On February 14 within All-Russia the Internet of the Congress of experts in internal diseases has taken place a symposium on a subject «A chronic lock - new solutions of an old problem». Reports have made Elena Aleksandrovna Poluektova (the candidate of medical sciences, the doctor of clinic of propaedeutics of internal diseases of medical faculty of the First MGMU of Of Setchenov), Alexander Sergeyevich Trukhmanov (the doctor of medical sciences, the professor of chair of propaedeutics of internal diseases of Medical faculty of the Moscow medical academy (MMA) of I.M.Setchenov) and Arcady Aleksandrovich Sheptulin (the doctor of medical sciences, the board member of the Russian Gastroenterologichesky Association, the member of the European gastroenterologichesky association).
Speakers have reported that 2.700.000 visits to the doctor of patients with chronic locks annually are registered, and on a depletive for them about 700 million dollars leave. Meanwhile, only 27 % of patients appear are satisfied with results of treatment whereas at the remained 73 % quality of life remains lowered. It is very serious problem as, according to researches, the standard of living of patients with chronic locks is similar to that at patients with a syndrome of angry intestines, a depression, diabetes and revmatoidny arthritis. According to tests, at such people level of uneasiness and mental discomfort is raised, and physical activity is reduced. Besides the main clinical manifestations of an illness, they suffer from a set of the collateral: morbidities, swellings of a stomach, tension, false desires to a defekatsiya and so on. Average duration of treatment at persons with locks, according to foreign statistical reports, is huge, and makes 18-20 years. In the conditions of Russia patients are under supervision, on the average, for 5,5 years. In our country locks become a problem for 20 % of adult population and 60 years are more senior than 30-40 % of persons, and 2-3 % of all medical consultations are carried out exactly on this matter.
Discussion of experts has been concentrated to a problem of introduction of new methods of therapy (including medicinal) chronic locks. It no wonder, after all 80 % of patients would like more about it the nobility. E.A.Poluektova has noted that than the lock has been caused, it is necessary to begin with diet normalisation, thus even reception of laxatives is required not always. It is important to note that the amount of consumed liquid as it has appeared, does not influence frequency, a consistence of a chair and transit time. And here indigestible cellulose, on the contrary, has quite good efficiency. Here it is important not to mix полисахариды, the part from which (starch, a glycogen) is digested, and therefore - useless. Only indigestible substances can help with treatment of locks: cellulose (is a part of cellular covers of plants), pectin (a substratum giving hardness to vegetables and fruit), a lignin (forms cellular covers of plants). They contain in apples, bananas, carrots, sheet salad. Daily need of an organism for indigestible fibres - 25-30 grammes. Quite often doctors in this regard appoint reception of bran (which are especially effective at persons of young age), but more than 50 % of patients independently stop such therapy because of development of side effects (swelling of a stomach and the raised meteorizm).
As to laxative preparations, the greatest efficiency is observed at purpose of osmotic medicines (are estimated by the American experts as category A). Stimulating laxatives are less popular (are estimated as category B and C). However both groups possess common faults is both effect of accustoming, and need of increase in a dose, and side effects. 25 % of patients note unpredictability of action of such means: in one case they, for example, can cause diarrhoeia, and in other reception does not bring any results at all. In this regard Arcady Aleksandrovich Sheptulin has told about the new preparations applied in therapy of chronic locks:
- "Lyubiproston" - the activator of hloridny channels. It is approved in the USA for treatment having bungled (category A). However the preparation was not registered by Europe and Russia because of what it is not applied in our country.
- "Linaklotid" - stimulates water secretion in intestines, a side effect - diarrhoeia. Also it is not licensed in Russia.
Preparations antagonists of 5-HT4-retseptorov:
- Tsizaprid. In Russia appeared under the name of Kardinaks, but has been withdrawn from circulation in connection with serious side effects, among which sudden cardiac arrest and ventricular arrhythmias.
- Tegaserod. The preparation at the female patients was especially effective. However in 2007 have found out that frequency of cardiovascular complications in the group taking this medicine, in 11 times is higher, than in control, using плацебо. Very often there was a myocardial infarction and a stroke. Result: Tegaserod is withdrawn from circulation.
- Prukaloprid (in 150 times is more selective, than Tsizaprid). Eliminates a lock, swelling, pains. In Russia the preparation carries the name Rezolor, in 2012 permission to its application not only for women is expected 18 years, but also at men and even children are more senior. The daily dose in 2 and 4 mg gives the greatest efficiency. For persons 60 years an initial dosage are more senior should to make 1 mg. In 2-3 % of cases in the first day of reception of a preparation nausea, vomiting and diarrhoeia is observed. The next days these side effects vanish, so it is possible to speak about safety and high efficiency of new means. That still is not revealed Prukaloprid's any influence on an electrocardiogram is very important. This medicine in the absence of visible effect from laxative is appointed.
The academician of the Russian Academy of Medical Science Vladimir Trofimovich Ivashkin (the professor, the doctor of the medical sciences, the deserved doctor of Russia) asked experts to pay special attention to cases of development of locks at young women with plentiful periods (till 7-8 days, with clots). More often at such patients zhelezodefitsitny anaemia, that is the lowered level of haemoglobin is observed. As one more symptom of violations pathological lengthening of a sigmovidny gut acts долихосигма, that is. If the doctor faces such dangerous "triad", it is required to show special attention to the patient. Sick women are irritable, more often, quickly get tired, it is difficult to them to perform daily work. To treat a lock here it is very difficult, as ladies do not trust in possibility of disposal of an illness. The main methods in this case - psychological influence and a diet. The specific breakfast is necessary for patients. In a diet there should be the products stimulating propulsivny activity of a gastroenteric path. Morning is useful for beginning with a glass of cool water, soft-boiled egg, porridge with inclusion of dried fruits (prunes, dried apricots, raisin). The portion of the salad seasoned with vegetable oil is during the day obligatory. For the night - fruit dishes (apple, a half of banana, tangerine, orange). The similar dinner stimulates a morning defekatsiya. It is possible to run also repeated courses of reception of ferriferous preparations. In any case - treatment should be carried out in close cooperation with the gynecologist.
«To a defekatsiya it is necessary to treat validly, as, for example, reception of guests (you in this case put the best ware on a table, lay a beautiful cloth). The person cannot treat this process
as to a bird who has sat down and at once has flown up. Therefore, if want to keep health including the toilet should be a place where to you it is comfortable», - has finished V.T.Ivashkin's symposium.