 days.

After the treatment, bloating, rumbling, pain in the umbilical region disappeared. The chair returned to normal.

During follow-up observation for 1 year, spring-autumn exacerbations are not observed.

The implementation method is further illustrated by the following examples.

Example 1

Patient S., born in 1983, was admitted with complaints of periodic aching pains in the umbilical region, moderate intensity, without irradiation, not associated with eating, bloating, rumbling in the stomach; constipation up to 4 days is regulated by a diet (prunes, dried apricots), decorated, mild, in the afternoon, without an admixture of mucus and blood. Appetite saved. Weight is stable.

From the anamnesis: considers herself a patient from 10 years old, when aching pain in the epigastrium first appeared after eating, was observed by a gastroenterologist with a diagnosis of chronic gastroduodenitis, exacerbations of spring / autumn were noted. I followed a diet, took antacids with a positive effect. 3 years ago constipation occurred up to 4 days. Not examined, not treated. Recently, the patient appeared periodic aching pain in the umbilical region. She took trimedate with a slightly positive effect.

Objectively: satisfactory condition, blood pressure 110/70 mm RT. Art. Heart rate 78 per minute. BH 18 in minutes Heart sounds are muffled, the rhythm is correct. There are no wheezing in the lungs, vesicular breathing. The tongue is wet, coated with a white coating. The abdomen is soft, moderately painful in the umbilical region. There was no chair. Survey Results:

ECG: semi-vertical position of the EOS. Sinus rhythm, correct. Weakly expressed diffuse changes in the myocardium.

EGDS: We pass the esophagus. The mucous membrane of the esophagus is pink, the cardia closes. Stomach: a moderate amount of mucous contents in the stomach cavity. The gastric mucosa is pink, moderately thinned. The folds are medium sized, elastic. Peristalsis can be traced in all departments. The angle of the stomach is not changed. The gatekeeper will close, we pass. The duodenal bulb is medium in size, not deformed. The mucous membrane of the duodenal bulb and the mucosa of the postbulbar section are pink. The folds are medium sized, elastic. The urease test is negative. Conclusion: chronic gastritis. Lactase test is slightly positive.

Biopsy: fragments of the mucous membrane of the duodenum from the proximal sections - in the submucosal layer of the Brunner gland. Intestinal villi of normal height. Crypts are shallow. The number of MEL is within normal limits. In their own plate there is a small lymphoplasmocytic infiltration. Conclusion: the mucous membrane of the duodenum of the usual structure.

Respiratory hydrogen test - excessive bacterial growth (91 ppm) was detected.

Ultrasound of the abdominal cavity: In orthostasis, prolapse of the abdominal cavity is recorded. Liver: rendered adequately; protrudes from the edge of the costal arch. The edge is smoothed, the surface is flat, the outline is clear, the capsule is not thickened. The size of the liver is not increased (PZR of the right lobe 125 mm, thickness of the left lobe 58 mm). The structure is homogeneous. The total echogenicity of the parenchyma is average. The diameter of the portal vein is 9 mm; the diameter of the IVC is 17 mm; uniform clearance. Vascular pattern saved. Gall bladder: irregularly shaped. Dimensions not enlarged: 53 × 17 × 27 mm, volume 17 ml. The walls of the bubble are thin, even, of a homogeneous structure. In the cavity of the bubble, homogeneous contents are determined, there are no calculi. In the lower third of the body closer to the neck there is a parietal echogenic formation measuring 6.2 × 2.9 mm, of a homogeneous structure, avascular when scanning in the CDC mode. Intrahepatic ducts are not dilated, the walls are smooth, segmental and lobar not significantly expanded, the lumen is homogeneous. The common bile duct is not expanded (3.5 mm), the walls are even, the lumen is uniform. The pancreas is visualized satisfactorily, the contour is fuzzy, the surface is even. Dimensions: 19 × 15 × 17 mm. The structure is homogeneous, average echogenicity. Pancreatic duct is not expanded, the walls are sealed. Volumetric formations are not identified. The spleen is adequately visualized, the contour is clear, the surface is even. Dimensions: 94 × 39 mm. Echogenicity of the parenchyma is increased, the structure is homogeneous. The splenic vein with a diameter of 6 mm, the lumen is uniform. There is no free fluid in the abdominal cavity. Conclusion: ultrasound signs of visceroptosis, deformation of the gallbladder, polyp of the gallbladder.

With sigmoidoscopy, internal hemorrhoidal nodes are not expressed. The sphincter tone is saved. The tube of a rectoscope is introduced 25 cm - further bending, soreness. Mucous pink, smooth, shiny. The vascular pattern is distinct. No ulcers, polyps, tumors were detected. Conclusion: no organic pathology was detected. Gynecologist consultation: cancel oral contraceptives, endocrinologist consultation. Endocrinologist consultation: Thyroid goiter 1 tbsp. Euthyroidism.

EMA GIT: hypermotor dyskinesia of the stomach, hypomotor dyskinesia of the ascending colon.

Physiotherapist consultation: circular shower No. 5, obverse lamp No. 5. Colonoscopy: the apparatus was performed in the dome of the cecum. The Bauginieva damper is polypous in shape, closed, oriented to the dome. There is a moderate amount of fluid in the lumen. Loops of the colon omitted, convoluted. The sigmoid colon forms a loop. The mucous membrane of the colon in the examined areas is pink, smooth, shiny. The vascular pattern is distinct, correct. Folds of the mucous membrane of medium size, elastic. Gut lumen is not deformed. The bowel tone is reduced. No ulcers, polyps, tumors were detected. Conclusion: in the examined areas of organic pathology from the colon was not detected.

Final diagnosis: Chronic gastritis, in the stage of subsiding exacerbation. Excessive bacterial growth syndrome. Lactase deficiency of moderate severity. Visceroptosis Gallbladder cholesterosis, polypoid form. Thyroid goiter 1 tbsp. Euthyroidism.

Laboratory data:

General blood analysis:

Indicator Norm Indicator Norm Hemoglobin 13,2 fourteen P / Nuclear one 1-6 Red blood cells 4.49 3.9-4.7 Segment. 58 47-72 Hematocrit 39.8 39-50 Eosinophils 2 0-5 White blood cells 7.3 4-9 Lymphocytes 33 19-37 Platelets 370 150-400 Monocytes 6 3-11 ESR 8 3-15

Blood chemistry:

Indicator 11/24/10 12/13/10 Norm About. protein 73,4 66-87 Bilirubin commonly. 14.8 3.4-21 Bilirubin Ave. 2.7 Cholesterol 7.27 6.91 1.4-5.2 Triglycerides 1.7 0-1.7 HS-LDL 4.1 2.1-3.3 Glucose 4.46 4.1-5.9 Urea 4,58 1.7-8.3 Iron 32.1 10.7-32.2 Mho 0.98 0.9-1.2 Prothrombin one hundred 70-130 Indicator Result date of HIV neg. 11/29/10 Rw neg. 11/29/10

A blood test - HBs-Ag and anti-HCV - were not detected. Clinical urine analysis - transparent, protein neg., Beats / weight 1019, white blood cells, red blood cells, ketones, glucose - no. Analysis of feces reaction to occult blood - neg.

Treatment. Lactose-free diet. Add as a daily dose of mezim forte 1 table. × 2 times, bifiform 1 table. 2 times and no-spa - 1 tab. 3 times a course of treatment within 14 days.,

The patient underwent physiotherapeutic treatment: Averm lamp No. 5, circulatory shower No. 5. Against the background of the therapy, the patient notes an improvement in her condition: reduction of abdominal pain, normalization of stool to 1 time per day, designed without pathological impurities. It works, has no disability. The prognosis of the disease is favorable. During follow-up observation for 1 year, spring-autumn exacerbations are not observed.

Example 2

Patient J., born in 1985, was admitted with complaints of periodic aching pains in the umbilical region, moderate intensity, aggravated before the act of defecation, stopped after the act of defecation, bloating, rumbling in the abdomen, flatulence; occasionally burping air. The stool is mushy, up to 3-4 times a day, in the daytime not abundant, without impurities of mucus and blood. Appetite reduced, lost weight over the past 4 months. 5 kg.

An anamnesis of this disease: considers himself sick for 1 year, when, against the background of stress, frequent gruel-like stools appeared up to 3 times a day, periodic aching pains in the abdomen, mainly in the umbilical region. He took enzymes with a positive effect. Not surveyed. There were pulling pains in the umbilical region, mainly in the right half of the abdomen, nausea, in connection with which he was hospitalized for ambulance.

Ultrasound of the abdominal organs showed no signs of digestive tract pathology. Colonoscopy did not reveal any organic pathology of the colon. In the general analysis of blood leukocytes 9 (the upper limit of the norm), in the blood test - without pathological changes. Spasmolytic therapy with a positive effect was carried out, the use of creon was recommended, and a gastroenterologist observed in m / residency. However, the patient had abdominal pain, the stool was 3-4 times a day, mushy, without an admixture of mucus and blood.

Received for examination and treatment. Objectively upon admission: satisfactory condition, blood pressure 120/70 mm RT. Art. Heart rate 70 min. BH 18 in minutes Heart sounds are muffled, the rhythm is correct. There are no wheezing in the lungs, vesicular breathing. The tongue is wet, coated with a white coating. The abdomen is soft, moderately painful on palpation in the umbilical and left iliac region. The stool was once a day, half-formed, without any admixture of mucus and blood.

Survey Results:

ECG: semi-vertical position of the EOS. Heart rate 67. Sinus rhythm, correct.

EGDS: We pass the esophagus. The mucous membrane of the esophagus is pink, the cardia closes. Stomach: a moderate amount of mucous contents and bile in the stomach cavity. The mucous membrane of the stomach is pink, hyperemic along the tops of the folds. The folds are medium sized, elastic. Peristalsis can be traced in all departments. The angle of the stomach is not changed. The gatekeeper is yawning. The duodenal bulb is medium in size, not deformed. Pink duodenal mucosa. The folds are medium sized, elastic. The jejunum is b / o. The urease test is negative. The lactase test is positive. Conclusion: superficial gastritis, duodeno-gastric reflux.

Biopsy: chronic mild duodenitis. There are no signs of celiac disease in the test material.

Hydrogen Breath Test with Lactulose (Dufalac): Excessive bacterial growth has been identified.

Sigmoidoscopy: with external examination, finger examination, anoscopy, internal hemorrhoidal nodes are not expressed. The sphincter tone is saved. The rectoscope tube was inserted 20 cm - further bending, soreness. Mucous pink, smooth, shiny. The vascular pattern is distinct. No ulcers, polyps, tumors were detected. Conclusion: no organic pathology was detected.

Ultrasound of the abdominal organs: Liver: rendered adequately; does not protrude from the edge of the costal arch. The edge is smoothed, the surface is flat, the outline is clear, the capsule is not thickened. The size of the liver is not increased (PZR of the right lobe 140 mm, thickness of the left lobe 76 mm). The structure is homogeneous. The total echogenicity of the parenchyma is average. The diameter of the portal vein is 10 mm, the diameter of the IVC is 19 mm; uniform clearance. Vascular pattern saved. Gall bladder: regular shape. Dimensions not enlarged: 60 × 23 × 35 mm, volume 30 ml. The walls of the bubble are thin. In the cavity of the bubble, homogeneous content is determined, there are no calculi. Intrahepatic, segmental and lobar are not expanded, the walls are even, the lumen is uniform. The common bile duct is not dilated (5.0 mm), the walls are even, the lumen is uniform. The pancreas is visualized satisfactorily, the surface is flat. Dimensions: 24 × 16 × 22 mm. The structure is homogeneous, fine-grained. General echogenicity is average. Pancreatic duct is not expanded. Volumetric formations are not identified. The spleen is adequately visualized, the contour is clear, the surface is even. Dimensions: 94 × 40 mm. Echogenicity of the parenchyma is average, the structure is homogeneous. The splenic vein with a diameter of 6 mm, the lumen is uniform. There is no free fluid in the abdominal cavity. Right kidney: in orthostasis, nephroptosis of 1 tbsp is recorded. Dimensions 101 × 49 mm, the cortical layer is diffusely uniform, of uniform thickness (14 mm). HRS extension not registered. There are no calculi. Respiratory mobility is maintained. Left kidney: typical location. Dimensions 100 × 52 mm, cortical layer of a homogeneous structure, up to 15 mm thick. CLS is not expanded, the pelvis is extrarenal. There are no calculi. Respiratory mobility is maintained. Conclusion: right-sided nephroptosis 1 tbsp.

Colonoscopy: the apparatus was carried out in the ileum by 20 cm. The mucosa of the small intestine is pink, velvety, its active motility. Single hypertrophic lymphoid follicles up to 0.2 cm in diameter are determined. The Bauginieva damper is polypous in shape, closed, oriented to the dome. There is a moderate amount of fluid in the lumen. The sigmoid colon forms a loop. The mucous membrane of the colon in the examined areas is pink, smooth, shiny. The vascular pattern is distinct, correct. Folds of the mucous membrane of medium size, elastic. Gut lumen is not deformed. Intestine tone saved. No ulcers, polyps, tumors were detected. Conclusion: no organic pathology from the colon.

Laboratory data:

General blood analysis:

Indicator Norm Indicator Norm Hemoglobin 14.8 17.3 P / Nuclear one 1-6 Red blood cells 4.97 3.9-5.7 Segment. 61 47-72 Hematocrit 43 39-50 Eosinophils 2 0-5 White blood cells 5.8 4-9 Lymphocytes thirty 19-37 Platelets 282 150-400 Monocytes 6 3-11 ESR four 3-15

Blood chemistry:

Indicator Norm About. protein 74.8 66-87 Bilirubin commonly 18.6 3.4-21 Cholesterol 3.79 1.4-5.2 Glucose 4.78 4.1-5.9 Urea 5.21 1.7-8.3 Mho 1,03 0.9-1.2 prothrombin 96.4 70-130 Indicator Result date of HIV neg. 11/18/10 Rw neg. 11/18/10

A blood test - HBs-Ag and anti-HCV - were not detected.

Clinical urine analysis - transparent, protein neg., Beats / weight 1014, white blood cells, red blood cells, ketones, glucose - no. Analysis of feces reaction to occult blood - denied. Diastasis of urine is normal, 311.1 U / L. Treatment: Lactose-free diet. Additionally, mesim forte 1 tablet was used as a daily dose. × 3 times, bifiform 1 tab. 3 times and no-spa - 2 tablets. 3 times a course of treatment for 14 days.

Against the background of the therapy, the patient notes an improvement in his condition: the abdominal pains were stopped, the stool returned to normal 1 time per day, shaped, not abundant, without pathological impurities. The prognosis of the disease is favorable.

Example 3

Patient K., born in 1960, complaints upon receipt of periodic aching pains in the umbilical region, not associated with eating, aggravated after lifting weights, aggravated before defecation, decreasing after the act of defecation, pain is disturbed in the daytime and at night; periodic burning pains in the epigastrium that occur after eating after 15-20 minutes, burning of the tongue and palate after eating after 15-20 minutes, periodically bitterness in the mouth, heartburn after eating; bloating and rumbling in the stomach; diarrhea up to 2 times a day, stools are mushy, brown, not plentiful, with a greasy sheen, without any admixture of mucus and blood. Notes intolerance to dairy and sour-milk products. Appetite saved. Weight is stable.

An anamnesis of this disease: considers himself ill since 2008, when the first aching pain in the left hypochondrium, burning of the palate and tongue, a mushy stool appeared up to 2 times a day. He began to note intolerance to dairy products. Outpatients with endoscopy revealed signs of cardia failure, erosive gastritis. Ultrasound of the abdominal cavity - cholesterosis of the gallbladder. He took rabeprazole for 4 weeks with a positive effect. Passed inpatient treatment. With endoscopy - signs of chronic gastritis, cardia failure, urease test is negative. Ultrasound of the abdominal cavity - steatosis of the liver, deformation of the gallbladder, pancreatic lipomatosis. With colonoscopy - dyskinesia of the colon according to the hypermotor type. The treatment was carried out: omeprazole, famotidine, duspatalin, furazolidone, white clay powders with a slightly positive effect. An outpatient examination of the stomach and small intestine revealed cicatricial deformity of the duodenum. Deterioration since February of this year, when heartburn and burning of the palate and tongue intensified, a mushy stool appeared again up to 2 times a day. Consulted, ds: GERD in the stage of reflux esophagitis. Rec-no: taking epicure 1 t. × 2 p. / D. with a slightly positive effect.

Objectively upon admission: satisfactory condition, HELL 115/78 mm RT. Art. Heart rate 70 min. BH 18 in minutes Heart sounds are muffled, the rhythm is correct. There are no wheezing in the lungs, vesicular breathing. The tongue is wet, coated with a white coating. The abdomen is soft, not swollen, moderately painful in the epigastrium and umbilical region. The chair was once a day, decorated, not plentiful, without pathological impurities. Marked extension of the umbilical ring.

Survey Results:

ECG: normal position of EOS. Heart rate 61. Sinus rhythm, correct.

Sigmoidoscopy: during external examination, finger examination, anoscopy - for 12 hours - skin fold - “watchdog”, visualized mucocutaneous defect of the anus, moderately painful on palpation. Defined by rectocele 1-2 tbsp .; internal hemorrhoidal nodes are moderately expressed in typical places; not tense, hypertrophic anal papillae. The sphincter tone is saved. The rectoscope tube was inserted 20 cm due to the presence of feces in the lumen of the usual color. In visible areas, the mucous pink, smooth, shiny, vascular pattern can be traced. At a distance of 15 cm from the anus along the posterior wall, a polyp with a diameter of up to 0.4 cm is visualized on a wide base with an unchanged apex - a biopsy. No other pathology was detected. Conclusion: Chronic anterior anal fissure, in the acute stage. Rectocele 1-2 tbsp. Internal hemorrhoids, remission. Polyp of the rectum. Biopsy: tubular adenoma of the colon.

EMA GIT: hypermotor dyskinesia of the stomach of the common bile duct and the descending part of the colon. Neurologist consultation: Dorsopathy of the cervical spine, glossoalgia.

EGDS: We pass the esophagus. The mucous membrane of the esophagus is pale pink, the cardia does not close, reflux. Stomach: a moderate amount of mucous contents in the stomach cavity. The gastric mucosa is pale pink, hyperemic in the form of stripes in the antrum. Folds are smoothed, elastic. Peristalsis can be traced in all departments. The angle of the stomach is not changed. The gatekeeper will close, we pass. The duodenal bulb is medium in size, moderately deformed. The mucous membrane of the duodenum is pale pink, swollen. The folds are medium sized, elastic. The jejunum is whitish at the tops of the folds. The urease test is negative. Lactase test is slightly positive. Conclusion: chronic gastritis, cardia failure, moderate deformation of the duodenal bulb. Biopsy: chronic mild bulbitis and duodenitis.

Ultrasound OBP: Liver: visualized adequately; does not protrude from the edge of the costal arch. The edge is smoothed, the surface is flat, the outline is clear, the capsule is not thickened. The size of the liver is not increased (PZR of the right lobe 152 mm, thickness of the left lobe 67 mm). The structure is homogeneous. The total echogenicity of the parenchyma is increased, the fat component is expressed. The diameter of the portal vein is 12.0 mm; the diameter of the IVC is 22.0 mm; uniform clearance. The vascular pattern is preserved, not deformed. Gall bladder: regular shape. Dimensions not enlarged: 62 × 29 × 34 mm, volume 33 ml. The walls of the bubble are densified, thickened (up to 3.3 mm), of a homogeneous structure. In the cavity of the bubble, a sludge precipitate (suspension) is determined, there are no calculi. Intrahepatic ducts are not dilated, the lumen is uniform. The common bile duct is not expanded (4.7 mm), the walls are sealed, the lumen is uniform. The pancreas is visualized satisfactorily, the contour is fuzzy, the surface is uneven. Dimensions: 33.0 × 19.2 × 22.7 mm. The structure is heterogeneous, unevenly compacted. General echogenicity is increased. Pancreatic duct is not expanded. The spleen is adequately visualized, the contour is fuzzy, the surface is smooth, the capsule is sealed. Dimensions: 114 × 54 mm. P 40 cm ² . (N47 cm ² ). The structure is heterogeneous (in the middle segment accumulation of calcifications, average density of up to 3.4 mm in diameter is determined), general echogenicity is average. The splenic vein with a diameter of 7.8 mm, the lumen is uniform. There is no free fluid in the abdominal cavity.

Final diagnosis: Secondary lactase deficiency of moderate severity. Chronic gastroduodenitis, not associated with H. pylori, in the stage of subsiding exacerbation. Gastroesophageal reflux disease in the stage of non-erosive reflux esophagitis. Duodenal ulcer, remission. Cicatricial deformity of the duodenal bulb. An emerging umbilical hernia. Liver steatosis. Chronic anterior anal fissure in the stage of subsiding exacerbation. Rectocele 1-2 tbsp., Internal hemorrhoids, remission. Polyp (tubular adenoma) of the rectum. Dorsopathy of the cervical spine, glossoalgia. An increase in the thyroid gland 1 tbsp. euthyroidism.

Ultrasound: liver steatosis, gallbladder cholesterosis, diffuse changes in the pancreas, calcification of the spleen parenchyma. Colonoscopy: the apparatus was performed in the dome of the cecum. Bauginieva damper closed, oriented to the dome. In the right colon there is a moderate amount of liquid contents. When bowel is boiling, severe pain is noted. The mucous membrane of the colon in the examined areas is pink, smooth, shiny. The vascular pattern is smoothed. Folds of the mucous membrane of medium size, elastic. Gut lumen is not deformed. Intestine tone saved. Conclusion: no organic pathology was detected.

Endocrinologist consultation: ds: Thyroid enlargement of 1 st., Euthyroidism. Recommended as an outpatient ultrasound of the thyroid gland, blood test (TSH and T4 svb.). Surgeon consultation ds: tubular adenoma of the colon. Surgical removal of adenoma is recommended. Hydrogen Breath Test with Lactulose (30 ml): Excessive bacterial growth (62 ppm) was detected. EGDS (control): chronic gastritis, cardia failure, moderate deformation of the duodenal bulb. The lactase test is negative. Hydrogen breath test with lactulose (30 ml): no bacterial growth was detected (12 ppm). Laboratory data:

General blood analysis:

Indicator Norm Indicator Norm Hemoglobin 13,2 16 P / Nuclear 2 1-6 Red blood cells 4,58 3.9-5.3 Segment. 54 47-72 Hematocrit 40,4 39-50 Eosinophils 2 0-5 White blood cells 3.9 4-9 Lymphocytes 36 19-37 Platelets 232 150-400 Monocytes 6 3-11 ESR 6 3-15

Blood chemistry

Indicator 03/09/11 Norm About. protein 68.3 66-87 Bilirubin commonly 7.8 3.4-21 Glucose 6.06 4.1-5.9 Cholesterol 5.94 1.4-5.2 Urea 5.56 1.7-8.3 Mho 0.95 0.9-1.2 Prothrombin one hundred 70-130 Indicator Result date of HIV neg. 03/14/11 Rw neg. 03/14/11

Glucose tolerance test - glucose level up to a load of 5.45 mmol / L, after a load - 6.58 mmol / L. Markers of hepatitis B and C were not found.

Clinical urine analysis - clear, protein neg., Beats / weight 1032, leukocytes neg., Red blood cells neg., Ketones, glucose - no. Analysis of feces for occult blood - neg. Treatment: lactose-free diet, daily - mezim forte 1 tablet. × 3 times, bifiform 1 tablet. 2 times and no-spa - 1 tab. 3 times a course of treatment for 14 days.

Electromyographic reduction of duodenal emanation. Hypermotor dyskinesia of the descending colon.

Against the background of the therapy, the patient notes an improvement in his condition: reduction of heartburn, the disappearance of pain in the umbilical region, the normalization of stool to 1 r / day, designed without any impurities of blood mucus.

96 patients with secondary lactase deficiency were treated. The study confirmed the achievement of the purpose of the invention is to increase the effectiveness of the treatment of secondary lactase deficiency.

Claims (1)

A method of treating secondary lactase deficiency, including diet and drug therapy, characterized in that as a daily dose of bifiform, 1 tablet is used as a medicine. 2-3 times and no-spa - 1-2 tablets. 3 times a course of treatment for 14 days.