UA121382U - METHOD OF TREATMENT OF THE TITLE ulcer IN CHILDREN - Google Patents

Abstract

A method of treating duodenal ulcer in children by the use of "triple" anthelicobacter therapy (amoxicillin + clarithromycin + de-nol for 7 days). In addition, prescribe tivortin 5 ml 3 times a day for 2 weeks.

Description

The useful model belongs to the field of medicine, namely to pediatrics, children's gastroenterology, and can be used in the treatment of duodenal ulcer in children.

Duodenal ulcer disease (DUOD) is one of the most serious diseases of the digestive organs in children. The results of treatment and prevention of VHDPK are insufficiently satisfactory, despite the synthesis of new generations of drugs, the development and implementation of new schemes and approaches, including the eradication of N. ruiogi. Unfortunately, today, practical doctors are increasingly registering cases of N. ruiogi resistance to known antibacterial drugs, therefore, new treatment regimens are actively being developed, taking into account all links of pathogenesis. One of the essential factors of ulcerogenesis is vascular-endothelial dysfunction, as a result of which the microcirculation is disturbed with the formation of trophic disorders, a decrease in the blood flow of the gastric mucosa (SOS) and DPK. As a rule, a local decrease in regional blood flow, a microcirculation disorder, accompanied by the development of tissue hypoxia, lead to impaired regeneration of the SOH with further activation of catabolic processes and the predominance of apoptosis. These same violations lead to the development of a complicated course of VHDPK. Most treatment regimens for VKHDIPK are aimed only at the eradication of helicobacteriosis. Taking into account the growing prevalence of VKHDIPC among the children's population and resistance to traditional medicines, it is necessary to include pathogenetically justified medicinal products in the complex treatment. The inclusion of nitric oxide (NO) donors in treatment regimens is promising.

The closest analogue of a useful model is the method of treatment of duodenal ulcer in children (Ivashchenko I.I. Sovremennye podhodjii k lecheniu i profilikatike chronichelicobacter-associated gastroduodenal diseases in children: Methodical recommendations / Ivashchenko I.I. - St. Petersburg, PYTER, 2010. - 45 c), in which "triple" anti-helicobacter therapy is used in the complex of the VHDPK treatment scheme.

The disadvantages of the closest analog-method are that this method of treating patients with

VHDPK does not reduce the risk of developing endothelial dysfunction, as they retain a low level of MO.

The basis of a useful model is the task of improving the method of treating duodenal ulcers in children by means of additional to "triple" anti-helicobacter therapy

From the purpose of Tivortin.

The common features of the useful model and the closest analogue are the use of "triple" antihelicobacter therapy (amoxicillin and clarithromycin and de-nol for 7 days).

Distinctive features of a useful model from the closest analogue are additional to the "triple" anti-helicobacter therapy, the appointment of Tivortin 5 ml 3 times a day during meals for 2 weeks.

Theoretical prerequisites for the implementation of the claimed method.

Adequate blood flow can reveal a pronounced protective effect on CO, and hypoxia, which occurs when blood flow is impaired, leads to deep hemorrhagic necrosis with the formation of erosions and ulcers. Chemotoxins of N. ruiogi have a harmful effect, which leads to a violation of synthesis. The presence of N. rushi in the SO of the stomach in patients with VHDPC deepens endothelial dysfunction, as evidenced by a statistically significant increase in the levels of endothelin, MO and regional blood flow in the abdominal trunk in N. ruiogi -positive individuals compared to the corresponding indicators in patients in the absence of N. ruiogi infection. Endothelial dysfunction can be considered as one of the factors contributing to ulcer formation.

It is noted that the MO generated by synthetic MO generators leads to a rapid dose-dependent morphological transformation of N. ruiogi. From a replicating spiral form, the microorganism transforms into a non-replicating, but viable, cocoon-like form. It is known that only spiral microorganisms are capable of inducing the secretion of interleukin-3 by CO gastric epithelial cells. This conversion can help reduce the activity of the inflammatory process. Under physiological conditions, MO acts as an endogenous mediator that contributes to maintaining the integrity and restoration of tissues, exhibits gastroprotective properties, preventing damage to the gastric mucosa by various damaging factors. In response to physical and chemical stimulation in the endothelium for a short period under the influence of acetylcholine, bradykinin, 5-hydroxy-tryptamine, adenyl nucleotides, the formation of MO increases. In macrophages and neutrophils, there is a calcium-independent inducible MO-synthase, upon activation of which there is a long-term increase in MO content. Under its influence, vasodilatation occurs, vascular permeability increases, edema develops, and the progression of the inflammatory reaction is observed. High concentrations of MO are one of the reasons for the development of many lesions of the alimentary canal, in particular peptic ulcer. A decrease in the level of active MO leads 60 to the release of inflammatory mediators.

The combination of effectiveness and safety of using the MO-tivortin donor makes it a particularly valuable tool in pediatric practice.

The method is carried out as follows.

In order to treat a duodenal ulcer in children, "triple" anti-helicobacter therapy is prescribed (amoxicillin and clarithromycin and de-nol for 7 days), and in addition to it, Tivortin is prescribed 5 ml 3 times a day during meals for 2 weeks.

Examples of the use of a useful model.

To evaluate the effectiveness of Tivortin in children with

VHDPK, 50 children were under observation: 24 children (group A) were treated according to the closest analogue ("triple" therapy: amoxicillin and clarithromycin and de-nol for 7 days) and 26 children (group B) were treated according to the method that it is stated: "triple" therapy (amoxicillin and clarithromycin and de-nol) for 7 days and additionally tivortin 5 ml three times a day during meals for two weeks. After the use of "triple" therapy (amoxicillin plus clarithromycin plus de-nol for 7 days) and Tivortin for two weeks, in contrast to the use of the prototype, an improvement in the general condition of the examined children was determined, pain and intoxication syndromes disappeared, the repair processes of the mucous membrane were accelerated during endoscopic examination. The dynamics of clinical and laboratory symptoms is presented in the table.

Table

Dynamics of clinical and laboratory symptoms in children

Clinical sign (group B) analogue (95) (group A) is | Pyaalyuyutya Leluvnia | treatment

Endoscopic remission 88477771 1111111111111л666ССсСсСсС2шСС

Note." - reliable with respect to the indicators of group A (p«e0.05)

A clinical example. Patient, H. Age - 15 years. He has been sick for three years. Ulcer relapses 2-3 times a year (spring, autumn). Diagnosis: Ulcer of the DPC bulb, recurrent course. Chronic gastroduodenitis (N. ruiogi -), moderate hyperacidity. He complains of pain and heaviness in the pyloroduodenal region, frequent "night pain", nausea, heartburn, headache, dizziness, constipation. The level of MO» 7.2 μmol/l, MOz 11.4 μmol/l, MO2-MOz, 17.0 μmol/l. Treatment was prescribed: amoxicillin 500 mg twice a day, clarithromycin 250 mg twice a day, de-nol 240 mg 3 times a day 30 minutes before meals for 7 days, tivortin 5 ml 3 times a day during meals for 2 weeks The patient's condition improved, on the third day the pain disappeared

From the stomach, on the 4th - heaviness in the epigastrium and heartburn, on the 6th - the headache and dizziness disappeared.

MO parameters increased after 2 weeks: MO» 11.2 μmol/l, MOz 14.4 μmol/l, MO»2--MOZz, 24.0 μmol/l. No recurrence of the disease was observed within 1 year after the prescribed course of treatment.

The use of tivortin in the complex treatment of VHDPK in children increased the effectiveness of treatment by 13.595, the rate of endoscopic remission by 21.895, and reduced the length of stay of children in the hospital by 3 days.

Technical result. The proposed method allows you to effectively treat duodenal ulcers in children, significantly reduce the risk of developing endothelial dysfunction, normalize the tone of precapillaries, improve the functional state of the vascular endothelium, has a cytoprotective and membrane-stabilizing effect, is characterized by good tolerability,

lack of toxic and allergic reactions, does not require expensive drugs, is economically useful and can be recommended for use in pediatric practice.

Claims (1)

USEFUL MODEL FORMULA The method of treatment of duodenal ulcer in children by using "triple" anti-helicobacter therapy (amoxicillin-clarithromycin-and-nol for 7 days), which differs in that Tivortin is additionally prescribed 5 ml 3 times a day during meals for 2 weeks.