RU2552319C1 - Method for assessing efficacy of nutritional support accompanying ulcerative colitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: marker used is a soluble form of adhesion molecules of the family ICAM - sICAM-1, sICAM-2, sICAM-3. If observing sICAM-1 decrease from 29-37.2 to 23-24, sICAM-2 decrease from 19.1-21.1 to 13-14, sICAM-3 decrease from 23-30.7 to 14-17, the nutritional support is considered to be effective.

EFFECT: method enables increasing the assessment accuracy of the efficacy of the nutritional support accompanying ulcerative colitis.

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Description

The invention relates to the field of gastroenterology, and in particular to methods for evaluating the effectiveness of nutritional support with ulcerative colitis.

A known method for diagnosing the effectiveness of enteral nutrition in postoperative disorders of the motor-evacuation function of the gastrointestinal tract, based on data of auscultation, balloonography, ionomanometry, direct myography and the use of special probes (1 - Pankov V.I.Prevention and treatment of postoperative dynamic gastrointestinal motility disorders intestinal tract. Author's abstract of the dissertation of the doctor of medical sciences. Ryazan, 1980).

The disadvantages of the known methods are low efficiency and informativeness, which does not provide the ability to determine the optimal amount of enteral nutrition in abdominal sepsis, as well as high cost, the need for special training for staff, pain for the patient, complications and adverse reactions.

A known method for evaluating the effectiveness (usefulness) of enteral nutrition in patients with abdominal sepsis. The essence of the method is that initially empty the stomach, after which a marker is introduced into the stomach, which is used as acetaminophen. After 15-40 minutes, determine its concentration in the blood plasma, which determines the possible effectiveness of enteral nutrition in abdominal sepsis (2 - RF patent No. 2484467, G01N 33/48, 2012). This method is adopted as a prototype.

The aim of the invention is to improve the accuracy of evaluating the effectiveness of nutritional support for ulcerative colitis.

The technical result is achieved by the fact that a soluble form of adhesion molecules of the ICAM family — sICAM-1, sICAM-2, sICAM-3 — is used as a marker, and when the level of sICAM-1 is reduced from 29-37.2 to 23-24, sICAM-2 s 19.1-21.1 to 13-14, sICAM-3 from 23-30.7 to 14-17 consider nutritional support effective.

The method is implemented as follows.

Upon admission, patients complain of weakness, weight loss of 8-15 kg in 2-3 years, loose stools up to 9-15 times a day, periodically an admixture of blood in the feces, false urge to defecate.

From the anamnesis it is known that they are sick for 2-7 years, when loose stools are observed for the first time up to 8-15 times a day, an increase in body temperature to 37-40.5 ° C, weight loss. With sigmoidoscopy, multiple erosion, contact bleeding, “granularity” are noted on the mucosa, the vascular pattern is smeared or absent due to mucosal edema, which indicates the presence of ulcerative proctosigmoiditis. With irrigoscopy, left-sided colitis. In blood tests - iron deficiency anemia - HB - 75-110 g / l. ESR - 45-90.

Diagnosed with ulcerative proctosigmoiditis, first detected, iron deficiency anemia 1 tbsp. Recommended intake of metronidazole, sulfasalazine in a dose of 3 g / day, prednisone 25-40 mg / day, sorbifer.

With exacerbation, frequent loose stools, low-grade fever, decreased serum iron.

ECG - the semi-vertical position of the electrical axis of the heart. The sinus rhythm is correct. Heart rate - 76-110. EGDS: the lumen of the esophagus is not deformed; when insufflated with air, it straightens well. The mucous membrane of the esophagus is pink, smooth, shiny, in the lower third of the esophagus linear erosions of up to 2.0 cm in length are determined, at the stage of epithelization. The socket of the cardia closes completely. Cardiac folds of the stomach are located at the level of the esophageal opening of the diaphragm. The lumen of the stomach is not deformed, with insufflation with air it is easily straightened. In the stomach lumen on an empty stomach, a moderate amount of mucous contents. The gastric mucosa is moderately hyperemic over the tops of the folds, has a spotty appearance in the antrum, and submucous hemorrhages are determined on the walls. Folds of medium size, convoluted, longitudinally oriented. Peristalsis is satisfactory, symmetrical. The angle of the stomach is not changed. The gatekeeper is round, closed, we pass. The bulb of the duodenum of medium size, the mucous membrane is swollen, moderately hyperemic. The exit from the bulb is free. Postbulbar sections: the duodenal mucosa is pale pink, active peristalsis, BDS in a typical place, when examined by an apparatus with an end-face optics, it is not visually changed. The urease test is negative. Conclusion: reflux esophagitis. Antral gastritis with a hemorrhagic component. Bulbit.

Colonoscopy - examination to the dome of the cecum, the mucous membrane of the descending colon and rectum is hyperemic, swollen with a bloom of fibrin, contact bleeding is noted.

Objectively upon admission: general condition of moderate severity, asthenic physique. Height - 160-175 cm, weight - 45-55 kg. Peripheral lymph nodes are not enlarged. With auscultation, vesicular breathing, no wheezing. BH 14-16 per minute. During auscultation, heart sounds are muffled, rhythmic, heart rate - 65-75 per min. HELL 110 / 75-130 / 80 mm Hg The pharynx is clean, the tongue is moist, and is encrusted at the root with a white coating. The abdomen is of the correct form, participates in the act of breathing, palpation is soft, painful along the colon. Liver at the edge of the costal arch. The gall bladder is not palpable, cystic symptoms are negative. The spleen is not palpated enlarged. Stool - unformed, up to 5-15 times, without pathological impurities. Urination is painless. No swelling.

The final clinical diagnosis: ulcerative colitis, total damage to the colon, a high degree of activity in the ulcer stage, continuously recurring severe course, pseudopolyposis. Chronic iron deficiency anemia of moderate severity.

Chronic gastroduodenitis, exacerbation. Reflux esophagitis.

Parenteral administration of antibiotics, local treatment with fucorcin is recommended. The treatment was carried out with 5-ASA preparations at a dose of 3 g / day, iron preparations, prednisone, and stool was reduced during treatment. Fluorography: without pathology.

Survey

General clinical blood test - iron deficiency anemia, increased ESR. Biochemical blood test - a decrease in total protein, a decrease in serum iron, an increase in C-reactive protein.

Blood group B (III), Rh - positive, Kell - negative.

Urinalysis: Rel. the density is 1.016-1.025, the reaction is 5.5-7, the protein is 0.15-0.45, there is no glucose, the leukocytes are 50-85 in s / sp, the red blood cells are negative.

In the coprogram, the reaction to occult blood is positive, the plant cell and starch ++. Calprotectin in feces - 930-1350 mcg / g.

ANCA - AutoAT to neutrophils not identified.

AT to saccharomycetes not detected. AHA and ATTTG - negative.

EMA: hypermotor dyskinesia of the stomach and descending colon. The frequency of slow waves of the stomach is 9.6-10.3 per min, the amplitude is 0.11-0.14 mV. The frequency of spikes is 3.8-4.4, the amplitude is 0.02-0.04 mV. The frequency of the slow waves of the descending part of the colon is 8.0-11 per min, the amplitude is 0.11-0.15 mV. The frequency of spikes is 4.0-5.3, the amplitude is 0.02-0.05 mV.

Treatment: glucocorticosteroids (metipred, topically in the form of rectal microclysters). Azathioprine, iv cefabol, metrogil, fluconazole. Cosmofer, sorbifer, bifidum - bacteria, omeprazole, creon.

The drug was treated with modules at a dose of 25-30 g 2-3 times on the first day of the drug, 35-40 g three times on the second day, 45-50 g three times a day from the third to the thirtieth day of treatment.

The effectiveness of nutritional support is assessed using the molecules sICAM-1, sICAM-2, sICAM-3 and with a decrease in the level of sICAM-1 from 29-37.2 to 23-24, sICAM-2 from 19.1-21.1 to 13 -14, sICAM-3 from 23-30.7 to 14-17 consider nutritional support effective.

Against the background of treatment, there has been a positive trend: an improvement in overall well-being, relief of pain, stool reduction, normalization of its consistency. The patient is discharged in satisfactory condition. The prognosis for gastroenterological pathology is positive.

The method is further illustrated by examples of its implementation.

Example 1

Patient Z, born in 1975 Complaints of admission to loose stools up to 10 times a day, intermittent blood impurities in the feces, false urge to defecate with gas exhaustion, weakness, weight loss of 12 kg in 2 years.

Anamnesis: Considers himself ill for 5 years, when he first noted loose stools up to 10 times a day, an increase in body temperature to 37-38 ° C, weight loss. When sigmoidoscopy performed in the clinic at the place of residence - multiple erosions on the mucosa, contact bleeding, "granularity", vascular pattern is absent, examination up to 20 cm. Conclusion: ulcerative colitis of the rectum 1 tbsp. With irrigoscopy, left-sided colitis. In blood tests - iron deficiency anemia - HB - 75 g / l. ESR - 89.

Diagnosed with ulcerative colitis, first detected, with left-sided damage to the colon, iron deficiency anemia 1 tbsp. Recommended intake of metronidazole, sulfasalazine at a dose of 3 g / day, prednisone 40 mg / day, sorbifer.

The patient took drugs for 6 months, then did not take. In 2013, deterioration was noted - frequent loose stools, low-grade fever, was aimed at inpatient treatment, and examination revealed a decrease in serum iron, RPHA for dysentery, salmonellosis, yersineosis - negative.

Ultrasound scan - without features, colonoscopy - examination to the dome of the cecum, the mucosa from the anus to the hepatic angle is hyperemic, swollen with a bloom of fibrin, contact bleeding is noted.

EGDS - subatrophic gastritis. Diagnosed with ulcerative colitis, recurrent course, with left-sided lesions, reactive hepatitis, chronic pancreatitis. Iron deficiency anemia (IDA), it is recommended to take metipred 40 mg, azathioprine 100 mg, mesalazine 4 g / day. After discharge, the patient took metipred with a gradual cancellation once a week by 1 tab., The patient did not accept azathioprine, and did not apply for a disability group. Real deterioration since July, increased stool up to 6-7 times; in connection with the deterioration, he was treated, during the examination: anemia, thrombocytosis, leukocytosis with a stab shift (33 p / o), accelerated ESR, in a biochemical blood test - a decrease in serum iron, HIV-neg.

Objectively upon admission: general condition of moderate severity, asthenic physique. Height - 165 cm, weight - 52 kg. Peripheral lymph nodes are not enlarged. With auscultation, vesicular breathing, no wheezing. BH 16 per minute. During auscultation, heart sounds are muffled, rhythmic, heart rate - 75 per minute. HELL 110/70 mm Hg The pharynx is clean, the tongue is moist, and is encrusted at the root with a white coating. The abdomen is of the correct form, participates in the act of breathing, palpation is soft, painful along the colon. Liver at the edge of the costal arch. The gall bladder is not palpable, cystic symptoms are negative. The spleen is not palpated enlarged. Stool - unformed, up to 5 times, without pathological impurities. Urination is painless. No swelling.

The final clinical diagnosis: ulcerative colitis, total damage to the colon, a high degree of activity in the ulcer stage, continuously recurring severe course, pseudopolyposis. Chronic iron deficiency anemia of moderate severity.

Chronic gastroduodenitis, exacerbation. Reflux - esophagitis.

A colonoscopy was performed - examination to the splenic angle, the mucous membrane is sharply hyperemic, swollen, more in the descending section, a lot of diffuse superficial erosion, severe contact bleeding, folding is smoothed due to swelling of the mucosa.

Parenteral administration of antibiotics, local treatment with fucorcin, antiseptic ointments are recommended. The treatment was carried out with 5-ASA preparations at a dose of 3 g / day, iron preparations, prednisone, stool reduction was noted during treatment, the manifestations of the rash decreased. Fluorography: without pathology.

Survey

ECG - the semi-vertical position of the electrical axis of the heart. The sinus rhythm is correct. Heart rate - 85. Endoscopy: the lumen of the esophagus is not deformed, with insufflation, the air straightens well. The mucous membrane of the esophagus is pink, smooth, shiny, in the lower third of the esophagus linear erosions of up to 1.8 cm in length are determined, at the stage of epithelization. The socket of the cardia closes completely. Cardiac folds of the stomach are located at the level of the esophageal opening of the diaphragm. The lumen of the stomach is not deformed, with insufflation with air it is easily straightened. In the stomach lumen on an empty stomach, a moderate amount of mucous contents. The gastric mucosa is moderately hyperemic over the tops of the folds, has a spotty appearance in the antrum, and submucous hemorrhages are determined on the walls. Folds of medium size, convoluted, longitudinally oriented. Peristalsis is satisfactory, symmetrical. The angle of the stomach is not changed. The gatekeeper is round, closed, we pass. The bulb of the duodenum of medium size, the mucous membrane is swollen, moderately hyperemic. The exit from the bulb is free. Postbulbar sections: the duodenal mucosa is pale pink, active peristalsis, BDS in a typical place, when examined by an apparatus with an end-face optics, it is not visually changed. The urease test is negative. Conclusion: Erosive esophagitis. Antral gastritis with a hemorrhagic component. Bulbit.

General clinical blood test

date of HB Eritre. No. Trome Lake PO Box S / i Eosin Lymph Monots ESR 09/05. 8.2 4.18 26.8 624 fifteen 9 70 one 16 four 41 09.09. 8.1 3.99 26 574 8.5 6 58 2 29th 5 41 09/18. 9.6 4.42 31.1 359 8 3 63 2 28 four 12 09/26. 10.8 4.64 34.8 211 8.1 3 70 one 21 5 7

Blood chemistry

Indicator 09.09 11.09 09/24 Norm Total protein 65.9 66.9 63.8 66.0-83 g / l Albumen 35,2 35-52 Common bilirubin 13 9.6 20,2 3-4-21 μmol / L Glucose 3.83 4.27 4.06 4.1-6.4 mmol / L Urea 5.38 4,54 1.7-8.3 μmol / L Cholesterol 4.42 5.75 6.25 1.4-5.2 μmol / L Creatinine 105.7 72,4 80.2 74-110 μmol / L Alkaline phosphatase 155.4 116.8 63.5 30-120 units / l ACT 33.5 22.3 13.1 5-35 units / l ALT 64.1 43.6 30,4 5-45 units / l Amylase 48.7 67.8 127.1 28-100 units / l Iron 2,8 14.1 10,2 12.5-32.2 μmol / L Potassium 4.45 4.23 5.31 3.5-5.1 mmol / L Sodium 136.8 140,4 143.2 136-146 mmol / L GGTP 86.4 89.2 66,4 7-56 units / l Chlorine 98 100.6 104.7 98-106 mmol / l CRP 127.24 10.1 0-5 mg / l Fibrinogen 3.56 2-4 g / l APTTV 32.8 25-35 sec Mho 1.29 0.9-1.2 Prothrombin 73.1 70-130% Prothrombin time 18.5 sec

HbsAg, a-HCV - neg.

At negative for HIV. RMP reaction is negative.

Blood type 0 (1), Rh - positive, Kell - negative.

Urinalysis: Rel. density 1,023, reaction 5.5, protein 0.2, no glucose, leukocytes - 75 p / sp, red blood cells - neg.

Urinalysis: Rel. density 1.014, reaction 7.0, no protein, no glucose, white blood cells - neg., red blood cells - neg.

Coprogram

Indicator Result Norm Consistency Liquid The form Neoform. Color Brown Smell Normal Occult blood reaction Will put. Negatives. Yeast mushrooms No No Iodophilic flora No No Starch No No White blood cells Moderately No Muscle fibers Slightly Protozoa Not found Not found Vegetable fiber Moderately Epithelium Slightly No Red blood cells Slightly No Worm Eggs Not found Not found

Feces for occult blood are negative, calprotectin in feces is 950 mcg / g. ANCA - AutoAT to neutrophils not identified. AT to saccharomycetes not detected. AHA and ATTTG - negative. Bacteriological analysis: inoculation from the wound discharge to the flora and sensitivity to antibiotics - the growth of microflora was not detected.

EMA: hypermotor dyskinesia of the stomach and descending colon. The frequency of slow waves of the stomach is 9.6 per minute, the amplitude is 0.11 mV. The spike frequency is 3.8, the amplitude is 0.02 mV. The frequency of the slow waves of the descending part of the colon is 8.0 per min, the amplitude is 0.11 mV. The spike frequency is 4.0, and the amplitude is 0.02 mV.

Treatment: Glucocorticosteroids (metipred 40 mg, topically in the form of rectal microclysters). Azathioprine 100 mg per day, iv cefabol 1000 mg 2 times a day. IV metrogil 250 mg 2 times a day, fluconazole 50 mg 1 tab. 2 times a day. I / O cosmofer 2.0 No. 5, then sorbifer 1 tab. 2 times a day, bifidum-bacterin 5 doses 3 times a day, omeprazole 20 mg 2 times a day, creon 10 thousand units. 3 times a day, topical skin treatment with antiseptics.

The drug was treated with modules at a dose of 25 g 2-3 times on the first day of the drug, 35 g three times on the second day, 45 g three times a day from the third to the thirtieth day of treatment.

The effectiveness of nutritional support is assessed by the level of sICAM-1, sICAM-2, sICAM-3 molecules in serum. The level of sICAM-1 decreased from 37.2 to 24, sICAM-2 from 21.1 to 14, sICAM-3 from 30.7 to 17. On this basis, nutritional support is considered effective.

Against the background of treatment, there is a positive dynamics: the stool is 2 times a day, half-formed, without pathological impurities, the pain syndrome is stopped, a regression of skin manifestations is noted.

The patient is discharged in satisfactory condition. The prognosis for gastroenterological pathology is dubious.

Due to the severe course of ulcerative colitis, the patient is recommended to undergo ITU.

Recommended by:

1. Compliance with diet No. 4 and diet.

Continue taking: Metipred 4 mg (36 mg - 9 tab.) Morning - 6 tab., Day - 3 tab., With a gradual decrease until completely canceled.

For the whole dose of metipred, take omeprazole 20 mg 2 times a day, calcium preparations DZ nycomed, azathioprine 50 mg 1 tab. 2 times a day, for a long time. Blood test 1 time per month, iron preparations under the control of biochemical parameters (blood serum iron) and OAK 1 time per month, probiotics (bifidum bacterin 5 doses 3 times a day) for 1 month, microclysters with prednisone 30 mg 2 times per day for 1 month, enzymes that do not contain bile acids, 1 tab. 3 times a day for 1 month.

Continue treatment of skin manifestations with antiseptics.

2. Observation of a gastroenterologist at the place of residence. Carrying out control endoscopy in a month. Control b / x blood tests (amylase, total protein, CRP, GGTP, ALT, ACT, alkaline phosphatase).

Example 2

Patient B was born in 1958, upon receipt of a complaint of periodic aching pains in the epigastric region, periodic pain in the right half and abdomen and lower abdomen, intensifying with bowel movements. Watery stool up to 8 times a day, without admixture of mucus and blood.

Final diagnosis: Ulcerative colitis, first detected, total lesion, moderate activity, phase of subsiding exacerbation. Gastroesophageal reflux disease in the stage of esophagitis. Chronic gastroduodenitis, not associated with HP, remission. Iron deficiency anemia of moderate severity. Severe hypolactasia.

Anamnesis of this disease: Considers herself a patient since 2002, when the diagnosis of duodenal ulcer was first established, treatment was performed. In 2008, she complained of pain in the epigastric region to a gastroenterologist in m / f.

The studies were performed: endoscopy: hernia of the esophageal opening of the diaphragm. Cicatricial and ulcerative deformity of the duodenal bulb. Chronic duodenal ulcer in the initial stage. The treatment was carried out: diet, omez 20 mg 1 t 2 r / d, Motilium 10 mg 1 t 30 minutes before meals, Fromilid 500 mg 2 r / d 7 days, then Linex 2 cap. 3 p / d, eglonil 50 mg 2 p / d. Treatment with a positive effect: the pain stopped. EGDS is a chronic ulcer of the duodenal bulb in the stage of the red scar. Since 2011, episodes of periodic relaxation of stool up to 7-8 times a day, slurry stools, without impurities of mucus and blood, began. Ultrasound scan: Diffuse changes in the liver and pancreas. Deformation of the gallbladder. Wall calcification. In b / x blood GGTP - 52.8. Treatment was prescribed: diet 5, enzymes as needed, linex 1 cap 3 r / d, hilak forte 30 drops 3 r / d (taken at the beginning of the meal) - 1 month, hepatoprotectors for a month. Treatment with a positive effect. During a routine examination in the clinic for m / f in b / x blood: iron 3.9 μmol / l, SSSS 64.6 μmol / l. Prescribed drug Durolex 1 tab. 2 p / d. The patient herself took furazolidone 1-2 tablets in the morning for a month, after taking the drugs, she noted a reduction in stool. Also, the patient associates stool frequency with stress. Fluorography is the norm.

At the initial examination: the general condition is satisfactory, normal nutrition. Heart sounds are clear, rhythmic. Heart rate - 78 bpm. The respiration in the lungs is vesicular, no wheezing. The abdomen is not swollen, on palpation it is soft, painful in the epigastric region and along the colon.

Survey Results:

ECG: semi-horizontal position of the EOS. Sinus rhythm, correct, heart rate 92 per minute. Marked diffuse changes in the myocardium.

Ultrasound of the abdominal cavity organs: Liver: not enlarged, CWR of the right lobe 126 mm (normal up to 150 mm), thickness of the left lobe 57 mm (normal up to 60 mm). The echostructure is heterogeneous. Echogenicity is increased. The vascular pattern is significantly depleted. The portal vein is 10 mm (normal up to 14 mm), the lumen is free. The bile ducts are not dilated. Additional formations are not identified. Choledoch 3 mm in diameter, free. Gall bladder: the shape is not changed, the dimensions are not increased - 5.4 × 2.1 cm. The walls are thickened - up to 3 mm (normal to 3 mm). Content is uniform. There are no calculi. The paravesical region is not changed. The pancreas is located typically, the contours are smooth, fuzzy. Dimensions: head 22 mm (norm up to 30 mm), body 10 mm (norm up to 20 mm), tail 20 mm. The echo structure is homogeneous. Wirsung duct 1.0 mm. Spleen: normal arrangement, the contours are even, clear. The capsule is not changed. The sizes are not increased. The echo structure is homogeneous. Echogenicity is average. The splenic vein is not expanded - 6 mm. Kidneys: located typically, the contours are even, clear. The right kidney is 99 × 44 mm, the left kidney is 99 × 44 mm. Corticomedullary differentiation is not changed. CLS is not expanded, there are no calculi. Free fluid in the abdominal cavity was not detected. Free fluid in the abdominal cavity was not detected. Conclusion: signs of fatty liver, chronic cholecystitis.

EGDS: The lumen of the esophagus is freely passable. The mucous membrane of the esophagus is pale pink, in the lower third is swollen, the cardia does not close completely, and the HPOD is visualized. The stomach is of the usual form, in the stomach a moderate amount of mucous contents mixed with bile. The folds are medium height, elastic, the angle of the stomach is not changed, the mucous membrane is pink, swollen, moderately hyperemic in places, in the antrum it has a mottled appearance. Peristalsis is satisfactory, the pylorus is round in shape, duodeno-gastric reflux is noted. The duodenum: medium sized bulb. The mucous membrane of the bulb of the duodenum 12 is pale pink, sometimes mottled. Postbulbar departments: the Vater papilla region without pathological changes. Skinny gut: pale pink with whitish mucus. Hp - negatively.

Conclusion: GPOD. Moderately expressed reflux esophagitis. Chronic gastroduodenitis. Duodeno-gastric reflux.

Own plate with weak lymphoplasmocytic infiltration. Conclusion: Chronic mild duodenitis.

Rapid diagnosis of lactase deficiency: a study of lactase activity in one biopsy of the mucous membrane of the small intestine. The lactase test is positive, which corresponds to severe hypolactasia.

Colonoscopy: An endoscope was placed into the ileum by 10 cm. The mucosa of the small intestine is pink with a vascular pattern. Peristalsis is active. The Bauginieva damper is polypous in shape, closed, oriented to the dome. The mucous membrane of the colon is hyperemic, swollen throughout. No vascular pattern. Multiple submucosal hemorrhages, multiple ulcerative defects of a point and polygonal shape, covered with fibrin are determined. Contact bleeding is moderate. Creases are not detected. The gut is shortened and looks like a tube. The lumen of the intestine is moderately narrowed due to edema. To clarify the diagnosis, a biopsy was taken from the mucous membrane of the sigmoid colon (in which a pronounced tissue density is noted). Conclusion: ulcerative colitis. Total defeat. Activity is moderate.

Biopsy: on microscopic examination, the surface and crypts are lined with goblet cells. Own plate with moderate lymphoplasmacytic and eosinophilic infiltration. Fibrosis and vascularization of the stroma. Conclusion: moderate colitis. Healed erosion.

Sigmoidoscopy: When examining the anus, slept external hemorrhoids outside the bleeding are determined at the time of examination. The tone of the anal sphincter is increased. A rectoscope was inserted 15 cm. The mucous membrane of the colon in visible areas is hyperemic, edematous. No vascular pattern. Multiple hemorrhages, ulcerative defects of a polygonal shape are determined. Contact bleeding is moderate. Conclusion: ulcerative colitis.

RPGA: Anti-Shigella flexneri I-V, VI and Anti-Shigella sonnei - not found.

Ultrasound of the veins of the lower extremities: Conclusion: varicose disease NK. Ultrasound signs of valvular insufficiency of veins of the NK. No additional formations were revealed in the lumen of the veins of the NK.

EMA: hypermotor dyskinesia of the stomach and descending colon. The frequency of slow waves of the stomach is 10.3 per min, the amplitude of 0.14 mV. The spike frequency is 4.4, and the amplitude is 0.04 mV. The frequency of the slow waves of the descending part of the colon is 11 per minute, the amplitude is 0.15 mV. The spike frequency is 5.3, the amplitude is 0.05 mV.

Consultation in a TB dispensary: chest x-ray - without pathology. DST - negatively. Conclusion: no data have been identified for pulmonary tuberculosis at present.

General blood analysis

Indicator 09/03/2013 09/13/2013 Norm Hemoglobin 11.1 11.6 12-16 g / dl Red blood cells 3.95 4.35 3.8-5.3 · 10 ⁶ / mm ³ Platelets 374 429 150-400 · 10 ³ / mm ³ White blood cells 7.9 8.9 4-9 · 10 ³ / mm ³ P / Nuclear 2 2 1-6% C / Nuclear 55 64 47-72% Eosinophils 3 2 0.5-5% Lymphocytes 34 28 19-39% Monocytes 6 four 3-11% ESR 54 32 1-20 mm / h

Blood chemistry

Indicator Norm ALT 9.5 5-34 units / l Amylase 28,4 28-100 units / l ACT 17 5-31 units / l Protein 77.1 66-87 g / l Common bilirubin 8.4 3.4-21 μmol / L GGTP 34 7-38 units / l Iron 6.6 10.7-32.2 μmol / L Potassium 4.86 3.5-5.1 mmol / L Calcium 2.44 2.2-2.7 mmol / L Creatinine 71.1 10.7-32.2 μmol / L Urea 3.01 1.7-8.3 mmol / L Sodium 141.5 136-146 mmol / L Triglycerides 1.41 0-1.7 mmol / L Chlorine 104.7 98-106 mmol / l Cholesterol 5.64 1.4-5.2 mmol / L

Immunological research

HBsAg - not detected, HCV - not detected.

Wasserman reaction is negative, HIV is negative.

Coagulogram: Fibrinogen - 3.59 (2-4 g / l); APTTV - 29 (25-35 sec); MHO - 1.06 INR (0.9-1.2); Prothrombin - 92.8 (70-130%); Prothrombin time - 15.6 sec.

Urinalysis: Rel. density 1.015, transparent, colorless, reaction 5.0, glucose, erythrocytes, ketones - none. White blood cells - 500.

Analysis of feces: the consistency is liquid, unformed, brown, yeast - none. Reaction to occult blood - positive, worm eggs - not found. Muscle fibers, digestible fiber - slightly. White blood cells, red blood cells - moderately. The epithelium is moderate.

The treatment: table 4, ercefuril, omez, mezim, white clay, ferrum lek, sulfasalazine, microclysters with prednisone, metrogil, modules, sorbifer.

The drug was treated with modules at a dose of 30 g 2-3 times on the first day of the drug, 40 g three times on the second day, 50 g three times a day from the third to the thirtieth day of treatment.

Evaluate the effectiveness of nutritional support for determining the level of sICAM-1, sICAM-2, sICAM-3 molecules. The serum level of sICAM-1 was reduced from 29 to 23, sICAM-2 from 19.1 to 13, sICAM-3 from 23 to 14. On this basis, nutritional support is considered effective.

Against the background of the therapy, the patient's condition with positive dynamics, the pain syndrome is partially stopped. Dyspeptic syndrome is absent. Stool 1-2 times a day, decorated, without any admixture of mucus and blood. The patient is discharged under the supervision of a gastroenterologist at the place of residence. The prognosis of the disease (gastroenterological) is dubious, requires dynamic observation. Works.

Tests of the proposed method on 61 patients. Tests confirmed the achievement of the purpose of the invention is to increase the effectiveness of nutritional support. An additional advantage of the method is the reduction of complications.

Information sources:

1. Pankov V.I. Prevention and treatment of postoperative dynamic gastrointestinal motility disorders. Abstract diss. Dr. med. sciences. Ryazan, 1980.

2. RF patent No. 2484467, G01N 33/48, 2012.

Claims (1)

A method for assessing the effectiveness of nutritional support in ulcerative colitis by biochemical studies, characterized in that the soluble form of adhesion molecules of the ICAM family - sICAM-1, sICAM-2, sICAM-3 and with a decrease in the level of sICAM-1 from 29-37, are used as a marker 2 to 23-24, sICAM-2 from 19.1-21.1 to 13-14, sICAM-3 from 23-30.7 to 14-17 consider nutritional support effective.