RU2490017C1 - Method of conservative treatment of lithic stage of cholelithiasis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly gastroenterology, and may be used for treating the lithic stage of cholelithiasis. For this purpose, ursodeoxycholic acid is administered for the night with underlying the mineral water Uvinskaya heated to 40-45°C.

EFFECT: method enables increasing the clinical effectiveness ensured by reducing high lithogenicity of bile with improved gallbladder contractility.

2 cl, 1 tbl, 2 ex

Description

The invention relates to medicine, in particular to gastroenterology, and for the treatment of the first (pre-stone) stage of gallstone disease (cholelithiasis).

In accordance with the classification of gallstone disease, its pre-stone stage is characterized by the presence of "biliary sludge" according to the results of ultrasound. During an ultrasound, changes in the structure of bile can be in the form of heterogeneous bile or various variants of biliary sludge.

It is also known that in patients with pre-stone stage of cholelithiasis, chronic gastritis of the stomach of various severity is often detected.

The following pathogenetic approaches to drug correction of the pre-stone stage of cholelithiasis are distinguished:

- reduction of cholesterol synthesis in hepatocyte;

- increased secretion of cholesterol with bile;

- restoration of contractile function of the gallbladder;

- reduction of cholesterol absorption in the intestine;

- restoration of intestinal transit.

There is a method of treating the pre-stone stage of cholelithiasis, including the use of the drug ursodeoxycholic acid (A. A. Ilchenko "Diseases of the gallbladder and biliary tract", M .: Anaharsis, 2006, p.111-115). The effectiveness of treatment is monitored by ultrasound, with the first study being carried out after 1 month of therapy.

The disadvantages of the method include the fact that the preparation of ursodeoxycholic acid (UDCA) slightly improves the contractility of the gallbladder, does not have an effective anti-inflammatory effect on the gallbladder and on the mucous membrane of the stomach.

There is a method of treating the pre-stone stage of gallstone disease with the help of mineral waters. A known method of course treatment of patients is carried out using the medical and dining room drinking sulfate-magnesium-calcium mineral water resort "Keys" (Tudakova V.G., Vladimirsky E.V., Gordeeva V.D., Rybolovlev E.V. / Treatment effectiveness patients with chronic stoneless cholecystitis with drinking mineral water of the Klyuchi resort / Modern aspects of rehabilitation medicine, balneology and physiotherapy. - Izhevsk. - 2008. - P.236-238). It was shown that this mineral water in these patients (especially in combination with hypokinesia of the gallbladder) has a choleretic, cholekinetic, antispasmodic effect, and also helps to reduce the lithogenic properties of bile.

The disadvantage of this method, taken as a prototype, is the absence of its positive effect in patients with cholelithiasis on the mucous membrane of the body of the stomach.

The aim of the claimed invention is to improve the quality of treatment and expand the scope of its application.

This goal is achieved by the fact that according to the method of conservative treatment of the pre-stone stage of cholelithiasis, which includes the internal use of mineral water, ursodeoxycholic acid is additionally used at night, and Uvinskaya mineral water heated to 40-45 ° C is used as mineral water. With a reduced acidity of the stomach, mineral water is taken 20-30 minutes before a meal, and with normal and increased acidity of the stomach 1 hour - 1 hour 30 minutes before a meal.

The application of the claimed method allows to reduce the impact of factors leading to the development of the pre-stone stage of gallstone disease, such as increased lithogenicity of bile, decreased contractility of the gallbladder, chronic inflammation of the gallbladder. In addition, the proposed method for the treatment of the pre-stone stage of cholelithiasis with concomitant chronic gastritis has a beneficial effect on the structural components of the gastric mucosa (coolant), reduces inflammatory activity, changes the proliferative activity of coolant cells and, probably, reduces the phenomena of cell apoptosis.

The advantage of the method is the positive effect of the combined use of UDCA and MB "Uvinskaya" at the ancestral stage of cholelithiasis, more pronounced in comparison with UDCA monotherapy, due to an improvement in the biochemical composition of gallbladder bile after therapy in the form of lowering bile cholesterol, increasing the content of bile acids in bile, increasing cholesterol coefficient. An unexpected effect was a beneficial effect on the structural components of the coolant, a decrease in inflammatory activity in all patients, and in some, a change in the proliferative activity of coolant cells.

The method is as follows.

Inside, a preparation of ursodeoxycholic acid (in particular, Ursosan) is prescribed in a daily dose of 10-15 mg / kg body weight at night in combination with the intake of Uvinskaya mineral water in an initial dose of 50 ml 3 times a day (before breakfast, lunch and dinner) at a temperature of 45 ° C. Mineral water is taken 30 minutes before meals at low and 1-1.5 hours before meals at high acidity of the stomach on the background of diet No. 5 according to M.I. To Pevzner. With normal tolerance of mineral water for 3 days, its dose is increased to 200 ml 3 times a day and continued in combination with ursodeoxycholic acid (UDCA) according to the same scheme. This combined treatment is continued for 24 days, then UDCA monotherapy is carried out for 2 months inside, based on a daily dose of 10-15 mg / kg of body weight at night.

According to its physical properties, the Uvinskaya mineral water is characterized as colorless, transparent, tastes somewhat brackish, odorless, has a stable chemical composition and a high daily rate. The chemical composition of mineral water is presented in table 1.

Table 1. The chemical composition of drinking mineral water "Uvinskaya" KATION ANIONS Sodium - 1.86 Sulfate - 4.58 Calcium - 0.31 chlorine - 0.23 Magnesium - 0.1 Bicarbonate - 0.12 potassium - 0.01 fluorine - 0.0009 Strontium - 0.002 Ammonium - 0.001 lithium - 0.0004 UNDISSOCIATED MOLECULES silicic acid - 0.005 metaboric acid - 0.08

Example 1:

Patient T., 53 years old.

Within 24 days against a background of diet No. 5 according to M.I. Pevzneru received treatment with ursodeoxycholic acid (2 capsules per night) + MB "Uvinskaya" at a temperature of 45 ° C. Given the reduced acidity of the stomach (pH of the stomach = 4.0), I took mineral water 30 minutes before eating. On the 5th day from the start of treatment, a decrease in pain and dyspeptic symptoms was noted, and the relief of syndromes on the 11th day of treatment. After completion of hydrotherapy, continued treatment with ursodeoxycholic acid for 2 months.

FGS (before treatment) Conclusion: Atrophic-hyperplastic gastritis.

Histological conclusion: Chronic superficial gastritis of the body of the stomach. The infiltration of the lamina propria by the mononuclear cells is high. Activity is moderate. N.R. not found. Ultrasound of the gallbladder (before treatment): Gallbladder (hypotonic) dimensions: 9.3 × 2.9 cm, the wall is not thickened, in the lumen - echo suspension

After treatment:

Ultrasound: Gall bladder (in normotone) sizes: 7.8 × 2.7 cm, the wall is not thickened, no echosuspension and calculi were found in the lumen of the bladder.

FGS: Conclusion: Atrophic gastritis of the body of the stomach of a moderate degree of activity.

Histological conclusion: Chronic superficial gastritis of the body of the stomach in the stage of moderate degree of activity.

Conclusion: high efficiency of the combination therapy.

Example 2

Patient Sh., 60 years old.

Within 24 days against a background of diet No. 5 according to M.I. Pevzneru received treatment with ursodeoxycholic acid (2 capsules per night) and MB “Uvinskaya” at a temperature of 45 ° C. Given normal acidity (pH = 1.8), he took mineral water 1 hour before a meal. On the 7th day from the start of treatment, a decrease in the symptoms of dyspepsia was noted, and the relief of symptoms on the 16th day. After completion of hydrotherapy, he continued treatment with ursodeoxycholic acid for 2 months.

FGS (before treatment) Conclusion: Superficial gastrobulbit.

Ultrasound (before treatment): Conclusion: Signs of chronic cholecystitis with the presence of echo suspension.

After treatment:

Ultrasound: In the lumen of the gallbladder, the stones are not located. The lumen is echo-negative.

FGS: Conclusion: Chronic gastritis.

During the control study 10 months after the course of treatment, the patient complained of bitterness in the mouth, no itchy skin.

Claims (2)

1. A method of conservative treatment of the pre-stone stage of cholelithiasis, including the internal use of mineral water, characterized in that it is additionally used at night with a preparation of ursodeoxycholic acid, and mineral water “Uvinskaya” heated to 40-45 ° C is used as mineral water. 2. The method according to claim 1, characterized in that with reduced acidity of the stomach, mineral water is taken 20-30 minutes before eating, and with normal and increased acidity of the stomach for 1 hour - 1 hour 30 minutes before eating.