RU2528641C2 - Method of treating patients with dyspepsia syndrome combined with overweight - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to gastroenterology, and can be used for providing the higher clinical effectiveness in the patients suffering dyspepsia syndrome combined with overweight. The method involves measuring an anxiety level (HARS) and a depression level (HDRS) according to Hamilton rating scales, assessing nutritional status by bioimpedancemetry, a degree of manifestation of sleep disorders, measuring glucose, testing glucose tolerance, immunoreactive insulin, cholesterol, high-density lipoprotein (HDLP), triglyceride in venous blood. If the patient is observed to suffer dyslipidemia and impaired glucose tolerance or variations of immunoreactive insulin, the preparation Dibikor is administered in a dose of 500 mg a day for three months. The patient suffering dyslipidemia and both of the disorders stated above requires administering Dibikor 1000 mg a day for three months. If the patient suffers an overweight with a body weight index falling within the range of 27 to 29.9 standard units and an active cell mass (ACM) percentage of 45 to 55 per cent as shown by bioimpedancemetry, the preparation Dietressa is administered in a dose of 1 tablet 3-4 times a day for three to six months. If the patient suffers an overweight with a body weight index falling within the range of 27 to 29.9 standard units and an active cell mass (ACM) percentage of 45 to 55 per cent as shown by bioimpedancemetry, the preparation Dietressa is administered in a dose of 2 tablet 3-4 times a day for three to six months. If the patient suffers mild and moderate sleep disorders and shows an emotive type of eating behaviour combined with mild affective disorders, the anti-depressant Valdoxane in a single dose of 25 mg a day for the night for two weeks. The course of the disease is followed by the anxiety and depression levels two weeks after the beginning of the therapy, with the positive progression of the diseases, the 25mg dose of Valdoxane remains unchanged to the end of the therapeutic course for three to six months. If no progression is exhibited, the dose is to be increased to 50 mg a day, and the therapy is continued from four to eight months. If the patient suffers severe sleep disorders and shows an emotive type of eating behaviour combined with moderate affective disorders, the anti-depressant Valdoxane in a single dose of 50 mg a day for the night for two to three months.

EFFECT: in each specific case, the method enables providing faster reduction of the clinical symptoms, including body fat weight reduction and active cell mass and water normalisation, normalising circadian rhythms of the vegetative balance, as well as prolonging the remission.

3 tbl, 2 ex

Description

The invention relates to medicine, namely to gastroenterology, and can be used to increase the effectiveness of the treatment of patients with dyspepsia syndrome in combination with overweight.

There is a method of treating dyspepsia syndrome, which consists in the appointment of antisecretory drugs - N ₂ blockers or proton pump inhibitors, as well as prokinetics: dopamine receptor antagonists - metoclopramide, domperidone and the combined drug - itopride hydrochloride (Ivashkin V.T. et al., 2011 RGA recommendations). The recommendations of the international conciliation meeting “Maastricht-Sh” (2005) provide for the eradication of Helicobacter pylori (HP) infection in patients with functional dyspepsia (Loginov AF Maastricht-3. Modern tactics for diagnosing and treating Helicobacter pylori infection. Pharmateka. - 2006, No. 12. - S.46-48).

However, this therapy does not take into account the nutritional status, actual nutrition, the nutritional behavior of the patient, does not affect the body mass index (BMI) in patients with a combination of dyspepsia syndrome (DM) and overweight.

It is known that the nature of nutrition affects the development and course of dyspepsia syndrome (A.A. Sheptulin. Differential diagnosis of dyspepsia syndrome. // "Consilium medicum", 2002. - Volume 04, N 9; Romanova MM, Aleksenko A .C. Comparative assessment of nutritional status and nutritional behavior in patients with dyspepsia syndrome and in combination with obesity. // Dietetics. 2011. - No. 3. - P.76-77). It is also known that the presence of excess body weight is closely associated with impaired actual nutrition. It has been established that in the nutritional status and nutritional behavior of these patients there are significant deviations, and also that 30% of patients suffering from dyspepsia syndrome are overweight (Romanova M.M. Nutritional status and eating behavior in patients with dyspepsia syndrome and in combination with metabolic syndrome. // Russian Journal of Gastroenterology, Hepatology, Coloproctology - 2011, No. 5, Volume XXI, Appendix. - P.173). It was also found that these patients have carbohydrate and lipid metabolism disorders, affective disorders, sleep disorders (Romanova M.M., Babkin A.P. Features of affective disorders and daily heart rate variability in patients with dyspepsia syndrome combined with obesity. // System analysis and management in biomedical systems. - 2007, Volume 6, No. 2. - P. 462-466), which can serve as a predictor of organic pathology with the development of metabolic syndrome and requires correction.

Standard therapy for diabetes does not affect nutritional status, nutritional behavior, actual nutrition, BMI, carbohydrate and lipid metabolism, daily chronobiorhythms of heart rate variability (HRV), melatonin, and the quality of life of patients. Meanwhile, being a powerful link in secondary prevention, the state of nutritional status and regulatory systems largely determines the effectiveness of therapy, the frequency of relapses and prognosis, as well as the quality of life of patients.

The goal is to develop a method for treating diabetes, which allows you to adjust the nutritional status, including indicators of carbohydrate and lipid metabolism, actual nutrition, circadian rhythms of the vegetative balance, accelerate the relief of clinical symptoms, prolong remissions, improve the quality of life of patients by adjusting the circadian rhythm of melatonin secretion.

The technical result is achieved by the fact that patients with diabetes carry out an additional examination, select exposure options, prescribe a comprehensive treatment.

An additional examination includes the following procedures. To assess anxiety and depressive disorders, questionnaires are conducted on the following test questionnaires: Hamilton scale for determining anxiety (HARS), Hamilton scale for determining depression (HDRS). When interpreting the data, the total score for all issues is taken into account, which determines the severity of the disorders: from 0 to 7.0 on the HARS scale and from 0 to 8.0 points on the HDRS scale - the absence of symptoms of anxiety and depression; more than 7.0 to 16.0 on the HARS scale and more than 8.0 to 20.0 points on the HDRS scale - subclinically expressed signs of anxiety and depression; more than 16.0 points on the HARS scale and more than 20.0 points on the HDRS scale - clinically expressed anxiety and depression.

To assess the nutritional status, bioimpedasmetry is used, for example, using the Diamant hardware-software complex and the actual nutrition is evaluated using special assessment programs, for example, using the Nutritest-1 program (Tutelyan V.A. Metabolic crisis, which is always with you. // Bulletin of the Association of Honored Doctors. - 2009, No. 1 (6). -P.18-21).

To assess the severity of sleep disturbances, which is an indirect indicator of the circadian rhythms of melatonin secretion, a sleep quality questionnaire (Insomnia: modern diagnostic and therapeutic approaches // Edited by Ya.I. Levina. M: Medpraktika - M., 2005) and scale Epvert's Drowsiness (Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991; 14: 540-545).

To assess the type of eating behavior, the DQIB questionnaire (Wardle J. Eating stile: a validation study of the Dutch Eating Behavior Questionnaire in normal subjects and women with eating disorders. J. Psychosom. Res. 1987; 31: 161-169).

To assess the regime and daily rhythm of food intake, a questionnaire is used to assess the quality of the diet and the daily rhythm of food intake (Romanova M.M., Makhortova I.S., Romanov N.A. Central Black Earth Region, - 2012, No. 46. - S.25-29).

To assess carbohydrate and lipid metabolism, blood tests are performed for glucose, immunoreactive insulin, cholesterol, high density lipoproteins (HDL), triglycerides.

Assessment of circadian secretion of melatonin is carried out by standard enzyme-linked immunosorbent assay (http://drgtech.ru/elisa_pdf/Eia-1432_ru.pdf) reagents of the company Buhlmann to study the metabolites of melatonin in the patient's urine collected during the day for four six-hour intervals.

To assess the quality of life using the questionnaire SF-36 (version 1).

When choosing a regimen for differentiated therapy, the following options are considered:

if the patient has dyslipidemia and one of the violations: tolerance to carbohydrates or an increase in the level of immunoreactive insulin, then the drug dibicor is prescribed at a dose of 500 mg per day for three months;

if the patient has dyslipidemia and both disorders: tolerance to carbohydrates and an increase in the level of immunoreactive insulin, then the drug dibicor is prescribed at a dose of 1000 mg per day for three months;

if the patient has overweight with a BMI in the range from 27 to 29.9 conventional units and according to bioimpedancemetry, the percentage of active cell mass (AKM) is from 45 to 55 percent, then a diet preparation is prescribed in a dose of 1 tablet 3-4 times a day for three to six months;

if the patient has overweight with a BMI of 27 to 29.9 conventional units and AKM is less than 45 percent or more than 55 percent, then a diet preparation is prescribed in a dose of 2 tablets 3-4 times a day for three to six months,

if the patient has mild to moderate sleep disturbances, an emotiogenic type of eating behavior in combination with mild affective disorders, then the antidepressant valdoxan is prescribed at 25 mg once a day for two weeks;

if the patient has sleep disorders of high severity, an emotiogenic type of eating behavior in combination with affective disorders of moderate severity, then an antidepressant valdoxan 50 mg is prescribed once a night for two to three months;

if the patient has sleep disturbances, an emotiogenic type of eating behavior in combination with high-grade affective disorders, then the patient is referred for treatment to a local psychiatrist.

Track the dynamics of the level of anxiety and depression two weeks after the start of treatment. If the dynamics is positive, then the dose of valdoxane of 25 mg is maintained until the end of the course of therapy for three to six months, if there is no dynamics, then the dose is increased to 50 mg per day and treatment is continued for four to eight months.

At the same time, all patients are prescribed individual diet therapy, compiled taking into account the nutritional status of the patient according to bioimpedancemetry and assessment of actual nutrition. Classes are conducted with a psychotherapist with the participation of a nutritionist to correct eating disorders (Romanova M.M., Makhortova I.S. A set of diagnostic and treatment-and-prophylactic methods for patients with diseases of the gastroduodenal zone in combination with metabolic syndrome // Innovative technologies based on fundamental scientific developments : Proceedings of the regional scientific and practical conference of students, graduate students and young scientists. - Voronezh: Voronezh State University, 2011. - P.122-124; Romanova MM, Aleksenko AS Features optimization body tion of health schools in the Health Center // Nutrition 2011. -. №3 -. S.35-37).

The method was tested on 12 patients. In the control group of 12 patients, treatment was performed using standard therapy for dyspepsia syndrome (Table 1, Table 2, Table 3).

The use of this method allows you to accelerate the relief of clinical symptoms, reduce BMI, adipose tissue mass, normalize the content of active cell mass (AKM) and water in the body, normalize the circadian rhythms of autonomic balance, melatonin secretion, food intake, actual nutrition, eating behavior, lipid and carbohydrate metabolism, affective disorders, lengthen the period of remission.

Table 1 Results of correction of indicators of actual nutrition, eating behavior and nutritional status six months after the start of treatment Indicator (in% to individual norm) Known method The proposed method Residual BMI increase one hundred 8.3 Residual AKM reduction one hundred 8.3 Residual increase in adipose tissue one hundred 8.3 Residual increase in total water one hundred 8.3 Eating disorders 83,4 8.3 Eating Disorders 75 8.3 Violations of the daily rhythm of food intake 83,4 -

table 2 The results of the correction of clinical manifestations, indicators of carbohydrate and lipid metabolism, waste rhythms of the autonomic balance, melatonin six months after the start of treatment Indicator (% of patients with correction) Known method The proposed method Glucose - 91.7 Glucose tolerance disorders - 91.7 Cholesterol - 91.7 Dyslipidemia - 91.7 Lack of affective disorders 16.6 91.7 HRV circadian rhythm recovery - one hundred Recovery of the circadian rhythm of melatonin secretion - one hundred Relief of clinical symptoms 59.3 one hundred Positive dynamics of the quality of life 16.6 one hundred Relapse within six months 83,4 -

Table 3 The daily rhythm of melatonin excretion in patients with dyspepsia syndrome during treatment with this method Time interval, h The proposed method, before treatment, ng / ml The proposed method, after treatment, ng / ml 9-15 7.93 4.87 15-21 7.06 3.69 21-3 6.38 14.84 3-9 5.12 14.78

Example 1. Patient Z., 29 years old, went to a polyclinic at the place of residence to a gastroenterologist complaining of discomfort in the epigastric region that occurs after eating, being overweight.

Examination data: endoscopy - no pathology detected; Ultrasound - no pathology detected; body mass index (BMI) is 28.7 conventional units. Violations of sleep, eating behavior, nutritional status, actual nutrition, daily rhythm of food intake, vegetative balance, secretion of melatonin, and affective disorders were revealed.

Diagnosis: overweight dyspepsia syndrome.

The patient was prescribed the standard treatment for dyspepsia syndrome - the drug gonaton 1 tablet before meals for 2 months.

Examination data after treatment after 6 months: body mass index (BMI) is 29.1 conventional units - an increase of 0.4 from the original.

Disorders of sleep, eating behavior, nutritional status and actual nutrition are not resolved.

During the survey, it turned out that 2 months after the end of the course of treatment with gonaton, a feeling of discomfort in the epigastric region after eating appeared again, and periodically repeated.

Complaints of overweight are still present, the patient is dissatisfied with the results of treatment.

Example 2. Patient L., 31 years old, came to the Health Center of the clinic at the place of residence with complaints of pain in the epigastric region that occurs after eating, overweight.

Data from a standard examination: endoscopy - no pathology detected, ultrasound - no pathology.

When choosing a differentiated purpose of therapy, it was taken into account that the patient as a result of an additional examination revealed: body mass index (BMI) is 28.8 conventional units (in the range from 27 to 29.9 conventional units); the percentage of active cell mass is 42 percent (less than 45 percent); sleep disturbances of moderate severity, an emotiogenic type of eating behavior in combination with affective disorders of moderate severity.

Diagnosis: dyspepsia syndrome with overweight. Affective disorder of moderate severity.

The patient was prescribed the following treatment: antidepressant valdoxan 50 mg once a night for three months, a diet preparation 2 tablets 3-4 times a day for three months, as well as individual diet therapy, taking into account the nutritional status of the patient according to bioimpedance measurement and assessment actual nutrition, classes with a psychotherapist with the participation of a nutritionist to correct eating disorders.

Examination data after treatment after 6 months: body mass index (BMI) is 24.7 conventional units - a decrease of 4.2 from the original.

There were no clinical manifestations of dyspepsia syndrome, sleep disorders, eating behavior, nutritional status and actual nutrition, affective disorders, dyslipidemia, impaired glucose tolerance, and an increase in the level of immunoreactive insulin.

The patient feels well, is satisfied with the success in treatment, and is positive.

Claims (1)

A method of treating patients with dyspepsia syndrome in combination with overweight, including determining the level of anxiety (HARS) and depression (HDRS) according to Hamilton scales, assessing nutritional status using bioimpedasmetry, the severity of sleep disorders, assessing the type of eating behavior, assessing glucose levels, glucose tolerance test, immunoreactive insulin, cholesterol, high density lipoproteins (HDL), triglycerides in venous blood, characterized in that when choosing a differentiated regimen of treatment The following options are available:
if the patient has dyslipidemia and impaired glucose tolerance or an increase in the level of immunoreactive insulin, then the drug dibicor is prescribed at a dose of 500 mg per day for three months; if the patient has dyslipidemia and impaired glucose tolerance in combination with an increase in the level of immunoreactive insulin, then dibicor is prescribed at a dose of 1000 mg per day for three months; if the patient has overweight with a BMI in the range from 27 to 29.9 conventional units and according to bioimpedancemetry, the percentage of active cell mass (AKM) is from 45 to 55 percent, then a diet preparation is prescribed in a dose of 1 tablet 3-4 times per day for three to six months; if the patient is overweight with a BMI of 27 to 29.9 conventional units and AKM is less than 45 percent or more than 55 percent, then a diet preparation is prescribed in a dose of 2 tablets 3-4 times a day for three to six months; if the patient has mild to moderate sleep disturbances, an emotiogenic type of eating behavior in combination with mild affective disorders, then the antidepressant valdoxan is prescribed at 25 mg once a day for two weeks; monitor the dynamics of the level of anxiety and depression two weeks after the start of treatment, if the dynamics is positive, then the dose of valdoxan of 25 mg is maintained until the end of the course of therapy for three to six months, if there is no dynamics, then the dose is increased to 50 mg per day and continue treatment for four to eight months; if the patient has sleep disorders of high severity, an emotiogenic type of eating behavior in combination with affective disorders of moderate severity, then the antidepressant valdoxan 50 mg is prescribed once a night for two to three months.