RU2483725C1 - METHOD OF TREATING CHRONIC EROSIVE GASTRITIS ASSOCIATED WITH Helicobacter pylori - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and is intended for treatment of chronic erosive gastritis, associated with Helicobacter pylori. Urease test with dental plaques is performed and if microorganisms are identified, 30-minute long gingival applications with metronidazol (Metrogyl Denta gel) are carried out for 3 days in addition to anti-Helicobacter therapy. Starting with the 4-th day patient brushes the teeth with toothpaste of "Mexidol" series, adding Metrogyl Denta gel in "a match head" amount. After 15 minutes oral cavity is rinsed with 0.02% chlorhexidine digluconate solution. Said procedures are carried out for a month and repeated a month before supposed aggravation in stomach.

EFFECT: method makes it possible to prolong remission terms.

1 ex, 2 tbl

Description

The invention relates to medicine, in particular to gastroenterology.

Currently, it is proved that chronic gastritis in countries with developed statistics is recorded in 80-90% of patients. According to published data, its prevalence is 2.5% among the entire population, 35% among diseases of the digestive tract, 85% among diseases of the stomach. It is assumed that in industrially developed countries every second adult suffers from it (Valenkevich LN, Yakhontova OI Digestive apparatus diseases. A guide to gastroenterology for doctors. - SPb .: DEAN Publishing House, 2006 - 656 p.) .

The development of chronic gastritis is influenced by environmental factors that are exogenous and endogenous in nature. Particular importance is attached to the etiological role of Helicobacter pylori (HP), since more than 90% of cases of chronic gastritis are associated with this infection (Zimmerman J.S. Etiology, pathogenesis and treatment of peptic ulcer associated with Helicobacter pylori infection: state of the problem and prospects. Clinical medicine No. 3, 2006, S.1-7). This microorganism in all infected individuals causes inflammatory changes in the gastric mucosa (coolant).

Currently, in the treatment of chronic erosive gastritis associated with HP, anti-Helicobacter therapy regimens are prescribed, including a proton pump inhibitor and two antibacterial drugs.

The disadvantage of this therapy is frequent relapse due to the presence of Helicobacter pylori.

Object of the invention: the prevention of self-infection of Helicobacter pylori, its persistence in plaque and an increase in the duration of remission in chronic erosive gastritis associated with this microorganism.

The presence of the pathogen in the gingival pockets in HP-infected patients has been proven by numerous studies and it has been established that the oral cavity can be a “reservoir” of HP (Bazikyan EA, Mayev IV, Nikoloyeva EN, Lukina GI, Mukhina EV Comparison of invasive and non-invasive methods for the detection of Helicobacter pylori in the stomach and oral cavity in patients with acid-dependent diseases // RZHGK. - 2008. - No. 4. - P.32-37).

The essence of the invention lies in the fact that in patients with chronic erosive gastritis associated with Helicobacter pylori, a urease test with plaque is preliminarily performed and, when the microorganism is detected, in addition to anti-Helicobacter therapy, 3 days after breakfast and gum applications with metronidazole are prescribed for 30 minutes , then, starting from 4 days, during the month - the sanitation of the oral cavity, including brushing your teeth twice a day after breakfast and at night for 2 minutes with paste from the Mexidol series with the addition of Metrogil The gel dent is the size of a match head, and 15 minutes after brushing your teeth, rinse your mouth with a 0.02% chlorhexidine bigluconate solution, with a repeat of the indicated sanitation of the mouth one month before the expected exacerbation of the stomach.

The removal of Helicobacter pylori from the oral cavity must be carried out because after a course of antibiotic therapy, the microorganisms disappear from the stomach, but remain in the plaque, and then again enter the stomach, where they multiply, which contributes to the development of the inflammatory process in the coolant.

The use of paste from the Mexidol series has an antioxidant, pronounced antihypoxic, immunomodulating effect, which contributes to the eradication of Helicobacter pylori from the oral cavity. Metrogil Denta gel is active against Helicobacter pylori. A time of 30 minutes is necessary for the therapeutic effect of the drug and the destruction of microorganisms in plaque. Carrying out this procedure within 30 days a month before the expected exacerbation is necessary to successfully remove the microorganism from the oral cavity and prevent its persistence and self-infection.

The use of a 0.02% chlorhexidine bigluconate solution in this technique is due to the fact that it is one of the most active local antiseptics.

The method is as follows: simultaneously with anti-Helicobacter therapy (omeprazole 20 mg 2 times a day 30 minutes before meals, clarithromycin 500 mg 2 times a day, flemoxin solutab 1 g 2 times a day for 14 days, then omeprazole 20 mg 1 time per day 4-6 weeks) patients within 3 days make applications with metronidazole ("Metrogil Denta gel") for 30 minutes 2 times a day after breakfast and at night. Starting from 4 days, brush your teeth 2 times a day, after breakfast and at night, for at least 2 minutes with Mexidol paste with the addition of Metrogil Dent gel the size of a match head, rinse the cavity 15 minutes after brushing your teeth mouth 0.02% solution of chlorhexidine bigluconate. The indicated sanitation of the oral cavity is carried out for a month and it is repeated a month before the expected exacerbation of the stomach.

Example 1. Patient S., 49 years old. Suffers for many years with chronic erosive gastritis. Marks exacerbations 2-3 times a year, despite ongoing anti-helicobacter therapy. During FGDS, multiple erosions were detected, in the biopsy specimens of the gastric mucosa the contamination of Helicobacter pylori in the antrum and cardia (+++), urease test with plaque (+++). Prior to this, the patient was not examined for plaque. No periodontal diseases have been identified. Helicobacter therapy was carried out: omeprazole 20 mg 2 times a day 30 minutes before meals, clarithromycin 500 mg 2 times a day, flemoxin solutab 1 g 2 times a day and oral HP treatment - for 3 days with metronidazole (Metrogil Denta gel ") for 30 minutes 2 times a day (after breakfast and at night). Then the patient brushed her teeth for 2 minutes with a paste from the Mexidol series with the addition of a gel (the size of a match head) into Metrogil Denta paste and rinsed her mouth with a 0.02% solution of chlorhexidine bigluconate 15 minutes after brushing. The patient performed the indicated sanitation of the oral cavity for a month. Exacerbation of chronic erosive gastritis was expected in October. Reconstruction of the oral cavity, as indicated above, was carried out in September. Complaints are not noted. At the end of such treatment and observation for 2 years, exacerbations of the disease were not observed. On control FGDS - the phenomena of superficial gastritis, Helicobacter pylori in the gastric mucosa and plaque was not detected.

A total of 120 patients with chronic erosive gastritis associated with Helicobacter pylori were examined and treated. All patients were divided into three groups. In the first group, 55 patients received anti-helicobacter therapy. He performed HP eradication from the oral cavity. After treatment in these patients, exacerbation after a year was noted in 1.82 ± 0.13% of cases, detection of HP in plaque was 5.45 ± 0.23%, and in the mucous membrane of the stomach 3.64 ± 0.19% of cases.

In the second group, consisting of 43 people, only anti-helicobacter therapy was carried out. After treatment, exacerbation after a year was noted in 20.93 ± 0.41% of cases, HP was detected in 100 ± 2.9% in plaque and in 13.95 ± 0.35% of cases in the gastric mucosa.

In the control group of 22 patients, for various reasons, receiving treatment with omeprazole only, after treatment, exacerbation after a year was noted by more than half of the patients (54.54 ± 0.51%). In plaque, HP was detected in 100 ± 4.7%, and in the mucous membrane of the stomach in 81.82 ± 0.39% of cases (Table 1).

To verify the presence of significant differences between the samples, Fisher's exact test was used. Significance level α = 0.05. When p <α, the differences are significant.

When comparing the three observation groups, significant differences were found between the first, second, first and third groups in relation to exacerbation one year after treatment (p1.2 = 0.003, p1.3 <0.001), HP detection in plaque after treatment (p1.2 <0.001, p1.3 <0.001), detection of HP in the gastric mucosa after treatment (p1.2 = 0.03, p1.3 <0.001) (Table 2)

Thus, the proposed method for the treatment of chronic erosive gastritis provides an increase in the timing of remission in this disease by preventing self-infection by the microorganism.

Table 1 Method of treatment anti-helicobacter therapy and oral eradication therapy anti-helicobacter therapy only omeprazole Exacerbation in a year n 55 n 43 n 22 Detection of HP in plaque after treatment 5.45 ± 0.23% 100.0 ± 2.9% 100.0 ± 4.7% HP detection in the coolant after treatment 3.64 ± 0.19% 13.95 ± 0.35% 81.82 ± 0.39%

table 2 P1,2 P1,3 P2.3 Exacerbation in a year 0.003 <0.001 0,036 Detection of HP in plaque after treatment <0.001 <0.001 one HP detection in the coolant after treatment 0,03 <0.001 <0.001

Claims (1)

A method for the treatment of chronic erosive gastritis associated with Helicobacter pylori, including anti-Helicobacter pylori therapy, characterized in that a urease test with plaque is preliminarily performed and, when the microorganism is detected, in addition to the Helicobacter pylori therapy, 3 days after breakfast and gum applications 30 gum metronidazole is prescribed for metronidazole min, then, starting from 4 days, for a month - sanitation of the oral cavity, including brushing your teeth twice a day after breakfast and at night for 2 minutes with paste from the Mexidol series with the addition of a matchogel gel of the size of a match head to it, and 15 minutes after brushing your teeth, rinse the mouth with a 0.02% solution of chlorhexidine bigluconate, with a repeat of the indicated sanitation of the oral cavity one month before the expected exacerbation of the stomach.