RU2402356C1 - Method of treating gastroesophageal reflux disease in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pediatrics, gastroenterology. Method includes introduction of proton pump inhibitor and prokinetics. As proton pump inhibitor, ultop in dose 10 mg is introduced 2 times per day. As prokynetic, motilium is introduced in dose 1 tablet 2 times per day. Additionally in period from 9.00 to 10.00 o'clock pysiotherapy is carries out by exposure to sinusoidal modulated currents. Impact is carried out with modulation depth 75-100%, frequency 50-75 Hz. Exposure is performed by means of electrodes applied transversally in epigastric area and lower thoracic spine. Course includes 8-10 procedures. In period from 10.00 to 11.00 reflexotherapy is carried out by massage of vacuum jar alternating it with massage by means of needle roller on urinary bladder duct paravertebrally, duration of impact is 2-3 minutes. After that, point massage of corporal C 7, E 25, E 36, F 3, F 6, GI 4, GI 11, MC 6, P 7, RP 4, RP 6, V 18, V 19, V 20, V 21, V 23, V 25, VB 20, VB 34, and auricular 51, 55, 83, 86, 87, 91, 95, 97, 100 points is carried out. Impact duration is 15-20 minutes, course includes 10-12 sessions. After that tsubotherapy is carried out by application of balls by means of hypoallergic plaster on corporal E 36, GI 4, RP6 and auricular 85, 86, 87 points. Points are periodically massaged during day every 1.5-2 hours, for 1-2 minutes with each ball. In period from 11.00 to 12.00 o'clock music aromatherapy is performed. Essential oils of lemon, tea tree jumper, live nature sounds and fragments of classical music are used. Course includes 10-14 sessions. Also phytotherapy is performed during 10-14 days by introduction of phytococktails "Biorhythm RS", "Biorhythm DS" in day dose 10-30 drops inside 15-20 minutes before meal, taking into account chronotype.

EFFECT: method improves clinic-endoscopic and psychosomatic statuses of patients, increases remission duration.

2 tbl, 2 ex, 2 dwg

Description

The invention relates to medicine, pediatrics, gastroenterology, and specifically to methods for treating gastroesophageal reflux disease in children.

To do this, use physiotherapy, reflexology, music aromatherapy and herbal medicine. Moreover, all procedures are carried out in a strictly defined sequence and at a certain time of the day. The invention allows in the early stages to stop pain and dyspeptic syndromes, improve the psycho-emotional status and contributes to long-term remission of the disease in this category of patients.

The urgency of the problem of gastroesophageal reflux disease is due to the widespread prevalence of this pathology among children, the progression and development of a number of complications. In approaches to the treatment of gastroesophageal reflux disease, there are many unresolved issues, in particular, there are no generally accepted patient management schemes, the frequency of use and the dosage regimen of drugs. In children, these aspects are practically not studied. Thus, the problem of gastroesophageal reflux disease is relevant for pediatrics. Children suffering from GERD need an individual approach to therapy, taking into account the age, clinical features and duration of the disease.

The aim of the proposed study was to propose a method for the treatment of gastroesophageal reflux disease in children, including the introduction of a proton pump inhibitor and prokinetics, characterized in that as a proton pump inhibitor, 10 mg of ultrasound are administered 2 times a day, and 1 tablet of motilium is administered as prokinetics 2 once a day and additionally carry out physiotherapy, reflexology, music aromatherapy and herbal medicine, leading to a quick relief of pain and dyspeptic syndromes, an improvement in psychoemotional about the status and prolong disease remission.

The closest analogues are the works: Ivashkin V.T., Sheptulin A.A. Algorithm for the diagnosis and treatment of gastroesophageal reflux disease // Russian Medical Journal. - 2003. - Volume 11. - No. 14. - S.839-841, according to which medical treatment methods are used: antacid preparations, proton pump inhibitors, prokinetics; Bueverov A.O. Gastroesophageal reflux disease: what to do when proton pump inhibitors are ineffective? // Russian Journal of Gastroenterology, Hepatology, Coloproctology. - 2002. - Volume 11. -C.71-73, also consisting in the appointment of drug therapy: H ₂ histamine-blockers in doses significantly higher than standard (up to 1200 mg / day), proton pump inhibitors, prokinetics, and in sufficiently large dosages (cisapride, 80 mg / day). These schemes lead to an increase in the dosage of drugs, which entails an increase in the number of side effects.

The closest set of essential features to the claimed invention is a method for the treatment of gastroesophageal reflux disease (Shcherbakov P.L. Gastroesophageal reflux disease in children. // Russian Medical Journal. - 2007. - Volume 9. - No. 2. -C.42-48 ), taken by us for the prototype, which consists in the use of drug therapy, namely, histamine H ₂ receptor blockers (cimetidine, ranitidine, famotidine, nizatidine, roxatidine) or proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole) drugs (almagel, phosphalugel, maalox), prokinetics (domperidone, metoclopromide, tegaserod).

The prototype and the claimed invention has the following essential features: the use of medication for the treatment of children with gastroesophageal reflux disease leads to improved well-being and reduced relapse of the disease.

The disadvantage of the prototype is that this treatment can lead to polygasma, an increase in the dosage of drugs, the frequency of their use, which entails an increase in the number of side effects (including drug hepatitis), a decrease in the duration of remission.

The invention is aimed at solving the problem of developing a method for the treatment of gastroesophageal reflux disease in children.

The solution to this problem provides an improvement in clinical endoscopic and psychosomatic statuses, and an increase in the duration of remission.

To achieve this technical result, the claimed invention, a method for the treatment of gastroesophageal reflux disease in children, is carried out by introducing a proton pump inhibitor and prokinetics, characterized in that as a proton pump inhibitor, 10 mg of Ultop are administered 2 times a day, and motilium is introduced as a prokinetics 1 tablet 2 times a day and additionally, from 9.00 to 10.00 hours, physiotherapy is carried out by exposure to sinusoidal modulated currents with a modulation depth of 75-100%, a frequency of 50-75 Hz through an electric childbirth, a transverse upper abdominal and lower thoracic spine, on a course 8-10 procedures; during the period from 10.00 to 11.00, reflexology is carried out by massage with a vacuum jar in alternation with a needle roller massage along the bladder channel paravertebrally for 2-3 minutes, then acupressure is performed with corporal C 7, E 25, E 36, F 3, F 6, GI 4, GI 11, MC 6, P 7, RP 4, RP 6, V 18, V 19, V 20, V 21, V 23, V 25, VB 20, VB 34 and auricular 51, 55, 83, 86, 87, 91, 95, 97, 100 points for 15-20 minutes, for a course of 10-12 sessions, then they undergo cubotherapy by applying balls using a hypoallergenic patch to corporal E 36, GI 4, RP 6 and auricular 85, 86, 87 points that are periodically Chesky massage during the day after 1.5-2 hours for 1-2 minutes with each ball; during the period from 11.00 to 12.00, they perform music aromatherapy using essential oils of lemon, tea tree, juniper, wildlife sounds and fragments of classical music, for a course of 10-14 sessions, also conduct phytotherapy by introducing “Biorhythm PC” phyto-cocktails for 10-14 days , "Biorhythm DS" in a daily dose of 10-30 drops inside 15-20 minutes before meals, taking into account the chronotype.

In relation to the prototype, the claimed invention has the following distinctive features: a complex effect is carried out by introducing a proton pump inhibitor and prokinetics, characterized in that as a proton pump inhibitor, 10 mg of Ultop are administered 2 times a day, and Motilium is administered as prokinetics 1 a tablet 2 times a day and additionally from 9.00 to 10.00 hours physiotherapy is carried out by exposure to sinusoidal modulated currents with a modulation depth of 75-100%, a frequency of 50-75 Hz through the electrodes, superimposed s cross in the epigastric region and the lower thoracic spine, for the course 8-10 procedures; during the period from 10.00 to 11.00, reflexology is carried out by massage with a vacuum jar in alternation with a needle roller massage along the bladder channel paravertebrally for 2-3 minutes, then acupressure is performed with corporal C 7, E 25, E 36, F 3, F 6, GI 4, GI 11, MC 6, P 7, RP 4, RP 6, V 18, V 19, V 20, V 21, V 23, V 25, VB 20, VB 34 and auricular 51, 55, 83, 86, 87, 91, 95, 97, 100 points for 15-20 minutes, for a course of 10-12 sessions, then they undergo cubotherapy by applying balls using a hypoallergenic patch to corporal E 36, GI 4, RP 6 and auricular 85, 86, 87 points that are periodically Chesky massage during the day after 1.5-2 hours for 1-2 minutes with each ball; during the period from 11.00 to 12.00, they perform music aromatherapy using essential oils of lemon, tea tree, juniper, wildlife sounds and fragments of classical music, for a course of 10-14 sessions, also conduct phytotherapy by introducing “Biorhythm PC” phyto-cocktails for 10-14 days , "Biorhythm DS" in a daily dose of 10-30 drops inside 15-20 minutes before meals, taking into account the chronotype.

According to the information available to the authors, the set of essential features characterizing the essence of the claimed invention is not known, which allows us to conclude that the invention meets the criterion of "novelty."

According to the authors, the essence of the claimed invention for a specialist does not follow explicitly from a known level of medicine, since the above treatment method using physiotherapy and reflexotherapy in combination with music aromatherapy and phytotherapy cannot be identified from it, which allows us to conclude that the criterion of “inventive step” .

The set of features characterizing the essence of the invention, in principle, can be used repeatedly in medicine with obtaining a technical result, which consists in a method of treating gastroesophageal reflux disease in children using physiotherapy and reflexotherapy in combination with music aromatherapy and phytotherapy, which allows us to conclude that the invention meets the criterion "Industrial applicability."

There is a causal relationship between the distinguishing features and the result: in children who have received the aforementioned therapy complex, their clinical and psychosomatic status improves, and the periods of disease remission are extended.

The complex application of these methods of therapy is pathogenetically justified, since it affects the neurohumoral regulation of the lower esophageal sphincter, normalizing motility and blood supply to the esophagus, stimulating the reparative regeneration of the mucous membrane.

Only the integrated application of all these methods provides an effect that significantly exceeds the effect of the use of each drug separately.

This method is as follows.

In the gastroenterology department of the Republican Children's Clinical Hospital, 80 children with gastroesophageal reflux disease aged 6 to 17 years were examined. Children were divided into two groups. The main group consisted of 50 children receiving complex therapy. The control group consisted of 30 children with gastroesophageal reflux disease receiving standard pharmacotherapy: a proton pump inhibitor - an ultrasound at a dose of 20 mg 2 times a day and prokinetics - motilium 1 tablet 4 times a day.

Upon admission to the hospital in the main group, complaints of nausea were made by 39 (78%) children, vomiting - 22 (44%), hiccups - 36 (72%), heartburn - 33 (66%), belching - 26 (52%), increased salivation - 11 (22%), decreased appetite - 33 (66%) children. Dysphagia was less common in 5 (10%), and odnophagia in 7 (14%) children. Abdominal pains were localized in the epigastric region (44 people, 88%), the projection of the pyloroduodenal zone (17 people, 34%), around the navel (10 people, 20%), and the right hypochondrium (11 people, 22%). Moreover, combined localization was noted in 30 children (60%). Pain without clear localization ("spilled") was observed in 1 child (2%)

For the relief of dyspeptic and pain syndromes, medical and physiotherapeutic methods, reflexology were used.

Physiotherapy was carried out using sinusoidal modulated currents from the Amplipulse 4 apparatus in a non-rectified mode with a modulation depth of 75-100% with a frequency of 50-75 Hz, type III and IV work were used for 5 minutes each, electrodes 10x15 cm were applied to the epigastric region and lower chest spinal section transversely, in the course of 8-10 procedures.

Reflexotherapy was carried out by massage with a vacuum jar in alternation with a needle roller massage along the bladder channel paravertebrally for 2-3 minutes, then acupressure was performed with corporal C 7, E 25, E 36, F 3, F 6, GI 4, GI 11, MS 6, P 7, RP 4, RP 6, V 18, V 19, V 20, V 21, V 23, V 25, VB 20, VB 34 and auricular 51, 55, 83, 86, 87, 91, 95, 97, 100 points for 15-20 minutes, for a course of 10-12 sessions, then the treatment was performed by applying balls using a hypoallergenic patch to corporal E 36, GI 4, RP 6 and auricular 85, 86, 87 points, which are periodically massaged Whether during the day after 1.5-2 hours for 1-2 minutes each bead.

As criteria for the results of treatment, the terms of stopping dyspeptic and pain syndromes, remission of the disease, and indicators of the psychoemotional status of children were used. For this, children were examined in the hospital and after discharge after 3, 6 and 12 months, the clinical endoscopic picture was examined, and the psychoemotional status was evaluated.

After the complex therapy, the data were obtained, summarized in table 1, from which it can be seen that dyspeptic and pain syndromes in the main group were eliminated at the earliest possible date.

Table 1 Terms of relief of dyspeptic and pain syndromes Symptoms Control group Main group Terms of stopping Nausea 3 one Vomiting 2 one Heartburn four 2 Burping 3 2 Hiccups four 2 Odinophagy 3 2 Dysphagia 3 2 Hypersalivation 5 2 Hoarseness 6 3 Pain behind the sternum four 2

The essence of the method of treating gastroesophageal reflux disease in children is confirmed graphically, where Fig. 1 shows the timing of the relief of dyspeptic and pain syndromes in the main and control groups, and Fig. 2 shows the dynamics of the SAN test indicators before and after the course of therapy.

On average, dyspeptic and pain syndromes in the main group stopped two times faster than in the control (Fig. 1).

During fibroesophagogastroduodenoscopy (PEGF), it was revealed that gastroesophageal reflux is detected in 32 (64%) children, superficial esophagitis in 26 (52%), and hypertrophic esophagitis in 24 (48%). Children with erosive esophagitis were not included in the study. Correction was carried out with medical methods and with the help of herbal medicine.

Phyto-cocktails "Biorhythm PC", "Biorhythm DS" are a mixture of alcoholic extracts of Rhodiola rosea, elecampane high, licorice, spiny eleutherococcus, have anti-inflammatory effect, improving the condition of the esophagus mucosa.

To determine the chronotype (genetically determined, internal, free-flowing biological rhythms that are independent of the external social conditions of life), a modified, adapted to children's age Estberg questionnaire was used, containing 21 questions. After filling out the questionnaire, they were analyzed: the answers were calculated and the chronotype was determined according to the following points: over 84 points - a pronounced morning type, 68 - 83 points - a weak morning type, 50 - 68 points - an indifferent type, 34 - 49 points - weakly expressed evening type, below 33 points - a pronounced evening type.

To obtain the maximum effect, phytococtails were prescribed using the chronotherapeutic approach: persons of the morning chronotype (in a state of well-being, they wake up early with a feeling of high performance, are most active in the first half of the day) - 20-30 drops in the morning (until 10.00 - 1 time per day) , persons of the evening chronotype (in a state of good health they wake up late, are most active in the afternoon) - 20 and 10 drops at 14.00 and 20.00, respectively, 2 times a day, persons of an independent chronotype (state of good well-being and maximum activity do not depend on the time of day) - 10 drops per 0.5 cup of water, juice or chilled tea - 3 times a day (last intake no later than 20.00) 15-20 minutes before meals.

The use of herbal preparations (Biorhythm PC, Biorhythm DS) is based on the ability of organic acids (oxalic, succinic, citric, malic, formic), essential oils, inulin, flavonoids, tannins, higher fatty acids (oleic and palmitic) , vitamins C, E, PP contained in the roots of licorice (Glycyrrhiza gladra), elecampane (Inula helenium), prickly eleutherococcus (Eleutherococcus senticosus) and Rhodiola rosea (Rhodiola rosea) to antioxidant, antiseptic, anti-inflammatory, anti-inflammatory, normal microcirculation action. The effectiveness of each component separately is described, however, these properties of the drug in the complex therapy of gastroesophageal reflux disease against the background of modern basic therapy in children have not yet been studied.

As a result of the examination of children in follow-up, the following data were obtained (table 2).

table 2 Endoscopic characteristics of the examined children before treatment and follow-up Endoscopic sign Before treatment In 3 months In 6 months After 12 months GER 84% 24% 24% 26% Superficial esophagitis 52% 16% eighteen% eighteen% Hypertrophic esophagitis 48% 12% four% 8%

In improving the adaptive reactions of the child, the psycho-emotional factor is especially important. In patients with gastroesophageal reflux disease, psychogenic reactions occur that belong to the group of reactive conditions. The presence of chronic pathology in most children is manifested by significant psychological factors - depression and symptomatic lability, complicating the course of the disease, requiring psychogenic correction.

Assessment of the psychoemotional status was carried out using the tests of Lusher, Eysenck and the SAN questionnaire before and after the course of therapy. On the SAN scale, health, activity, mood were assessed. The difference in parameters should be positive and upward. Using the Eysenck test, factors of extraversion - introversion and neuroticism - were determined. According to the results of the Luscher color test, the tendency to increase anxiety was studied when comparing the first and second elections.

An analysis of the data obtained from the psychological testing revealed: according to the results of the SAN, Eysenck questionnaire, 36 (72%) of the examined children showed a decrease in activity and well-being compared with mood. The Luscher test made it possible to establish tension in 28 (56%) people, and anxiety in 33 (66%).

To correct the psychoemotional status, music aromatherapy is used daily, which provides a stable positive therapeutic effect and increases the adaptive capabilities of the growing body of the child, and resistance to adverse environmental factors. The sounds of wildlife and fragments of classical music are used for the Mozart effect - deep relaxation, restoration of strength and mental abilities, improve mood. A unique feature of this music is the ability to use at any age.

Also, in order to correct the psycho-emotional status, essential oils are used. Lemon oil has good antiseptic and antimicrobial effects, has an analgesic effect, eliminates depression, tones the nervous system, and increases interest in life. Juniper oil has a strong bactericidal effect and is used for diseases of the gastrointestinal tract. Tea tree essential oil is favorable for children with increased mental sensitivity, painfully reacting to any minor nuisance, it strengthens self-confidence and facilitates communication with others.

Positive dynamics of psychoemotional status (positive state, sense of satisfaction, calm, active desire for success) after treatment was observed in 100% of children in the main group. In children from the control group, the negative state continued to persist in 18 (58%) children (figure 2).

Example 1

Kristina K., 15 years old, over a period of 1.5 years noted the periodic occurrence of pain when swallowing, behind the sternum, nausea, sometimes vomiting, heartburn, belching, loss of appetite. I stopped the pain myself by taking baking soda. During the next exacerbation, she was sent to the Republican Children's Clinical Hospital in Vladikavkaz. Primary hospitalization. Heredity burdened on the paternal side: gastroesophageal reflux disease with esophagitis.

Objective status: a girl of medium level of physical development, the skin is pale pink. The tongue is densely lined with white-yellow bloom. Palpation of the abdomen determines pain in the epigastric region, in the pyloroduodenal zone. The liver is not enlarged, cystic symptoms are positive. The girl is irritable, tearful, closed, apathetic.

Data from paraclinical research methods: general blood test, general urinalysis, biochemical blood test - without pathology. On FEGDS, gastroesophageal reflux disease with esophagitis of the II degree, hypertrophic gastroduodenitis with increased acid-forming function of the stomach is determined.

The treatment was carried out: diet therapy, an ultop proton pump inhibitor at a dosage of 10 mg 2 times a day, prokinetic motilium 1 tablet 2 times a day, as well as sinusoidal modulated currents to the epigastric region and lower thoracic spine No. 10, reflexology by alternating massage with a vacuum jar with a needle roller massage along the bladder channel paravertebrally for 3 minutes, then acupressure of corporal C 7, E 25, E 36, F 3, F 6, GI 4, GI 11, MC 6, P 7, RP 4, RP 6, V 18, V 19, V 20, V 21, V 23, V 25, VB 20, VB 34 and auricular 51, 55, 83, 86, 87 , 91, 95, 97, 100 points for 15-20 minutes, then cuotherapy by applying balls using a hypoallergenic patch to corporal E 36, GI 4, RP 6 and auricular 85, 86, 87 points, which were periodically massaged throughout the day after 1.5-2 hours, 2 minutes with each ball, per course of 12 sessions; phytococtails "Biorhythm PC", "Biorhythm DS" of 10 drops per 0.5 cup of water 3 times a day, taking into account the independent chronotype for 14 days, music and aromatherapy - 14 sessions.

Pain and dyspeptic syndromes stopped on the 2nd day of therapy. Active, shows interest in studies and painting. Endoscopic remission persisted for 1.5 years.

Example 2

Soslan G., 10 years old, was admitted with complaints of pain in the epigastrium, behind the sternum, heartburn, hiccups, increased salivation, decreased appetite. These complaints are disturbing for 6 months. Outpatient treatment was not performed. Primary hospitalization. Heredity is not burdened.

Objective status: a boy of medium level of physical development, the skin is pale pink. The tongue is moderately overlaid with a white coating. On palpation of the abdomen, pain in the epigastric region is determined. The liver is not enlarged, cystic symptoms are negative. The boy with a depressed mood, closed, restless sleep.

Data from paraclinical research methods: general blood test, general urinalysis, biochemical blood test - without pathology. On FEGDS gastroesophageal reflux disease with esophagitis of the I degree, superficial gastritis with normal acid-forming function of the stomach is determined.

The therapy was carried out: diet therapy, an ultop proton pump inhibitor at a dosage of 10 mg 2 times a day, prokinetic motilium 1 tablet 2 times a day, as well as sinusoidal modulated currents to the epigastric region and lower thoracic spine No. 8, reflexology by alternating massage with a vacuum jar with a needle roller massage along the bladder channel paravertebrally for 2 minutes, then acupressure of corporal C 7, E 25, E 36, F 3, F 6, GI 4, 14 GI 11, MC 6, P 7, RP 4, RP 6 , V 18, V 19, V 20, V 21, V 23, V 25, VB 20, VB 34 and auricular 51, 55, 83, 86, 87, 91, 95, 97, 100 points for 15-20 minutes, then cubotherapy with balls using a hypoallergenic patch on corporal E 36, GI 4, RP 6 and auricular 85, 86, 87 points, which were periodically massaged for after 1.5-2 hours, 2 minutes with each ball, per course of 10 sessions; phytococtails "Biorhythm PC", "Biorhythm DS" of 30 drops in the morning, taking into account the morning chronotype for 10 days, music and aromatherapy - 10 sessions.

Pain and dyspeptic syndromes stopped on day 1-2 of therapy. The mood is good, active, outgoing, calm sleep. Endoscopic remission persisted for 2 years.

Claims (1)

A method of treating gastroesophageal reflux disease in children, comprising administering a proton pump inhibitor and prokinetics, characterized in that ultrasonica is administered as a proton pump inhibitor 10 mg 2 times a day, and as a prokinetics, Motilium is administered 1 tablet 2 times a day and additionally , during the period from 9.00 to 10.00 h, physiotherapy is performed by exposure to sinusoidal modulated currents with a modulation depth of 75-100%, a frequency of 50-75 Hz through electrodes placed transversely in the epigastric region and lower thoracic region Nick, on the course of 8-10 procedures; during the period from 10.00 to 11.00, reflexotherapy is carried out by massage with a vacuum jar in alternation with a needle roller massage along the bladder channel paravertebrally, lasting 2-3 minutes, then acupressure is performed with corporal C 7, E 25, E 36, F 3, F 6, GI 4, GI 11, MC 6, P 7, RP 4, RP 6, V 18, V 19, V 20, V 21, V 23, V 25, VB 20, VB 34 and auricular 51, 55, 83, 86 , 87, 91, 95, 97, 100 points for 15-20 minutes, for a course of 10-12 sessions, then the treatment is performed by applying balls using a hypoallergenic patch to corporal E 36, GI 4, RP6 and auricular 85, 86, 87 points that periodically massaged during the day after 1.5-2 hours for 1-2 minutes with each ball; during the period from 11.00 to 12.00, they perform music aromatherapy using essential oils of lemon, tea tree, juniper, wildlife sounds and fragments of classical music, for a course of 10-14 sessions, also conduct phytotherapy by introducing “Biorhythm PC” phyto-cocktails for 10-14 days , "Biorhythm DS" in a daily dose of 10-30 drops inside 15-20 minutes before meals, taking into account the chronotype.

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