RU2479845C2 - Method for specifying therapeutic approach to children suffering gastroesophageal reflux disease - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: what is considered is child's urine 6-sulphatoxymelatonine, and if the derived value appears to exceed 41.0 ng/ml, the standard therapeutic course is stated to be inadequate and to be prolonged by prescribing melatonine, and essential surgical management is regarded.

EFFECT: method provides a rapid and non-invasive technique for specifying the optimal therapeutic approach to children suffering gastroesophageal reflux disease.

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Description

The invention relates to medicine, namely to pediatric gastroenterology, and can be used for the treatment of patients with gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a chronic recurrent disease characterized by certain esophageal and non-esophageal clinical manifestations and various morphological changes in the mucous membrane of the esophagus due to retrograde reflux of gastric or gastrointestinal contents into it (“Pediatric Gastroenterology” (amended chapters) .A.Baranova, E.V. Klimansky, G.V. Rimarchuk. M., 2002, p. 202-208).

Depending on the severity of clinical manifestations and the revealed severity of the esophagus mucosa, the standard treatment is chosen for the treatment of GERD, which includes the use of antacid, antisecretory drugs, prokinetics, or an individual selection of medicines is carried out.

For example, standard therapy can be supplemented by means to restore the balance of the parasympathetic and sympathetic links of the nervous regulation of the gastrointestinal tract or by means to regulate the level of gastrointestinal hormones. In this case, the course of treatment can be as long as 3-4 weeks, and 1.5-2 months.

In some cases, surgical treatment is chosen as the most appropriate for the patient's condition.

To determine the treatment tactics for children with gastroesophageal reflux disease, a diagnostic complex is used that traditionally includes clinical, instrumental and laboratory methods for examining a sick child (L. Semenyuk “Erosive-ulcerative form of gastroesophageal reflux disease in children: risk factors, clinic, diagnosis and treatment ". Abstract of dissertation for the degree of Doctor of Medical Sciences, Ekaterinburg, 2007).

So known methods based on the analysis of morphological indicators of the process of restoring the balance of aggressive and protective factors, which ultimately determine the effectiveness of treatment.

However, these methods of determining the treatment tactics of children with gastroesophageal reflux disease are associated with biopsy, have contraindications, do not exclude the likelihood of complications, and cannot be recommended for use in wide medical practice.

There is a method of determining the tactics of treating children with gastroesophageal reflux disease based on an assessment of the dynamics of the severity of the inflammatory process in the gastric mucosa using endoscopy.

However, the clinical endoscopic manifestations of the disease are delayed in time with respect to changes at the cellular level of the organization of the mucous membrane of the esophagogastroduodenal zone, which leads to the ineffectiveness of using clinical endoscopic data as determining treatment tactics.

Since one of the important pathophysiological mechanisms leading to the development of GERD is motor dysfunction of the upper digestive tract, to determine the tactics for treating the disease, it is primarily the state of motor function that is assessed, the degree of its recovery and therapeutic measures are adjusted.

For the prototype of the present invention, a method for determining treatment tactics is selected, including laboratory determination of an indicator of regulation of the motor function of the gastrointestinal tract.

This method is based on determining the level of gastrointestinal hormone - melatonin in the patient’s blood, which can be used to judge the dysregulation of the motor function of the gastrointestinal tract, as well as the state of microcirculation, cell proliferation, cytoprotection, and secretory function of the stomach (Komarov F.I., Rapoport S.I., Malinovskaya N.K., Anisimov V.N. Melatonin in the norm and pathology.M: Publishing House Medpraktika - M., 2004).

The determination by a laboratory method of an indicator that not only reflects the state of the motor function of the gastrointestinal tract with GERD, but also is an integrative indicator of the balance of local aggressive and protective factors, today is very promising for use in wide medical practice.

However, for pediatric gastroenterological practice, an indicator of the content of melatonin in biological media for a quantitative criterion for assessing the effectiveness of treatment of GERD has not been developed and has not yet been used.

The objective of the invention is to develop for use in wide clinical practice a simple, non-invasive method that provides timely and constant monitoring of the therapy in the treatment of GERD in children.

The problem is solved in that in the method for determining the tactics of treatment of children with gastroesophageal reflux disease, including laboratory determination of the indicator of regulation of the motor function of the gastrointestinal tract, the indicator of the content of 6-sulfate-simelatonin in the urine of the child and with an increase in its level more than 41.0 ng / ml the standard course of therapy is assessed as insufficient and (or) prolong the treatment period, prescribe melatonin, consider the need for surgical treatment.

The novelty of the method is due to the fact that the available scientific and practical information to solve the problem proposed technical solution in gastroenterology, in general, and children, in particular, was not used.

The scientific and technical level of the invention is due to new scientific information obtained as a result of studies related to the study of the mechanisms of formation and chronicity of gastroenterological diseases in children, and the establishment of the fact of the relationship of the biogenic amine - 6-sulfate-simelatonin, caused by a violation of the melatonin metabolism with the effectiveness of the treatment.

In this case, a correlation was established between an increase in the initial level of 6-sulfate-hydroxymelatonin in children with GERD with signs of impaired and restored regulation of the motor function of the gastrointestinal tract, as well as a relationship between the severity of the disease and the degree of increase in the level of 6-sulfate-hydroxymelatonin before treatment.

Based on the revealed pattern, a conclusion was drawn on the prognostic significance of this fact in terms of determining the effectiveness of standard basic therapy and the need to change treatment tactics.

A new way to determine the treatment tactics of children with gastroesophageal reflux disease is that they use the laboratory to examine the urine of a sick child and use an indicator of the level of 6-sulfate-simelatonin to measure the state of regulation of the motor function of the gastrointestinal tract, and before treatment. Also new is the fact that an increase in the level of 6-sulfate-hydroxymelatonin in the urine, more than 41.0 ng / ml, indicates the highest degree of violation of regulatory processes that cause acid formation in the stomach and changes in the motor-evacuation activity of the esophagogastroduodenal region, and therefore requires no standard therapy.

The efficiency of the method is confirmed in the treatment of 21 patients with gastroesophageal reflux disease. The accuracy of the method is confirmed in 82% of cases.

The technical result of the invention is to increase the effectiveness of treatment of children with GERD.

The method is as follows.

A sick child is collected urine in the morning on an empty stomach, then 6-sulfatoxymelatonin is determined by enzyme-linked immunosorbent assay. The presence of a level of this indicator of more than 41.0 ng / ml is the basis for the correction of a standard course of therapy.

Specific examples of the method are given in the form of extracts from medical records.

1. Anton A., 15 years old. The medical history No. 2690/09 of 02/02/2009. According to endoscopy data dated November 6, 2009, esophagitis with a single erosion of the lower third of the esophagus in the epithelialization stage of 2-3 was revealed. The content of 6-sulfate hydroxymelatonin in the urine from 03.11.2009 is 40.1 ng / ml. He received standard complex antisecretory, antireflux therapy. After 5 months (FGDS dated 03.25.2010), positive endoscopic dynamics in the form of the absence of an erosive process of the esophageal region is noted.

2. Daniel P., 15 years old. The medical history No. 3061/09 of 08/08/2009. When esophagogastroduodenoscopy from 12/10/2009, esophagitis with a single erosion of the lower third of the esophagus in the epithelization stage 2-3 takes place. The level of 6-sulfate hydroxymelatonin in the urine dated 12/15/2009 was 41.9 ng / ml. The treatment was carried out with an antisecretory drug, prokinetics for 4 weeks, then antacids for 8 weeks. At endoscopic observation after 3 months - FGDS from 02.15.2010 erosive esophagitis persists, which required a second course of standard antisecretory therapy. The control of esophagogastroduodenoscopy dated June 23, 2010 revealed a recurrence of the erosive process of the mucous membrane of the esophagus, and in connection with this, a prolonged course of therapy with an increase in the dose of antisecretory agent was again prescribed.

3. Vladimir D., 13 years old. The medical history No. 308/10 of January 28, 2010. A gastroesophageal reflux disease of the 2nd degree was diagnosed (PEGF from 03.02.10) with a single esophageal erosion in the epithelization stage of 2-3, the level of 6-sulfate-simelatonin in the urine from 02.02.2010 was 44.7 ng / ml, antisecretory drugs, prokinetics during 4 weeks, then antacid maintenance therapy. In control endoscopy after 4 months of April 28, 2010, recurrence of the erosive process of the esophagus was noted, which required an increase in the dose of the antisecretory drug, as well as correction of regulatory disorders by prescribing melatonin.

4. Elena T., 15 years old. The medical history No. 2414/08 of 11.24.2008. According to the endoscopic examination dated November 27, 2008, distal reflux esophagitis with multiple erosions in the epithelialization stage 1-2 was revealed, Barrett's esophagus, confirmed by histological data. The urinary 6-sulfate-hydroxymelatonin content of November 27, 2008 was 49.2 ng / ml. Received antisecretory drugs for 3 months with improvement, however, further, during dynamic observation for a year after the antisecretory drug was canceled, relapses of erosive and ulcerative esophagitis again. She was referred for surgical treatment.

Claims (1)

A method for determining the treatment tactics of children with gastroesophageal reflux disease, including laboratory determination of an indicator of regulation of the motor function of the gastrointestinal tract, characterized in that as such, an indicator of the content of 6-sulfate-hydroxymelatonin in the urine of the child and with an increase in its level of more than 41.0 ng / ml the standard course of therapy is assessed as insufficient and (or) prolong the duration of treatment, prescribe melatonin, consider the need for surgical treatment.