Problems of a motility of a gastroenteric path
On February 28, 2012 took place next конгересс the All-Russia educational Internet program for the doctors, devoted to discussion of a problem of a motility of a gastroenteric path. Experts proved an urgency of the marked direction, talked about clinical value of diagnostics of impellent violations of a gastroenteric path and practical aspects of their pharmacotherapy.
The candidate of medical sciences Yury Aleksandrovich Kucheryavy told, in particular, about why the understanding of a motility of bodies of ZhKT is so necessary for the clinical physician. He noted that motility violation ZhKT (dyskinesia) is the leading reason of emergence of such clinical symptoms as:
- Pain, discomfort, weight in an epigastriya
- Eructation, feeling of early saturation
- Lock, diarrhea
According to the lecturer, the understanding of mechanisms of emergence of these symptoms is necessary for adequate therapy of motor violations. Besides, not a secret that medical experts deal presently with increase in frequency of occurrence of functional pathology in population, polymorphism of complaints, a combination of nozologiya (a so-called syndrome of a recross of functional frustration) and, as a result, experience considerable difficulties directed by the exact diagnosis. Therefore, the thorough knowledge of clinical markers of violations of a motility is necessary for each of them. Only at the accounting of all facts of a combination of frustration possibly purpose of effective and safe therapy.
The main illnesses considered concerning violations of a motility of ZhKT it is a functional dispepsiya (FD), a gastroezofagealny reflyuksny illness (GERB), postgastrorezektsionny syndromes (PGRS) and their combinations.
Yu.A.Curly-headed gave statistics of prevalence of various symptoms among patients from functional dispepsiy (FD):
- Feeling of overflow of a stomach (75 % of cases)
- Stomach swelling (70 % of cases)
- Pain (50-55 % of cases)
- Early saturation (50-52 % of cases)
- Nausea (48-50 % of cases)
- Eructation (40 % of cases)
- Weight reduction (40 % of cases)
- Epigastralnoye burning (30-35 % of cases)
- Vomiting (20 % of cases)
Very interesting data concerning potential genetic risk factor of GERB and FD association were sounded. As it appeared, to all fault аллель C825T coding 3-субъединицу of G (GNB3) protein. GNB3 protein – the important regulator providing specificity and time of an endocellular transduktsiya of signals, and its mutation it is associated with risk of arterial hypertension and a depression.
Among diagnostic methods of violations of a motility of ZhKT experts especially noted a daily ph-metriya which becomes sharply necessary statement at impossibility of the exact diagnosis because of polymorphism of complaints of the patient. It is an authentic method of an assessment of the intragastric acidity, considered as "a gold standard» in diagnostics of a gastroezofagealny reflyuksny illness (GERB), Barret’s gullet, hernias of an esophageal opening of a diaphragm and other illnesses. The daily ph-metriya is carried out by means of the special computer system intended for long 24-hour research of vnutripolostny acidity of the top departments of a gastroenteric path. Measurements it is carried out by means of a transnazalny ph-metric probe and the independent registering block. The daily rn-metriya allows to establish precisely time period during which the mucous membrane of a gullet is exposed to influence of hydrochloric acid and to estimate efficiency of an esophageal road clearance. Unfortunately, the equipment necessary for researches is present far not at all clinics, especially this problem concerns regional medical institutions.