Rehabilitation after peptic ulcer disease object of work. Evaluation of the effectiveness of physical rehabilitation for gastric and duodenal ulcers. Learn more on this topic

Therapeutic physical culture is currently an integral part of complex treatment, a means of primary and, especially, secondary prevention of gastric and duodenal ulcers. Without exercise therapy, full rehabilitation of patients is impossible. The use of exercise therapy at various stages of treatment of patients with various conditions requires the constant use of various control methods. These methods can only conditionally be called methods for assessing the effectiveness of exercise therapy, since they provide much more information. With their help, the functional state of the patient at the moment is determined, the adequacy of exercise therapy in terms of physical activity and specific focus and in combination with other therapeutic measures. Methods for assessing the effectiveness of exercise therapy, having multifaceted characteristics, largely contribute to the disclosure of the mechanisms of influence of physical exercises themselves and thereby form the basis of a scientific approach to exercise therapy.

To determine the effectiveness of exercise therapy, constant observations of the patient are carried out, determining his condition, the impact of the exercises used, a separate lesson, and a certain period of treatment. Special studies of the functional state are also important, which provide an objective assessment of the patient, his individual characteristics, and adaptation to physical activity.

Knowledge and application of methods for studying body functions increases the effectiveness of therapeutic physical education classes. Assessing the patient’s functional state before starting physical therapy exercises is necessary to distribute patients into homogeneous groups according to their functional state, and to correctly plan and dosage physical activity. Ongoing examinations during the course of treatment and research into the impact of a single session make it possible to evaluate the effectiveness of a single session, make timely changes to the treatment plan (for example, expanding the motor mode) and training methods. Taking into account the effectiveness at the end of treatment sums up the course of training.

Improvement in the condition of patients with peptic ulcer disease in the phase of fading exacerbation is noted with the relief of pain and dyspepsia, the absence of pain on palpation, improvement, well-being, refusal of medications, expansion of the dietary regimen, restoration of motor function of the stomach and improvement of the autonomic regulation of the functions of internal organs according to ortho- and clinostatic samples Endoscopically, it is verified by a decrease in the inflammatory reaction of the mucous membrane around the ulcer, cleansing the bottom of the ulcer, and a tendency to scarring. Persistent improvement is determined by a change in the type of course (rhythm of exacerbations): the absence of relapse within a year with previously frequent recurrences, the formation of a scar and the elimination of inflammation in its area according to endoscopy, or the disappearance of a “niche” confirmed by x-ray.

Determination of the effectiveness of treatment when applying exercise therapy procedures is carried out on the basis of data on the well-being of patients; functional state of the digestive system (indicators of secretory and motor function of the stomach, data from X-ray and endoscopic examinations); reactions of the cardiovascular and respiratory systems to physical activity; state of excitability of the autonomic nervous system; reducing the treatment period; reducing the frequency and duration of complications; restoration of performance.

To take into account the effectiveness of exercise therapy for peptic ulcer disease, the following can be used:

A survey regarding existing subjective sensations: heartburn, belching, bloating, abdominal pain, bowel habits (constipation, diarrhea).

Monitoring pulse and blood pressure;

Breathing tests by Stange and Genchi;

Dynamic control of body weight. Body weight is determined by weighing on a medical scale.

With the positive effect of physical exercise, subjective sensations disappear, appetite and stool normalize, pulse tends to slow down, the time of the Stange test lengthens, and the body weight of patients stabilizes.

In assessing the effectiveness of LH, the patient’s well-being plays a very important role. If insomnia, loss of appetite, pain in the abdomen, or dysfunction of the intestines occurs, it is necessary to carefully examine the patient for a more correct differentiated choice of means and forms of exercise therapy.

To determine the effectiveness of a particular lesson, medical and pedagogical observations are carried out. The most important thing is to determine how the treatment problems are solved in this session, whether the physical activity corresponds to the patient’s capabilities, and what his individual reactions to exercise therapy are.

To clarify these issues, during a physical therapy session, the physiological curve and density of the session are determined by changing the pulse rate.

During observations, attention is paid to external signs of fatigue, the appearance of pain, and the ability to perform exercises. Based on observations, you should change the training method, for example, reduce the dosage of physical activity. In most cases, physical exercise should cause slight fatigue, which is characterized by redness of the skin, perspiration, and increased breathing. The appearance of pain and fatigue, accompanied by noisy shortness of breath, severe weakness, loss of coordination and balance, dizziness, and changes in the structure of physical exercise, should not be allowed.

During exercise therapy classes, the pulse rate should be examined 3 times, before the class, in the middle of the class (after the most difficult exercise) and after the end of the class.

To assess the distribution of physical activity during physical therapy sessions, you should count your pulse multiple times and construct a physiological curve.

To assess the effectiveness of exercise therapy during the entire course of treatment, it is necessary to study the patient’s condition before starting classes with him. During the initial examination of the patient, complaints, features of the course of the disease, objective data, state of physical development and functionality, and clinical data are determined and recorded in the exercise therapy card. Repeated (after certain periods) and final examinations reveal the dynamics of these indicators, which allows us to draw conclusions about the effectiveness of exercise therapy.

The study of the characteristics of the course of the disease is carried out according to the medical history and anamnesis. Attention is drawn to the duration of the disease, the presence of exacerbations, treatment methods and results achieved, physical activity before and during the disease.

Physical development is determined by anthropometric measurements.

Great care should be taken to define functionality. For this purpose, various tests with dosed physical activity are used. These tests also help determine the reserve capabilities of the body, its adaptation to physical activity, and justify the purpose and transition from one motor mode to another. The nature of the load in functional tests is selected depending on the motor mode in which the patient is.

The analysis of a self-monitoring card helps to assess the effectiveness of exercise therapy, in which quarterly and annually the dynamics of the patient’s well-being, sleep, appetite, objective research data (height, body weight, chest circumference, waist circumference, pulse rate, blood pressure, duration of breath holding during inhalation) are noted and exhalation, spirometry, dynamometry indicators).

Along with this, in assessing the results of exercise therapy, one of the main roles is given to the analysis of a special map of the physical rehabilitation room. It contains information about the patient, the main and concomitant diagnosis of the disease, and brief clinical and functional data. Since the differentiated choice of exercise therapy procedures is determined by the initial one; functional state of the digestive system; the map separately highlights the characteristics of the secretory and motor functions of the stomach, intestinal motility (constipation, diarrhea). It also contains anthropometric data, indicators of individual functional tests, and doctor’s guidelines.

The prescription of forms and means of exercise therapy is made only after determining the response of the cardiovascular and respiratory systems to physical activity (Martine-Kushelevsky test). Studies are carried out no earlier than 1.5 hours after eating. Clothing should be light, not interfere with movement and not interfere with heat transfer. The optimal ambient temperature should be 18-20 °C.

The improvement in the condition of patients with peptic ulcer disease in the remission phase is evidenced by an improvement in the general condition, a decrease in the severity of neurotic disorders, the possibility of further expansion of the dietary regimen, an improvement in the autonomic regulation of the functions of internal organs according to ortho- and clinostatic tests, and a change in the rhythm of relapse with the absence of relapse throughout the year - about lasting improvement. On the contrary, the appearance of pain, heartburn, recurrence of ulcers or erosions according to endoscopic or x-ray examination confirm the deterioration of the patients' condition.

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• Introduction
• 1. Anatomical, physiological, pathophysiological and clinical features of the disease
• 1.1 Etiology and pathogenesis of gastric ulcer
• 1.2 Classification
• 1.3 Clinical picture and preliminary diagnosis
• 2. Methods of rehabilitation of patients with gastric ulcer
• 2.1 Physical therapy (physical therapy)
• 2.2 Acupuncture
• 2.3 Acupressure
• 2.4 Physiotherapy
• 2.5 Drinking mineral waters
• 2.6 Balneotherapy
• 2.7 Music therapy
• 2.8 Mud therapy
• 2.9 Diet therapy
• 2.10 Herbal medicine
• Conclusion
• List of used literature
• Applications

Introduction

In recent years, there has been a tendency towards an increase in the incidence of the population, among which gastric ulcer has become widespread.

According to the traditional definition of the World Health Organization (WHO), peptic ulcer disease (ulcus ventriculi et duodenipepticum, morbus ulcerosus) is a general chronic relapsing disease prone to progression, with a polycyclic course, the characteristic features of which are seasonal exacerbations, accompanied by the appearance of an ulcerative defect in the mucous membrane, and the development of complications that threaten the patient’s life. A feature of the course of gastric ulcer is the involvement of other organs of the digestive system in the pathological process, which requires timely diagnosis for the preparation of treatment complexes for patients with peptic ulcer, taking into account concomitant diseases. Gastric ulcer affects people of the most active, working age, causing temporary and sometimes permanent loss of ability to work.

High morbidity, frequent relapses, long-term disability of patients, resulting in significant economic losses - all this allows us to classify the problem of peptic ulcer disease as one of the most pressing in modern medicine.

Rehabilitation occupies a special place in the treatment of patients with peptic ulcer disease. Rehabilitation is the restoration of health, functional status and ability to work, impaired by diseases, injuries or physical, chemical and social factors. The World Health Organization (WHO) gives a definition of rehabilitation very close to this: “Rehabilitation is a set of activities designed to ensure that persons with disabilities as a result of disease, injury and birth defects adapt to new living conditions in the society in which they live.”

According to WHO, rehabilitation is a process aimed at comprehensive assistance to sick and disabled people so that they achieve the maximum possible physical, mental, professional, social and economic usefulness for a given disease.

Thus, rehabilitation should be considered as a complex socio-medical problem, which can be divided into several types or aspects: medical, physical, psychological, professional (labor) and socio-economic.

As part of this work, I consider it necessary to study physical methods of rehabilitation for gastric ulcers, focusing on acupressure and music therapy, which determines the purpose of the study.

Object of study: gastric ulcer.

Subject of research: physical methods of rehabilitation of patients with gastric ulcer.

The tasks are aimed at consideration:

Anatomical, physiological, pathophysiological and clinical features of the disease;

Methods of rehabilitation of patients with gastric ulcer.

1. Anatomical, physiological, pathophysiological and clinical features of the disease

1.1 Etiology and pathogenesis of gastric ulcer

Gastric ulcer is characterized by the formation of ulcers in the stomach due to a disorder of the general and local mechanisms of nervous and humoral regulation of the main functions of the gastroduodenal system, disruption of trophism and activation of proteolysis of the gastric mucosa and often the presence of Helicobacter pylori infection. At the final stage, an ulcer occurs as a result of a violation of the relationship between aggressive and protective factors with a predominance of the former and a decrease in the latter in the gastric cavity.

Thus, the development of peptic ulcer disease, according to modern concepts, is caused by an imbalance between the effects of aggressive factors and defense mechanisms that ensure the integrity of the gastric mucosa.

Factors of aggression include: increased concentration of hydrogen ions and active pepsin (proteolytic activity); Helicobacter pylori infection, the presence of bile acids in the cavity of the stomach and duodenum.

The protective factors include: the amount of protective mucus proteins, especially insoluble and premucosal, secretion of bicarbonates (“alkaline tide”); resistance of the mucous membrane: proliferative index of the mucous membrane of the gastroduodenal zone, local immunity of the mucous membrane of this zone (the amount of secretory IgA), the state of microcirculation and the level of prostaglandins in the gastric mucosa. With peptic ulcer and non-ulcer dyspepsia (gastritis B, pre-ulcerative condition), aggressive factors sharply increase and protective factors in the gastric cavity decrease.

Based on currently available data, the main and predisposing factors of the disease have been identified.

The main factors include:

Disturbances of humoral and neurohormonal mechanisms that regulate digestion and tissue reproduction;

Disorders of local digestive mechanisms;

Changes in the structure of the mucous membrane of the stomach and duodenum.

Predisposing factors include:

Hereditary-constitutional factor. A number of genetic defects have been identified that occur in certain stages of the pathogenesis of this disease;

Helicobacter pylori infestation. Some researchers in our country and abroad consider Helicobacter pylori infection to be the main cause of peptic ulcers;

Environmental conditions, primarily neuropsychic factors, nutrition, bad habits;

Medicinal effects.

From a modern point of view, some scientists consider peptic ulcer disease as a polyetiological multifactorial disease . However, I would like to emphasize the traditional direction of the Kiev and Moscow therapeutic schools, which believe that the central place in the etiology and pathogenesis of peptic ulcer disease belongs to disorders of the nervous system that arise in its central and autonomic parts under the influence of various influences (negative emotions, overexertion during mental and physical work , viscero-visceral reflexes, etc.).

There is a large number of works indicating the etiological and pathogenetic role of the nervous system in the development of peptic ulcer disease. The spasmogenic or neurovegetative theory was the first to be created .

Works by I.P. Pavlov's ideas about the role of the nervous system and its higher department - the cerebral cortex - in the regulation of all vital functions of the body (the ideas of nervism) were reflected in new views on the process of development of peptic ulcer disease: this is the cortico-visceral theory of K.M. Bykova, I.T. Kurtsina (1949, 1952) and a number of works indicating the etiological role of disruption of neurotrophic processes directly in the mucous membrane of the stomach and duodenum in peptic ulcer disease.

According to the cortico-visceral theory, peptic ulcer disease is the result of disturbances in the cortico-visceral relationship. Progressive in this theory is the proof of two-way communication between the central nervous system and internal organs, as well as the consideration of peptic ulcer disease from the point of view of a disease of the whole organism, in the development of which a disorder of the nervous system plays a leading role. The disadvantage of the theory is that it does not explain why the stomach is affected when the cortical mechanisms are disrupted.

Currently, there are several fairly convincing facts showing that one of the main etiological factors in the development of peptic ulcer disease is a violation of nerve trophism. An ulcer arises and develops as a result of a disorder in the biochemical processes that ensure the integrity and stability of living structures. The mucous membrane is most susceptible to dystrophies of neurogenic origin, which is probably explained by the high regenerative ability and anabolic processes in the gastric mucosa. Active protein-synthetic function is easily disrupted and can be an early sign of degenerative processes, aggravated by the aggressive peptic effect of gastric juice.

It has been noted that in gastric ulcers the level of hydrochloric acid secretion is close to normal or even reduced. In the pathogenesis of the disease, a decrease in the resistance of the mucous membrane, as well as the reflux of bile into the gastric cavity due to insufficiency of the pyloric sphincter, is of greater importance.

A special role in the development of peptic ulcer is assigned to gastrin and cholinergic postganglionic fibers of the vagus nerve, which are involved in the regulation of gastric secretion.

There is an assumption that histamine is involved in the stimulating effect of gastrin and cholinergic mediators on the acid-forming function of parietal cells, which is confirmed by the therapeutic effect of histamine H2 receptor antagonists (cimetidine, ranitidine, etc.).

Prostaglandins play a central role in protecting the epithelium of the gastric mucosa from the action of aggressive factors. The key enzyme in the synthesis of prostaglandins is cyclooxygenase (COX), present in the body in two forms COX-1 and COX-2.

COX-1 is found in the stomach, kidneys, platelets, and endothelium. Induction of COX-2 occurs under the influence of inflammation; the expression of this enzyme is carried out predominantly by inflammatory cells.

Thus, summarizing the above, we can come to the conclusion that the main links in the pathogenesis of peptic ulcer are neuroendocrine, vascular, immune factors, acid-peptic aggression, protective mucous-hydrocarbonate barrier of the gastric mucosa, helicobacteriosis and prostaglandins.

1.2 Classification

Currently, there is no generally accepted classification of peptic ulcer disease. A large number of classifications based on various principles are proposed. In foreign literature, the term “peptic ulcer” is more often used and a distinction is made between peptic ulcers of the stomach and duodenum. The abundance of classifications emphasizes their imperfection.

According to the WHO classification of the IX revision, gastric ulcer (heading 531), duodenal ulcer (heading 532), ulcer of unspecified localization (heading 533) and, finally, gastrojejunal ulcer of the resected stomach (heading 534) are distinguished. The WHO international classification should be used for accounting and statistical purposes, but for use in clinical practice it must be significantly expanded.

The following classification of peptic ulcer is proposed.

I. General characteristics of the disease (WHO nomenclature)

1. Gastric ulcer (531)

2. Duodenal ulcer (532)

3. Peptic ulcer of unspecified localization (533)

4. Peptic gastrojejunal ulcer after gastrectomy (534)

II. Clinical form

1. Acute or newly diagnosed

2. Chronic

III. Flow

1. Latent

2. Mild or rarely recurrent

3. Moderate or recurrent (1-2 relapses per year)

4. Severe (3 or more relapses within a year) or continuously relapsing; development of complications.

1. Exacerbation (relapse)

2. Fading exacerbation (incomplete remission)

3. Remission

V. Characteristics of the morphological substrate of the disease

1. Types of ulcers a) acute ulcer; b) chronic ulcer

2. Size of the ulcer: a) small (less than 0.5 cm); b) average (0.5--1 cm); c) large (1.1--3 cm); d) gigantic (more than 3 cm).

3. Stages of ulcer development: a) active; b) scarring; c) “red” scar stage; d) “white” scar stage; e) long-term non-scarring

4. Localization of the ulcer:

a) stomach: A: 1) cardia, 2) subcardial section, 3) body of the stomach, 4) antrum, 5) pyloric canal; B: 1) anterior wall, 2) posterior wall, 3) lesser curvature, 4) greater curvature.

b) duodenum: A: 1) bulb, 2) postbulbar part;

B: 1) anterior wall, 2) posterior wall, 3) lesser curvature, 4) greater curvature.

VI. Characteristics of the functions of the gastroduodenal system (only pronounced disorders of secretory, motor and evacuation functions are indicated)

VII. Complications

1. Bleeding: a) mild, b) moderate, c) severe, d) extremely severe

2. Perforation

3. Penetration

4. Stenosis: a) compensated, b) subcompensated, c) decompensated.

5. Malignancy

Based on the presented classification, as an example, we can propose the following formulation of the diagnosis: gastric ulcer, newly diagnosed, acute form, large (2 cm) ulcer of the lesser curvature of the body of the stomach, complicated by mild bleeding.

1.3 Clinical picture and preliminary diagnosis

Judgment about the possibility of a peptic ulcer should be based on the study of complaints, anamnestic data, physical examination of the patient, and assessment of the functional state of the gastroduodenal system.

The typical clinical picture is characterized by a clear connection between the occurrence of pain and food intake. There are early, late and “hunger” pains. Early pain appears 1/2-1 hour after eating, gradually increases in intensity, lasts 1 1/2-2 hours and subsides as gastric contents are evacuated. Late pain occurs 1 1/2-2 hours after eating at the height of digestion, and “hungry” pain occurs after a significant period of time (6-7 hours), i.e. on an empty stomach, and stops after eating. Night pain is close to “hungry”. The disappearance of pain after eating, taking antacids, anticholinergic and antispasmodic drugs, as well as the subsidence of pain during the first week of adequate treatment is a characteristic sign of the disease.

In addition to pain, the typical clinical picture of gastric ulcer includes various dyspeptic symptoms. Heartburn is a common symptom of the disease, occurring in 30-80% of patients. Heartburn may alternate with pain, precede it for a number of years, or be the only symptom of the disease. However, it should be borne in mind that heartburn is often observed in other diseases of the digestive system and is one of the main signs of insufficiency of cardiac function. Nausea and vomiting are less common. Vomiting usually occurs at the height of pain, being a kind of culmination of the pain syndrome, and brings relief. Often, to eliminate pain, the patient himself artificially induces vomiting.

Constipation is observed in 50% of patients with gastric ulcer. They intensify during periods of exacerbation of the disease and are sometimes so persistent that they bother the patient even more than pain.

A distinctive feature of peptic ulcer disease is its cyclical course. Periods of exacerbation, which usually last from several days to 6-8 weeks, are followed by a phase of remission. During remission, patients often feel practically healthy, even without following any diet. Exacerbations of the disease, as a rule, are seasonal; for the middle zone, this is mainly the spring or autumn season.

A similar clinical picture in persons with no previously established diagnosis is more likely to suggest peptic ulcer disease.

Typical ulcerative symptoms are more common when the ulcer is localized in the pyloric part of the stomach (pyloroduodenal form of peptic ulcer). However, it is often observed with an ulcer of the lesser curvature of the body of the stomach (mediogastric form of peptic ulcer). However, in patients with mediogastric ulcers, the pain syndrome is less defined, pain can radiate to the left half of the chest, lumbar region, right and left hypochondrium. Some patients with the mediogastric form of peptic ulcer experience a decrease in appetite and weight loss, which is not typical for pyloroduodenal ulcers.

The greatest clinical features occur in patients with ulcers localized in the cardial or subcardial parts of the stomach.

Laboratory tests have a relative, indicative value in recognizing peptic ulcer disease.

A study of gastric secretion is necessary not so much for diagnosing the disease as for identifying functional disorders of the stomach. Only a significant increase in acid production detected during fractional probing of the stomach (basal HCl secretion rate over 12 mmol/h, HCl rate after submaximal stimulation with histamine over 17 mmol/h and after maximum stimulation over 25 mmol/h) should be taken into account as a diagnostic sign of peptic ulcer disease .

Additional information can be obtained by examining intragastric pH. Peptic ulcer disease, especially pyloroduodenal localization, is characterized by pronounced hyperacidity in the body of the stomach (pH 0.6--1.5) with continuous acid formation and decompensation of alkalization of the environment in the antrum (pH 0.9--2.5). Establishing true achlorhydria practically eliminates this disease.

Clinical blood tests in uncomplicated forms of peptic ulcer usually remain normal; only a number of patients have erythrocytosis due to increased erythropoiesis. Hypochromic anemia may indicate bleeding from gastroduodenal ulcers.

A positive fecal reaction to occult blood is often observed during exacerbations of peptic ulcer disease. However, it should be borne in mind that a positive reaction can be observed in many diseases (tumors of the gastrointestinal tract, nosebleeds, bleeding gums, hemorrhoids, etc.).

Today, the diagnosis of gastric ulcer can be confirmed using x-ray and endoscopic methods.

ulcerative stomach acupressure music therapy

2. Methods of rehabilitation of patients with gastric ulcer

2.1 Physical therapy (physical therapy)

Physical therapy (physical therapy) for peptic ulcers helps regulate the processes of excitation and inhibition in the cerebral cortex, improves digestion, blood circulation, breathing, redox processes, and has a positive effect on the patient’s neuropsychic state.

When performing physical exercises, spare the stomach area. In the acute period of the disease in the presence of pain, exercise therapy is not indicated. Physical exercises are prescribed 2-5 days after the cessation of acute pain.

During this period, the therapeutic exercise procedure should not exceed 10-15 minutes. In a lying position, exercises are performed for the arms and legs with a limited range of motion. Avoid exercises that actively involve the abdominal muscles and increase intra-abdominal pressure.

When the acute phenomena cease, physical activity is gradually increased. To avoid exacerbation, this is done carefully, taking into account the patient’s reaction to the exercises. Exercises are performed in the starting position lying, sitting, standing.

To prevent adhesions against the background of general strengthening movements, exercises for the muscles of the anterior abdominal wall, diaphragmatic breathing, simple and complicated walking, rowing, skiing, outdoor and sports games are used.

Exercises should be performed with caution if they increase pain. Complaints often do not reflect the objective condition, and the ulcer can progress with subjective well-being (disappearance of pain, etc.).

In this regard, when treating patients, one should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. You can gradually expand the patient’s motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing exercises and exercises for the abdominal muscles.

Contraindications to the use of exercise therapy include: bleeding; generating ulcer; acute perivisceritis (perigastritis, periduodenitis); chronic perivisceritis when acute pain occurs during exercise.

A complex of exercise therapy for patients with gastric ulcers is presented in Appendix 1.

2.2 Acupuncture

Gastric ulcer from the point of view of its occurrence, development, as well as from the point of view of the development of effective treatment methods represents a major problem. The scientific search for reliable methods of treating peptic ulcer disease is due to the insufficient effectiveness of known methods of therapy.

Modern ideas about the mechanism of action of acupuncture are based on somato-visceral relationships, carried out both in the spinal cord and in the overlying parts of the nervous system. The therapeutic effect on reflexogenic zones where acupuncture points are located helps to normalize the functional state of the central nervous system, hypothalamus, maintain homeostasis and more quickly normalize the disturbed activity of organs and systems, stimulates oxidative processes, improves microcirculation (through the synthesis of biologically active substances), and blocks pain impulses. In addition, acupuncture increases the body’s adaptive capabilities, eliminates prolonged excitation in various brain centers that control smooth muscles, blood pressure, etc.

The best effect is achieved if acupuncture points located in the zone of segmental innervation of the affected organs are irritated. Such zones for peptic ulcer disease are D4-7.

The study of the general condition of patients, the dynamics of laboratory, radiological, and endoscopic examinations give the right to objectively evaluate the acupuncture method used, its advantages and disadvantages, and to develop indications for differentiated treatment of patients with peptic ulcer disease. They showed a pronounced analgesic effect in patients with persistent pain symptoms.

Analysis of indicators of gastric motor function also revealed a clear positive effect of acupuncture on tone, peristalsis and gastric evacuation.

Treatment of patients with gastric ulcer with acupuncture has a positive effect on the subjective and objective picture of the disease, and relatively quickly eliminates pain and dyspeptic symptoms. When used in parallel with the achieved clinical effect, normalization of the secretory, acid-forming and motor functions of the stomach occurs.

2.3 Acupressure

Acupressure is used for gastritis and stomach ulcers. Acupressure is based on the same principle as when carrying out the method of acupuncture, moxibustion (Zhen-Jiu therapy) - with the only difference that the BAP (biologically active points) are affected with a finger or brush.

To resolve the issue of using acupressure, a detailed examination and establishment of an accurate diagnosis is necessary. This is especially important for chronic gastric ulcers due to the risk of malignant degeneration. Acupressure is unacceptable for ulcerative bleeding and is possible no earlier than 6 months after its cessation. A contraindication is also cicatricial narrowing of the gastric outlet (pyloric stenosis) - a gross organic pathology in which there is no expectation of a therapeutic effect.

1st session: 20, 18, 31, 27, 38;

2nd session: 22, 21, 33, 31, 27;

3rd session: 24, 20, 31, 27, 33.

The first 5-7 sessions, especially during an exacerbation, are carried out daily, the rest - after 1-2 days (12-15 procedures in total). Repeated courses are carried out according to clinical indications after 7-10 days. Before seasonal exacerbations of peptic ulcer disease, preventive courses of 5-7 sessions every other day are recommended.

In case of increased acidity of gastric juice with heartburn, points 22 and 9 should be included in the recipe.

In case of stomach atony, low acidity of gastric juice, poor appetite, after a mandatory X-ray or endoscopic examination, you can conduct a course of acupressure using the exciting method of points 27, 31, 37, combining it with massage using the inhibitory method of points 20, 22, 24, 33.

2.4 Physiotherapy

Physiotherapy is the use of natural and artificially generated physical factors, such as electric current, magnetic field, laser, ultrasound, etc., for therapeutic and preventive purposes. Various types of radiation are also used: infrared, ultraviolet, polarized light.

Basic principles of using physiotherapy in the treatment of patients with peptic ulcers:

a) selection of mild procedures;

b) use of small dosages;

c) gradual increase in the intensity of exposure to physical factors;

d) rational combination of them with other therapeutic measures.

As active background therapy to influence the increased reactivity of the nervous system, methods such as:

Low-frequency pulse currents using the electrosleep technique;

Central electroanalgesia using a tranquilizing technique (using LENAR devices);

UHF on the collar zone; galvanic collar and bromine electrophoresis.

Of the methods of local therapy (i.e., effects on the epigastric and paravertebral zones), the most popular remains galvanization in combination with the introduction of various medicinal substances by electrophoresis (novocaine, benzohexonium, platiphylline, zinc, dalargin, solcoseryl, etc.).

2.5 Drinking mineral waters

Drinking mineral waters of various chemical compositions affect the regulation of the functional activity of the gastro-duodenal system.

It is known that the secretion of pancreatic juice and the secretion of bile under physiological conditions are carried out as a result of the induction of secretin and pancreozymin. It logically follows that mineral waters help stimulate these intestinal hormones, which have a trophic effect. To carry out these processes, a certain time is required - from 60 to 90 minutes, and therefore, in order to use all the medicinal properties inherent in mineral waters, it is advisable to prescribe them 1-1.5 hours before meals. During this period, water can penetrate the duodenum and have an inhibitory effect on the excited secretion of the stomach.

Warm (38-40° C) low-mineralized waters, which can relax the spasm of the pylorus and quickly evacuate into the duodenum, have a similar effect. When mineral waters are prescribed 30 minutes before meals or at the height of digestion (30-40 minutes after meals), their local antacid effect is mainly manifested and those processes that are associated with the influence of water on endocrine and nervous regulation do not have time to occur, Thus, many aspects of the healing effect of mineral waters are lost. This method of prescribing mineral waters is justified in a number of cases for patients with duodenal ulcer with sharply increased acidity of gastric juice and severe dyspeptic syndrome in the phase of a fading exacerbation of the disease.

For patients with impaired motor-evacuation function of the stomach, taking mineral waters is not indicated, since the ingested water is retained in the stomach for a long time along with food and will have a juice effect instead of an inhibitory one.

For patients with peptic ulcers, alkaline weakly and moderately mineralized waters are recommended (mineralization, respectively, 2-5 g/l and more than 5-10 g/l), sodium bicarbonate carbonate, sodium-calcium carbonate bicarbonate-sulfate, bicarbonate-chloride carbonate, sodium sulfate, magnesium-sodium, for example: Borjomi, Smirnovskaya, Slavyanovskaya, Essentuki No. 4, Essentuki Novaya, Pyatigorsk Narzan, Berezovskaya, Moscow mineral water and others.

2.6 Balneotherapy

External use of mineral waters in the form of baths is an active background therapy for patients with gastric ulcers. They have a beneficial effect on the state of the central and autonomic nervous systems, endocrine regulation, and the functional state of the digestive organs. In this case, baths from mineral waters available at the resort or from artificially created waters can be used. These include chloride, sodium, carbon dioxide, iodine-bromine, oxygen, etc.

Chloride and sodium baths are indicated for patients with gastric ulcers, any severity of the disease in the phase of a fading exacerbation, incomplete and complete remission of the disease.

Radon baths are also actively used. They are available at gastrointestinal resorts (Pyatigorsk, Essentuki, etc.). To treat this category of patients, radon baths of low concentrations are used - 20-40 nCi/l. They have a positive effect on the state of neurohumoral regulation in patients and on the functional state of the digestive organs. The most effective in influencing trophic processes in the stomach are radon baths at concentrations of 20 and 40 nCi/l. They are indicated for any stage of the disease, for patients in the phase of fading exacerbation, incomplete and complete remission, concomitant lesions of the nervous system, blood vessels and other diseases for which radon therapy is indicated.

For patients with peptic ulcer disease with concomitant diseases of the joints of the central and peripheral nervous system, female genital organs, especially with inflammatory processes and ovarian dysfunction, it is advisable to prescribe treatment with iodine-bromine baths; it is good to prescribe them to patients of an older age group. Pure iodine-bromine waters do not exist in nature. Use artificial iodine-bromine baths at a temperature of 36-37°C for 10-15 minutes, for a course of treatment 8-10 baths, released every other day, it is advisable to alternate with peloid applications, or physiotherapeutic procedures, the choice of which is determined by both the general condition of the patients and concomitant diseases gastrointestinal tract, cardiovascular and nervous systems.

2.7 Music therapy

It has been proven that music can do a lot. Calm and melodic, it will help you relax faster and better, and restore strength; cheerful and rhythmic raises tone and improves mood. Music will relieve irritation and nervous tension, activate thought processes and increase performance.

The healing properties of music have been known for a long time. In the VI century. BC. The great ancient Greek thinker Pythagoras used music for medicinal purposes. He preached that a healthy soul requires a healthy body, and both require constant musical influence, concentration in oneself and ascent to the highest regions of existence. More than 1000 years ago, Avicenna recommended diet, work, laughter and music as treatments.

According to their physiological effect, melodies can be soothing, relaxing or tonic, invigorating.

The relaxing effect is useful for stomach ulcers.

For music to have a healing effect, it must be listened to in this way:

1) lie down, relax, close your eyes and completely immerse yourself in the music;

2) try to get rid of any thoughts expressed in words;

3) remember only pleasant moments in life, and these memories should be figurative in nature;

4) a recorded musical program must last at least 20-30 minutes, but no more;

5) you should not fall asleep;

6) after listening to a music program, it is recommended to do breathing exercises and several physical exercises.

2.8 Mud therapy

Among the methods of treating gastric ulcers, mud therapy occupies one of the leading places. Therapeutic mud affects metabolism and bioenergetic processes in the body, enhances microcirculation of the stomach and liver, improves gastric motility, reduces acidification of the duodenum, stimulates the reparative processes of the gastroduodenal mucosa, and activates the activity of the endocrine system. Mud therapy has an analgesic and anti-inflammatory effect, improves metabolism, changes the body's reactivity, and its immunobiological properties.

Silt mud is used at a temperature of 38-40°C, peat mud at 40-42°C, the duration of the procedure is 10-15-20 minutes, every other day, for a course of 10-12 procedures.

This mud therapy technique is indicated for patients with gastric ulcer in the phase of fading exacerbation, incomplete and complete remission of the disease, with severe pain syndrome, with concomitant diseases in which the use of physical factors on the collar area is indicated.

In case of severe pain, you can use the method of combining mud applications with reflexology (electropuncture). Where it is not possible to use mud therapy, you can use ozokerite and paraffin therapy.

2.9 Diet therapy

Dietary nutrition is the main background of any antiulcer therapy. The principle of fractional (4-6 meals a day) meals must be observed regardless of the phase of the disease.

Basic principles of therapeutic nutrition (principles of “first tables” according to the classification of the Institute of Nutrition): 1. good nutrition; 2. maintaining the rhythm of eating; 3. mechanical; 4. chemical; 5. thermal sparing of the gastroduodenal mucosa; 6. gradual expansion of the diet.

The approach to dietary therapy for peptic ulcer disease is currently marked by a departure from strict to gentle diets. Mainly pureed and non-mashed versions of diet No. 1 are used.

Diet No. 1 includes the following products: meat (veal, beef, rabbit), fish (pike perch, pike, carp, etc.) in the form of steamed cutlets, quenelles, soufflés, beef sausages, boiled sausage, occasionally - lean ham, soaked herring (the taste and nutritional properties of herring increase if it is soaked in whole cow's milk), as well as milk and dairy products (whole milk, dry, condensed milk, fresh non-sour cream, sour cream and cottage cheese). If tolerated well, yogurt and acidophilus milk can be recommended. Eggs and dishes made from them (soft-boiled eggs, steam omelette) - no more than 2 pieces per day. Raw eggs are not recommended, as they contain avidin, which irritates the gastric mucosa. Fats - unsalted butter (50-70 g), olive or sunflower (30-40 g). Sauces - milk, snacks - mild, grated cheese. Soups - vegetarian from cereals, vegetables (except cabbage), milk soups with vermicelli, noodles, pasta (well boiled). You need to salt food in moderation (8-10 g of salt per day).

Fruits, berries (sweet varieties) are given in the form of puree, jelly, if tolerated, compotes and jelly, sugar, honey, jam. Non-acidic vegetable, fruit, and berry juices are indicated. Grapes and grape juices are poorly tolerated and can cause heartburn. If tolerance is poor, juices should be added to cereals, jelly or diluted with boiled water.

Not recommended: pork, lamb, duck, goose, strong broths, meat soups, vegetable and especially mushroom broths, undercooked, fried, fatty and dried meats, smoked meats, salted fish, hard-boiled eggs or scrambled eggs, skim milk, strong tea, coffee, cocoa, kvass, all alcoholic drinks, carbonated water, pepper, mustard, horseradish, onions, garlic, bay leaves, etc.

You should abstain from cranberry juice. For drinks, we can recommend weak tea, tea with milk or cream.

2.10 Herbal medicine

For most patients suffering from gastric ulcers, it is advisable to include in complex treatment decoctions and infusions of medicinal herbs, as well as special antiulcer mixtures consisting of many medicinal plants. Herbs and folk recipes used for stomach ulcers:

1. Collection: Chamomile flowers - 10 g; fennel fruits - 10 gr.; marshmallow root - 10 g; wheatgrass root - 10 g; licorice root - 10 gr. 2 teaspoons of the mixture per 1 cup of boiling water. Infuse, wrap, strain. Take one glass of infusion at night.

2. Collection: Fireweed leaves - 20 gr.; linden blossom - 20 gr.; chamomile flowers - 10 gr.; fennel fruits - 10 gr. 2 teaspoons of the mixture per glass of boiling water. Leave it wrapped and strain. Take 1 to 3 glasses throughout the day.

3. Collection: Crayfish necks, roots - 1 part; plantain, leaf - 1 part; horsetail - 1 part; St. John's wort - 1 part; valerian root - 1 part; chamomile - 1 part. A tablespoon of the mixture per glass of boiling water. Steam for 1 hour. Take 3 times a day before meals.

4. Collection:: Series -100 gr.; celandine -100 gr.; St. John's wort -100 gr.; plantain -200 gr. A tablespoon of the mixture per glass of boiling water. Leave covered for 2 hours, strain. Take 1 tablespoon 3-4 times a day, an hour before or 1.5 hours after meals.

5. Freshly squeezed juice from cabbage leaves, when taken regularly, cures chronic gastritis and ulcers better than all medications. Preparing juice at home and taking it: the leaves are passed through a juicer, filtered and the juice is squeezed out. Take 1/2-1 glass warmed 3-5 times a day before meals.

Conclusion

So, in the course of my work I found out that:

2. Therapeutic exercise, acupressure, physiotherapy, music therapy, balneotherapy, mud therapy, diet therapy, herbal medicine A pia, acupuncture and other physical methods are integral, integral parts of rehabilitation And ational measures for patients with stomach ulcer. Their main the goal is to develop longer period of remission of the disease. Each method used in treatment has its own specific effect. I nium, but today the use of acupressure and music therapy is considered the most effective, due to the neurogenic nature of the onset of the disease. The use of acupressure and music eliminates vegetative-vascular disorders, has a beneficial effect on the secretory and motor functions of the stomach, and reduces pain.

It is obvious that non-drug approaches in the treatment of peptic ulcer disease are represented by a fairly wide range of effects, which should be more actively used today, when Medicinal options are limited by the high cost of drugs. In addition, non-pharmacological treatment approaches have a pronounced overall effect, which cannot be achieved by the narrowly targeted action of drugs, so using them in combination, you can get a comprehensive effect.

List of used literature

1. Abdurakhmanov, A.A. Peptic ulcer of the stomach and duodenum. - Tashkent, 1973. - 329 p.

2. Alabastrov A.P., Butov M.A. Possibilities of alternative non-drug therapy for gastric ulcer. // Clinical Medicine, 2005. - No. 11. - P. 32 -26.

3. Baranovsky A.Yu. Rehabilitation of gastroenterological patients in the work of a therapist and family doctor. - St. Petersburg: Foliot, 2001. - 231 p.

4. Belaya N.A. Massotherapy. Educational and methodological manual. - M.: Progress, 2001. - 297 p.

5. Biryukov A.A. Therapeutic massage: Textbook for universities. - M.: Academy, 2002. - 199 p.

6. Vasilenko V.Kh., Grebnev A.L. Diseases of the stomach and duodenum. - M.: Medicine, 2003. - 326 p.

7. Vasilenko V.Kh., Grebenev A.L., Sheptulin A.A. Peptic ulcer disease. - M.: Medicine, 2000. - 294 p.

8. Virsaladze K.S. Epidemiology of gastric and duodenal ulcers // Clinical Medicine, 2000.- No. 10. - P. 33-35.

9. Gaichenko P.I. Treatment of gastric ulcers. - Dushanbe: 2000. - 193 p.

10. Degtyareva I.I., Kharchenko N.V. Peptic ulcer disease. - K.: Healthy, 2001. - 395 p.

11. Epifanov V.A. Therapeutic physical training and massage. - M.: Academy, 2004.- 389 p.

12. Ermakov E.V. Clinic for gastric and duodenal ulcers. - M.: Ter. archive, 1981.- No. 2. - pp. 15 - 19.

13. Ivanchenko V.A. Natural medicine. - M.: Project, 2004. - 384 p.

14. Kaurov, A.F. Some materials on the epidemiology of peptic ulcer disease. - Irkutsk, 2001. - 295 p.

15. Kokurkin G.V. Reflexology for peptic ulcers of the stomach and duodenum. - Cheboksary, 2000. - 132 p.

16. Komarov F.I. Treatment of peptic ulcer. - M.: Ter. archive, 1978.- No. 18. - P. 138 - 143.

17. Kulikov A.G. The role of physical factors in the treatment of inflammatory and erosive-ulcerative diseases of the stomach and duodenum // Physiotherapy, balneology and rehabilitation, 2007. - No. 6. - P. 3 - 8.

18. Leporsky A.A. Therapeutic exercise for digestive diseases. - M.: Progress, 2003. - 234 p.

19. Physical therapy in the system of medical rehabilitation / Ed. A.F. Kaptelina, I.P. Lebedeva.- M.: Medicine, 1995. - 196 p.

20. Physical therapy and medical supervision / Ed. IN AND. Ilyinich. - M.: Academy, 2003. - 284 p.

21. Physical therapy and medical supervision / Ed. V.A. Epifanova, G.A. Apanasenko. - M.: Medicine, 2004. - 277 p.

22. Loginov A.S. Identification of risk groups and a new level of disease prevention \\ Active issues of gastroenterology, 1997.- No. 10. - P. 122-128.

23. Loginov A.S. Issues of practical gastroenterology. - Tallinn. 1997.- 93 p.

24. Lebedeva R.P. Genetic factors and some clinical aspects of peptic ulcer \\ Current issues of gastroenterology, 2002.- No. 9. - P. 35-37.

25. Lebedeva, R.P. Treatment of peptic ulcer \\ Current issues of gastroenterology, 2002.- No. 3. - P. 39-41

26. Lapina T.L. Erosive and ulcerative lesions of the stomach \\ Russian Medical Journal, 2001 - No. 13. - pp. 15-21

27. Lapina T.L. Treatment of erosive and ulcerative lesions of the stomach and duodenum \\ Russian Medical Journal, 2001 - No. 14 - P. 12-18

28. Magzumov B.X. Social genetic aspects of studying the incidence of gastric and duodenal ulcers. - Tashkent: Sov. healthcare, 1979.- No. 2. - P. 33-43.

29. Minushkin O.N. Gastric ulcer and its treatment \\ Russian Medical Journal. - 2002. - No. 15. - P. 16 - 25

30. Rastaporov A.A. Treatment of gastric ulcer and duodenal ulcer \\ Russian Medical Journal. - 2003. - No. 8 - P. 25 - 27

31. Nikitin Z.N. Gastroenterology - rational methods of treating ulcerative lesions of the stomach and duodenum \\ Russian Medical Journal. - 2006 - No. 6. - pp. 16-21

32. Parkhotik I.I. Physical rehabilitation for diseases of the abdominal organs: Monograph. - Kyiv: Olympic Literature, 2003. - 295 p.

33. Ponomarenko G.N., Vorobyov M.G. Physiotherapy manual. - St. Petersburg, Baltika, 2005. - 148 p.

34. Rezvanova P.D. Physiotherapy. - M.: Medicine, 2004. - 185 p.

35. Samson E.I., Trinyak N.G. Therapeutic exercise for diseases of the stomach and intestines. - K.: Health, 2003. - 183 p.

36. Safonov A.G. State and prospects for the development of gastroenterological care to the population. - M.: Ter. archive, 1973.- No. 4. - P. 3-8.

37. Stoyanovsky D.V. Acupuncture. - M.: Medicine, 2001. - 251 p.

38. Timerbulatov V.M. Diseases of the digestive system. - Ufa. Healthcare of Bashkortostan. 2001.- 185 p.

39. Three N.F. Peptic ulcer disease. Medical practice - M.: Progress, 2001. - 283 p.

40. Uspensky V.M. Pre-ulcerative condition as the initial stage of peptic ulcer disease (pathogenesis, clinical picture, diagnosis, treatment, prevention). - M.: Medicine, 2001. - 89 p.

41. Ushakov A.A. Practical physiotherapy. - 2nd ed., rev. and additional - M.: Medical Information Agency, 2009. - 292 p.

42. Physical rehabilitation / Under the general editorship. S.N. Popova. - Rostov n/d: Phoenix, 2003. - 158 p.

43. Fisher A.A. Peptic ulcer disease. - M.: Medicine, 2002. - 194 p.

44. Frolkis A.V., Somova E.P. Some issues of inheritance of the disease. - M.: Academy, 2001. - 209 p.

45. Chernin V.V. Diseases of the esophagus, stomach and duodenum (a guide for doctors). - M.: Medical Information Agency, 2010. - 111 p.

46. ​​Shcherbakov P.L. Treatment of gastric ulcer // Russian Medical Journal, 2004 - No. 12. - P. 26-32

47. Shcherbakov P.L. Gastric ulcer // Russian Medical Journal, 2001 - No. 1- P. 32-45.

48. Shcheglova N.D. Peptic ulcer of the stomach and duodenum. - Dushanbe, 1995.- pp. 17-19.

49. Elyptein N.V. Diseases of the digestive system. - M.: Academy, 2002.- 215 p.

50. Efendieva M.T. Physiotherapy for gastroesophageal reflux disease. // Issues of balneology, physiotherapy and therapeutic physical culture. 2002. - No. 4. - P. 53 - 54.

Annex 1

Exercise therapy procedure for patients with gastric ulcer (V. A. Epifanov, 2004)

Appendix 2

BAP scheme for acupressure for gastric ulcers

Posted on Allbest.ru

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Basic data on gastric and duodenal ulcers, their etiology and pathogenesis, clinical picture, complications. Features of diagnostics. Characteristics of a complex of rehabilitation measures for the recovery of patients with peptic ulcer disease.

Peptic ulcer disease is one of the most common ­ nious diseases of the digestive system. The disease is characterized by a long course, a tendency to relapse and exacerbation, which increases the degree of economic damage from this disease. Gastric ulcer and two ­ duodenum is a chronic, cyclical, recurrent disease characterized by ulceration in the gastroduodenal zone.

The etipathogenesis of peptic ulcer disease is quite complex and until now there is no single position on this issue. At the same time, it has been established that the development of peptic ulcer disease is promoted by various lesions of the nervous system (acute psychological trauma, physical and especially mental overstrain, various nervous diseases). It should also be noted the importance of the hormonal factor, in particular the disruption of the production of digestive hormones (gastrin, secretin, etc.), as well as a disturbance in the metabolism of histamine and serotonin, under the influence of which the activity of the acid-peptic factor increases. Violation of diet and food composition is of certain importance. In recent years, more and more attention has been given to the infectious (viral) nature of this disease. Hereditary and constitutional factors also play a certain role in the development of peptic ulcer disease.

Clinical manifestations peptic ulcers are very diverse. Its main symptom is pain, most often in the epigastric region; with an ulcer in the duodenum, pain is usually localized to the right of the midline of the abdomen. Depending on the location of the ulcer, pain can be early (0.5-1 hour after eating) and late (1.5-2 hours after eating). Sometimes there are pains on an empty stomach, as well as night pains. Quite common clinical symptoms of peptic ulcer disease are heartburn, which, like pain, can be rhythmic in nature; sour belching and vomiting, also with sour contents, are quite often observed, usually after eating. During a peptic ulcer there are four phases: exacerbation, fading exacerbation, incomplete remission And complete remission. The most dangerous complication of peptic ulcer disease is perforation of the stomach wall, accompanied by acute “dagger” pain in the abdomen and signs of inflammation of the peritoneum. This requires immediate surgical intervention.

The complex of rehabilitation measures includes medications, motor regimen, exercise therapy and other physical methods of treatment, massage, and nutritional therapy. Exercise therapy and massage improve or normalize neurotrophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

Exercise therapy classes at bed rest prescribed in the absence of contraindications (severe pain, ulcerative bleeding). This usually coincides with 2-4 days after hospitalization. The tasks of this period include:

1 assistance in regulating the processes of excitation and inhibition in the cerebral cortex;

2 improvement of redox processes.

3 counteracting constipation and congestion in the intestines;

4 improvement of circulatory and respiratory functions.

The period lasts about two weeks. At this time, static breathing exercises are indicated, which enhance inhibition processes in the cerebral cortex. Performed in the initial position lying on the back with relaxation of all muscle groups, these exercises are able to put the patient into a drowsy state, help reduce pain, eliminate dyspeptic disorders, and normalize sleep. Simple gymnastic exercises for small and medium muscle groups are also used, with a small number of repetitions in combination with breathing exercises and relaxation exercises, but exercises that increase intra-abdominal pressure are contraindicated. The duration of the classes is 12-15 minutes, the pace of the exercises is slow, the intensity is low.

Rehabilitation of the second period is prescribed when the patient is transferred to ward mode. The tasks of the first period include the tasks of household and work rehabilitation of the patient, restoration of correct posture when walking, and improvement of coordination of movements. The second period of classes begins with a significant improvement in the patient’s condition. UGG, LH, abdominal wall massage are recommended. The exercises are performed in a lying position, sitting, on the knees, standing with gradually increasing effort for all muscle groups, still excluding the abdominal muscles (Fig. 26). The most acceptable position is lying on your back: it allows you to increase the mobility of the diaphragm, has a gentle effect on the abdominal muscles and helps improve blood circulation in the abdominal cavity. Patients perform exercises for the abdominal muscles without tension, with a small number of repetitions.

If the gastric evacuation function is slow, the LH complexes should include more exercises lying on the right side, and if it is moderate - on the left side. During this period, patients are also recommended massage, sedentary games, and walking. The average duration of a lesson in a ward mode is 15-20 minutes, the pace of exercise is slow, the intensity is low. Therapeutic gymnastics is carried out 1-2 times a day.

The tasks of the third period include: general strengthening and healing of the patient’s body; improvement of blood and lymph circulation in the abdominal cavity; restoration of household and work skills. In the phase of incomplete and complete remission, in the absence of complaints and the general good condition of the patient, a free regimen is prescribed. Exercises are used for all muscle groups, exercises with light weights (up to 1.5-2 kg), coordination, outdoor and sports games. The density of the lesson is average, the duration increases to 30 minutes.

In sanatorium-resort conditions, the volume and intensity of exercise therapy classes increases, all means and methods of exercise therapy are shown. Recommended for GG in combination with hardening procedures; group classes of physical training (ORU, DU, exercises with objects); dosed walking, walks (up to 4-5 km); sports and outdoor games; skiing; occupational therapy. Therapeutic massage is also used: from behind - segmental massage in the back area from C 4 to D 9 on the left, in front - in the epigastric region, the location of the costal arches. The massage should be gentle at first. The intensity of the massage and the duration of the procedure gradually increases from 8-10 to 20-25 minutes towards the end of the treatment.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Marina asks:

How is rehabilitation carried out after a stomach ulcer?

Currently, rehabilitation after a stomach ulcer is carried out using the following methods:

• Physiotherapy;
• Acupuncture;
• Acupressure;
• Sanatorium-resort treatment using mineral waters (balneotherapy);
• Mud therapy;
• Diet therapy;

The following exercises have an excellent rehabilitation effect:

• Rhythmic walking in place;
• Breathing exercises in a sitting position;
• Exercises for arms in a sitting position;
• Throwing and catching a sword in a standing position;
• Arm exercises in a lying position.

Acupressure represents the impact on various biologically active points with your fingers. The principle of acupressure is the same as that of acupuncture. Massage of active points should be carried out daily. Moreover, it is better to find out the necessary points from an acupuncturist and ask him to teach you how to massage them correctly.

Physiotherapy has a positive effect in rehabilitation after a stomach ulcer. The following methods are used for rehabilitation:

• Electricity;
• Ultrasound;
• Infrared, ultraviolet radiation;
• Polarized light;
• Electrophoresis on the epigastric region with Novocaine, Platiphylline, Zinc, Dalargin, Solcoseryl.

Mud therapy indicated during the period of attenuation of an exacerbation of a stomach ulcer. For treatment, silt mud is used at a temperature of 38-40 o C. The procedure is carried out at the beginning for 10 minutes, then extends to 20 minutes. The course of therapy consists of 10 – 12 procedures.

Diet therapy is based on compliance with table No. 1. Meals should be fractional (5 - 6 times a day) and in small portions. The diet must be based on lean meat and fish, from which cutlets, meatballs, soufflés, quenelles and steamed zrazy are prepared. Boiled sausages and sausages are also acceptable. In addition, the diet includes dishes made from cottage cheese (casseroles, souffles, cheesecakes, lazy dumplings) and other dairy products. Soups should be vegetarian, slimy, with a dressing of boiled pureed vegetables and well-cooked cereals. Porridges should be semi-liquid. Eggs can be boiled soft-boiled or in the form of a steam omelet. Fruits and berries are consumed in the form of purees, jelly, mousses, jellies, compotes, jam, etc. You should eat yesterday's bread made from white flour. Dry cookies, biscuits, and savory buns are also allowed.

Mushrooms, broths, fatty meats and fish, poorly cooked lean meats, anything fried, strong tea, coffee, carbonated water, hot seasonings (mustard, horseradish, onions, garlic) and raw vegetables with coarse fiber (cabbage, turnips, etc.) are excluded from the diet. radish, bell pepper, etc.). You should also not eat anything smoked, canned, spicy, fatty, pickled or pickled.

Phytotherapy helps accelerate the onset of remission or prevent exacerbation of stomach ulcers. Cabbage and potato juice has an excellent effect. Cabbage juice is taken 1 glass 3 times a day, before meals. Take half a glass of potato juice 20 minutes before meals.

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Introduction

Anatomical, physiological, pathophysiological and clinical features of the disease

1 Etiology and pathogenesis of gastric ulcer

2 Classification

3 Clinical picture and preliminary diagnosis

Methods of rehabilitation of patients with gastric ulcer

1 Physical therapy (physical therapy)

2 Acupuncture

3 Acupressure

4 Physiotherapy

5 Drinking mineral waters

6 Balneotherapy

7 Music therapy

8 Mud therapy

9 Diet therapy

10 Herbal medicine

Conclusion

List of used literature

Applications

Introduction

In recent years, there has been a tendency towards an increase in the incidence of the population, among which gastric ulcer has become widespread.

According to the traditional definition of the World Health Organization (WHO), peptic ulcer disease (ulcus ventriculi et duodenipepticum, morbus ulcerosus) is a general chronic relapsing disease prone to progression, with a polycyclic course, the characteristic features of which are seasonal exacerbations, accompanied by the appearance of an ulcerative defect in the mucous membrane, and the development of complications that threaten the patient’s life. A feature of the course of gastric ulcer is the involvement of other organs of the digestive system in the pathological process, which requires timely diagnosis for the preparation of treatment complexes for patients with peptic ulcer, taking into account concomitant diseases. Gastric ulcer affects people of the most active, working age, causing temporary and sometimes permanent loss of ability to work.

High morbidity, frequent relapses, long-term disability of patients, resulting in significant economic losses - all this allows us to classify the problem of peptic ulcer disease as one of the most pressing in modern medicine.

Rehabilitation occupies a special place in the treatment of patients with peptic ulcer disease. Rehabilitation is the restoration of health, functional status and ability to work, impaired by diseases, injuries or physical, chemical and social factors. The World Health Organization (WHO) gives a definition of rehabilitation very close to this: “Rehabilitation is a set of activities designed to ensure that persons with disabilities as a result of disease, injury and birth defects adapt to new living conditions in the society in which they live.”

According to WHO, rehabilitation is a process aimed at comprehensive assistance to sick and disabled people so that they achieve the maximum possible physical, mental, professional, social and economic usefulness for a given disease.

Thus, rehabilitation should be considered as a complex socio-medical problem, which can be divided into several types or aspects: medical, physical, psychological, professional (labor) and socio-economic.

As part of this work, I consider it necessary to study physical methods of rehabilitation for gastric ulcers, focusing on acupressure and music therapy, which determines the purpose of the study.

Object of study: gastric ulcer.

Subject of research: physical methods of rehabilitation of patients with gastric ulcer.

The tasks are aimed at consideration:

-anatomical, physiological, pathophysiological and clinical features of the course of the disease;

-methods of rehabilitation of patients with gastric ulcer.

1. Anatomical, physiological, pathophysiological and clinical features of the disease

.1 Etiology and pathogenesis of gastric ulcer

Gastric ulcer is characterized by the formation of ulcers in the stomach due to a disorder of the general and local mechanisms of nervous and humoral regulation of the main functions of the gastroduodenal system, disruption of trophism and activation of proteolysis of the gastric mucosa and often the presence of Helicobacter pylori infection. At the final stage, an ulcer occurs as a result of a violation of the relationship between aggressive and protective factors with a predominance of the former and a decrease in the latter in the gastric cavity.

Thus, the development of peptic ulcer disease, according to modern concepts, is caused by an imbalance between the effects of aggressive factors and defense mechanisms that ensure the integrity of the gastric mucosa.

Factors of aggression include: increased concentration of hydrogen ions and active pepsin (proteolytic activity); Helicobacter pylori infection, the presence of bile acids in the cavity of the stomach and duodenum.

The protective factors include: the amount of protective mucus proteins, especially insoluble and premucosal, secretion of bicarbonates (“alkaline tide”); resistance of the mucous membrane: proliferative index of the mucous membrane of the gastroduodenal zone, local immunity of the mucous membrane of this zone (the amount of secretory IgA), the state of microcirculation and the level of prostaglandins in the gastric mucosa. With peptic ulcer and non-ulcer dyspepsia (gastritis B, pre-ulcerative condition), aggressive factors sharply increase and protective factors in the gastric cavity decrease.

Based on currently available data, the main and predisposing factors have been identified diseases.

The main factors include:

-disturbances of humoral and neurohormonal mechanisms regulating digestion and tissue reproduction;

-disorders of local digestive mechanisms;

-changes in the structure of the mucous membrane of the stomach and duodenum.

Predisposing factors include:

-hereditary constitutional factor. A number of genetic defects have been identified that occur in certain stages of the pathogenesis of this disease;

-Helicobacter pylori infestation. Some researchers in our country and abroad consider Helicobacter pylori infection to be the main cause of peptic ulcers;

-environmental conditions, primarily neuropsychic factors, nutrition, bad habits;

-medicinal effects.

From a modern point of view, some scientists consider peptic ulcer disease as a polyetiological multifactorial disease . However, I would like to emphasize the traditional direction of the Kiev and Moscow therapeutic schools, which believe that the central place in the etiology and pathogenesis of peptic ulcer disease belongs to disorders of the nervous system that arise in its central and autonomic parts under the influence of various influences (negative emotions, overexertion during mental and physical work , viscero-visceral reflexes, etc.).

There is a large number of works indicating the etiological and pathogenetic role of the nervous system in the development of peptic ulcer disease. The spasmogenic or neurovegetative theory was the first to be created .

Works by I.P. Pavlov's ideas about the role of the nervous system and its higher part - the cerebral cortex - in the regulation of all vital functions of the body (the ideas of nervism) are reflected in new views on the process of development of peptic ulcer disease: this is the cortico-visceral theory K.M. Bykova, I.T. Kurtsina (1949, 1952) and a number of works indicating the etiological role of disruption of neurotrophic processes directly in the mucous membrane of the stomach and duodenum in peptic ulcer disease.

According to the cortico-visceral theory, peptic ulcer disease is the result of disturbances in the cortico-visceral relationship. Progressive in this theory is the proof of two-way communication between the central nervous system and internal organs, as well as the consideration of peptic ulcer disease from the point of view of a disease of the whole organism, in the development of which a disorder of the nervous system plays a leading role. The disadvantage of the theory is that it does not explain why the stomach is affected when the cortical mechanisms are disrupted.

Currently, there are several fairly convincing facts showing that one of the main etiological factors in the development of peptic ulcer disease is a violation of nerve trophism. An ulcer arises and develops as a result of a disorder in the biochemical processes that ensure the integrity and stability of living structures. The mucous membrane is most susceptible to dystrophies of neurogenic origin, which is probably explained by the high regenerative ability and anabolic processes in the gastric mucosa. Active protein-synthetic function is easily disrupted and can be an early sign of degenerative processes, aggravated by the aggressive peptic effect of gastric juice.

It has been noted that in gastric ulcers the level of hydrochloric acid secretion is close to normal or even reduced. In the pathogenesis of the disease, a decrease in the resistance of the mucous membrane, as well as the reflux of bile into the gastric cavity due to insufficiency of the pyloric sphincter, is of greater importance.

A special role in the development of peptic ulcer is assigned to gastrin and cholinergic postganglionic fibers of the vagus nerve, which are involved in the regulation of gastric secretion.

There is an assumption that histamine is involved in the stimulating effect of gastrin and cholinergic mediators on the acid-forming function of parietal cells, which is confirmed by the therapeutic effect of histamine H2 receptor antagonists (cimetidine, ranitidine, etc.).

Prostaglandins play a central role in protecting the epithelium of the gastric mucosa from the action of aggressive factors. The key enzyme in the synthesis of prostaglandins is cyclooxygenase (COX), present in the body in two forms COX-1 and COX-2.

COX-1 is found in the stomach, kidneys, platelets, and endothelium. Induction of COX-2 occurs under the influence of inflammation; the expression of this enzyme is carried out predominantly by inflammatory cells.

Thus, summarizing the above, we can come to the conclusion that the main links in the pathogenesis of peptic ulcer are neuroendocrine, vascular, immune factors, acid-peptic aggression, protective mucous-hydrocarbonate barrier of the gastric mucosa, helicobacteriosis and prostaglandins.

.2 Classification

Currently, there is no generally accepted classification of peptic ulcer disease. A large number of classifications based on various principles are proposed. In foreign literature, the term “peptic ulcer” is more often used and a distinction is made between peptic ulcers of the stomach and duodenum. The abundance of classifications emphasizes their imperfection.

According to the WHO classification of the IX revision, gastric ulcer (heading 531), duodenal ulcer (heading 532), ulcer of unspecified localization (heading 533) and, finally, gastrojejunal ulcer of the resected stomach (heading 534) are distinguished. The WHO international classification should be used for accounting and statistical purposes, but for use in clinical practice it must be significantly expanded.

The following classification of peptic ulcer disease is proposed.. General characteristics of the disease (WHO nomenclature)

.Gastric ulcer (531)

2.Duodenal ulcer (532)

.Peptic ulcer of unspecified localization (533)

.Peptic gastrojejunal ulcer after gastrectomy (534)

II. Clinical form

.Acute or newly diagnosed

III. Flow

.Latent

2.Mild or rarely recurrent

.Moderate or recurrent (1-2 relapses per year)

.Severe (3 or more relapses within a year) or continuously relapsing; development of complications.

IV. Phase

.Exacerbation (relapse)

2.Fading exacerbation (incomplete remission)

.Remission

V. Characteristics of the morphological substrate of the disease

.Types of ulcers a) acute ulcer; b) chronic ulcer

Sizes of the ulcer: a) small (less than 0.5 cm); b) average (0.5-1 cm); c) large (1.1-3 cm); d) gigantic (more than 3 cm).

Stages of ulcer development: a) active; b) scarring; c) “red” scar stage; d) “white” scar stage; e) long-term non-scarring

Ulcer location:

a) stomach: A: 1) cardia, 2) subcardial section, 3) body of the stomach, 4) antrum, 5) pyloric canal; B: 1) anterior wall, 2) posterior wall, 3) lesser curvature, 4) greater curvature.

b) duodenum: A: 1) bulb, 2) postbulbar part;

B: 1) anterior wall, 2) posterior wall, 3) lesser curvature, 4) greater curvature.. Characteristics of the functions of the gastroduodenal system (only pronounced disorders of secretory, motor and evacuation functions are indicated)

VII. Complications

1.Bleeding: a) mild, b) moderate, c) severe, d) extremely severe

2.Perforation

.Penetration

.Stenosis: a) compensated, b) subcompensated, c) decompensated.

.Malignancy

Based on the presented classification, as an example, we can propose the following formulation of the diagnosis: gastric ulcer, newly diagnosed, acute form, large (2 cm) ulcer of the lesser curvature of the body of the stomach, complicated by mild bleeding.

1.3 Clinical picture and preliminary diagnosis

Judgment about the possibility of a peptic ulcer should be based on the study of complaints, anamnestic data, physical examination of the patient, and assessment of the functional state of the gastroduodenal system.

The typical clinical picture is characterized by a clear connection between the occurrence of pain and food intake. There are early, late and “hunger” pains. Early pain appears 1/2-1 hour after eating, gradually increases in intensity, lasts 1 1/2-2 hours and subsides as gastric contents are evacuated. Late pain occurs 1 1/2-2 hours after eating at the height of digestion, and “hungry” pain occurs after a significant period of time (6-7 hours), i.e. on an empty stomach, and stops after eating. Night pain is close to “hungry”. The disappearance of pain after eating, taking antacids, anticholinergic and antispasmodic drugs, as well as the subsidence of pain during the first week of adequate treatment is a characteristic sign of the disease.

In addition to pain, the typical clinical picture of gastric ulcer includes various dyspeptic symptoms. Heartburn is a common symptom of the disease, occurring in 30-80% of patients. Heartburn may alternate with pain, precede it for a number of years, or be the only symptom of the disease. However, it should be borne in mind that heartburn is often observed in other diseases of the digestive system and is one of the main signs of insufficiency of cardiac function. Nausea and vomiting are less common. Vomiting usually occurs at the height of pain, being a kind of culmination of the pain syndrome, and brings relief. Often, to eliminate pain, the patient himself artificially induces vomiting.

Constipation is observed in 50% of patients with gastric ulcer. They intensify during periods of exacerbation of the disease and are sometimes so persistent that they bother the patient even more than pain.

A distinctive feature of peptic ulcer disease is its cyclical course. Periods of exacerbation, which usually last from several days to 6-8 weeks, are followed by a phase of remission. During remission, patients often feel practically healthy, even without following any diet. Exacerbations of the disease, as a rule, are seasonal; for the middle zone, this is mainly the spring or autumn season.

A similar clinical picture in persons with no previously established diagnosis is more likely to suggest peptic ulcer disease.

Typical ulcerative symptoms are more common when the ulcer is localized in the pyloric part of the stomach (pyloroduodenal form of peptic ulcer). However, it is often observed with an ulcer of the lesser curvature of the body of the stomach (mediogastric form of peptic ulcer). However, in patients with mediogastric ulcers, the pain syndrome is less defined, pain can radiate to the left half of the chest, lumbar region, right and left hypochondrium. Some patients with the mediogastric form of peptic ulcer experience a decrease in appetite and weight loss, which is not typical for pyloroduodenal ulcers.

The greatest clinical features occur in patients with ulcers localized in the cardial or subcardial parts of the stomach.

Laboratory tests have a relative, indicative value in recognizing peptic ulcer disease.

A study of gastric secretion is necessary not so much for diagnosing the disease as for identifying functional disorders of the stomach. Only a significant increase in acid production detected during fractional probing of the stomach (basal HCl secretion rate over 12 mmol/h, HCl rate after submaximal stimulation with histamine over 17 mmol/h and after maximum stimulation over 25 mmol/h) should be taken into account as a diagnostic sign of peptic ulcer disease .

Additional information can be obtained by examining intragastric pH. Peptic ulcer disease, especially pyloroduodenal localization, is characterized by pronounced hyperacidity in the body of the stomach (pH 0.6-1.5) with continuous acid formation and decompensation of alkalization of the environment in the antrum (pH 0.9-2.5). Establishing true achlorhydria practically eliminates this disease.

Clinical blood tests in uncomplicated forms of peptic ulcer usually remain normal; only a number of patients have erythrocytosis due to increased erythropoiesis. Hypochromic anemia may indicate bleeding from gastroduodenal ulcers.

A positive fecal reaction to occult blood is often observed during exacerbations of peptic ulcer disease. However, it should be borne in mind that a positive reaction can be observed in many diseases (tumors of the gastrointestinal tract, nosebleeds, bleeding gums, hemorrhoids, etc.).

Today, the diagnosis of gastric ulcer can be confirmed using x-ray and endoscopic methods.

ulcerative stomach acupressure music therapy

2. Methods of rehabilitation of patients with gastric ulcer

.1 Physical therapy (physical therapy)

Physical therapy (physical therapy) for peptic ulcers helps regulate the processes of excitation and inhibition in the cerebral cortex, improves digestion, blood circulation, breathing, redox processes, and has a positive effect on the patient’s neuropsychic state.

When performing physical exercises, spare the stomach area. In the acute period of the disease in the presence of pain, exercise therapy is not indicated. Physical exercises are prescribed 2-5 days after the cessation of acute pain.

During this period, the therapeutic exercise procedure should not exceed 10-15 minutes. In a lying position, exercises are performed for the arms and legs with a limited range of motion. Avoid exercises that actively involve the abdominal muscles and increase intra-abdominal pressure.

When the acute phenomena cease, physical activity is gradually increased. To avoid exacerbation, this is done carefully, taking into account the patient’s reaction to the exercises. Exercises are performed in the starting position lying, sitting, standing.

To prevent adhesions against the background of general strengthening movements, exercises for the muscles of the anterior abdominal wall, diaphragmatic breathing, simple and complicated walking, rowing, skiing, outdoor and sports games are used.

Exercises should be performed with caution if they increase pain. Complaints often do not reflect the objective condition, and the ulcer can progress with subjective well-being (disappearance of pain, etc.).

In this regard, when treating patients, one should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. You can gradually expand the patient’s motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing exercises and exercises for the abdominal muscles.

Contraindications to the use of exercise therapy include: bleeding; generating ulcer; acute perivisceritis (perigastritis, periduodenitis); chronic perivisceritis when acute pain occurs during exercise.

A complex of exercise therapy for patients with gastric ulcers is presented in Appendix 1.

2.2 Acupuncture

Gastric ulcer from the point of view of its occurrence, development, as well as from the point of view of the development of effective treatment methods represents a major problem. The scientific search for reliable methods of treating peptic ulcer disease is due to the insufficient effectiveness of known methods of therapy.

Modern ideas about the mechanism of action of acupuncture are based on somato-visceral relationships, carried out both in the spinal cord and in the overlying parts of the nervous system. The therapeutic effect on reflexogenic zones where acupuncture points are located helps to normalize the functional state of the central nervous system, hypothalamus, maintain homeostasis and more quickly normalize the disturbed activity of organs and systems, stimulates oxidative processes, improves microcirculation (through the synthesis of biologically active substances), and blocks pain impulses. In addition, acupuncture increases the body’s adaptive capabilities, eliminates prolonged excitation in various brain centers that control smooth muscles, blood pressure, etc.

The best effect is achieved if acupuncture points located in the zone of segmental innervation of the affected organs are irritated. Such zones for peptic ulcer disease are D4-7.

The study of the general condition of patients, the dynamics of laboratory, radiological, and endoscopic examinations give the right to objectively evaluate the acupuncture method used, its advantages and disadvantages, and to develop indications for differentiated treatment of patients with peptic ulcer disease. They showed a pronounced analgesic effect in patients with persistent pain symptoms.

Analysis of indicators of gastric motor function also revealed a clear positive effect of acupuncture on tone, peristalsis and gastric evacuation.

Treatment of patients with gastric ulcer with acupuncture has a positive effect on the subjective and objective picture of the disease, and relatively quickly eliminates pain and dyspeptic symptoms. When used in parallel with the achieved clinical effect, normalization of the secretory, acid-forming and motor functions of the stomach occurs.

2.3 Acupressure

Acupressure is used for gastritis and stomach ulcers. Acupressure is based on the same principle as when carrying out the method of acupuncture, moxibustion (Zhen-Jiu therapy) - with the only difference that the BAP (biologically active points) are affected with a finger or brush.

To resolve the issue of using acupressure, a detailed examination and establishment of an accurate diagnosis is necessary. This is especially important for chronic gastric ulcers due to the risk of malignant degeneration. Acupressure is unacceptable for ulcerative bleeding and is possible no earlier than 6 months after its cessation. A contraindication is also cicatricial narrowing of the gastric outlet (pyloric stenosis) - a gross organic pathology in which there is no expectation of a therapeutic effect.

At peptic ulcer The following combination of points is recommended (the location of the points is presented in Appendix 2):

1st session: 20, 18, 31, 27, 38;

Session 2: 22, 21, 33, 31, 27;

1st session: 24, 20, 31, 27, 33.

The first 5-7 sessions, especially during an exacerbation, are carried out daily, the rest - after 1-2 days (12-15 procedures in total). Repeated courses are carried out according to clinical indications after 7-10 days. Before seasonal exacerbations of peptic ulcer disease, preventive courses of 5-7 sessions every other day are recommended.

In case of increased acidity of gastric juice with heartburn, points 22 and 9 should be included in the recipe.

In case of stomach atony, low acidity of gastric juice, poor appetite, after a mandatory X-ray or endoscopic examination, you can conduct a course of acupressure using the exciting method of points 27, 31, 37, combining it with massage using the inhibitory method of points 20, 22, 24, 33.

2.4 Physiotherapy

Physiotherapy - this is the use for therapeutic and preventive purposes of natural and artificially generated physical factors, such as: electric current, magnetic field, laser, ultrasound, etc. Various types of radiation are also used: infrared, ultraviolet, polarized light.

a) selection of mild procedures;

b) use of small dosages;

c) gradual increase in the intensity of exposure to physical factors;

d) rational combination of them with other therapeutic measures.

As active background therapy to influence the increased reactivity of the nervous system, methods such as:

-low-frequency pulse currents using the electrosleep technique;

-central electroanalgesia using a tranquilizing technique (using LENAR devices);

-UHF on the collar zone; galvanic collar and bromine electrophoresis.

Of the methods of local therapy (i.e., effects on the epigastric and paravertebral zones), the most popular remains galvanization in combination with the introduction of various medicinal substances by electrophoresis (novocaine, benzohexonium, platiphylline, zinc, dalargin, solcoseryl, etc.).

2.5 Drinking mineral waters

Drinking mineral waters of various chemical compositions affect the regulation of the functional activity of the gastro-duodenal system.

It is known that the secretion of pancreatic juice and the secretion of bile under physiological conditions are carried out as a result of the induction of secretin and pancreozymin. It logically follows that mineral waters help stimulate these intestinal hormones, which have a trophic effect. To carry out these processes, a certain time is required - from 60 to 90 minutes, and therefore, in order to use all the medicinal properties inherent in mineral waters, it is advisable to prescribe them 1-1.5 hours before meals. During this period, water can penetrate the duodenum and have an inhibitory effect on the excited secretion of the stomach.

Warm (38-40° C) low-mineralized waters, which can relax the spasm of the pylorus and quickly evacuate into the duodenum, have a similar effect. When mineral waters are prescribed 30 minutes before meals or at the height of digestion (30-40 minutes after meals), their local antacid effect is mainly manifested and those processes that are associated with the influence of water on endocrine and nervous regulation do not have time to occur, Thus, many aspects of the healing effect of mineral waters are lost. This method of prescribing mineral waters is justified in a number of cases for patients with duodenal ulcer with sharply increased acidity of gastric juice and severe dyspeptic syndrome in the phase of a fading exacerbation of the disease.

For patients with impaired motor-evacuation function of the stomach, taking mineral waters is not indicated, since the ingested water is retained in the stomach for a long time along with food and will have a juice effect instead of an inhibitory one.

For patients with peptic ulcers, alkaline weakly and moderately mineralized waters are recommended (mineralization, respectively, 2-5 g/l and more than 5-10 g/l), sodium bicarbonate carbonate, sodium-calcium carbonate bicarbonate-sulfate, bicarbonate-chloride carbonate, sodium sulfate, magnesium-sodium, for example: Borjomi, Smirnovskaya, Slavyanovskaya, Essentuki No. 4, Essentuki Novaya, Pyatigorsk Narzan, Berezovskaya, Moscow mineral water and others.

2.6 Balneotherapy

External use of mineral waters in the form of baths is an active background therapy for patients with gastric ulcers. They have a beneficial effect on the state of the central and autonomic nervous systems, endocrine regulation, and the functional state of the digestive organs. In this case, baths from mineral waters available at the resort or from artificially created waters can be used. These include chloride, sodium, carbon dioxide, iodine-bromine, oxygen, etc.

Chloride and sodium baths are indicated for patients with gastric ulcers, any severity of the disease in the phase of a fading exacerbation, incomplete and complete remission of the disease.

Radon baths are also actively used. They are available at gastrointestinal resorts (Pyatigorsk, Essentuki, etc.). To treat this category of patients, radon baths of low concentrations are used - 20-40 nCi/l. They have a positive effect on the state of neurohumoral regulation in patients and on the functional state of the digestive organs. The most effective in influencing trophic processes in the stomach are radon baths at concentrations of 20 and 40 nCi/l. They are indicated for any stage of the disease, for patients in the phase of fading exacerbation, incomplete and complete remission, concomitant lesions of the nervous system, blood vessels and other diseases for which radon therapy is indicated.

For patients with peptic ulcer disease with concomitant diseases of the joints of the central and peripheral nervous system, female genital organs, especially with inflammatory processes and ovarian dysfunction, it is advisable to prescribe treatment with iodine-bromine baths; it is good to prescribe them to patients of an older age group. Pure iodine-bromine waters do not exist in nature. Use artificial iodine-bromine baths at a temperature of 36-37°C for 10-15 minutes, for a course of treatment 8-10 baths, released every other day, it is advisable to alternate with peloid applications, or physiotherapeutic procedures, the choice of which is determined by both the general condition of the patients and concomitant diseases gastrointestinal tract, cardiovascular and nervous systems.

2.7 Music therapy

It has been proven that music can do a lot. Calm and melodic, it will help you relax faster and better, and restore strength; cheerful and rhythmic raises tone and improves mood. Music will relieve irritation and nervous tension, activate thought processes and increase performance.

The healing properties of music have been known for a long time. In the VI century. BC. The great ancient Greek thinker Pythagoras used music for medicinal purposes. He preached that a healthy soul requires a healthy body, and both require constant musical influence, concentration in oneself and ascent to the highest regions of existence. More than 1000 years ago, Avicenna recommended diet, work, laughter and music as treatments.

According to their physiological effect, melodies can be soothing, relaxing or tonic, invigorating.

The relaxing effect is useful for stomach ulcers.

For music to have a healing effect, it must be listened to in this way:

) lie down, relax, close your eyes and completely immerse yourself in the music;

) try to get rid of any thoughts expressed in words;

) remember only pleasant moments in life, and these memories should be figurative in nature;

) a recorded musical program must last at least 20-30 minutes, but no more;

) should not fall asleep;

) after listening to a music program, it is recommended to do breathing exercises and several physical exercises.

.8 Mud therapy

Among the methods of treating gastric ulcers, mud therapy occupies one of the leading places. Therapeutic mud affects metabolism and bioenergetic processes in the body, enhances microcirculation of the stomach and liver, improves gastric motility, reduces acidification of the duodenum, stimulates the reparative processes of the gastroduodenal mucosa, and activates the activity of the endocrine system. Mud therapy has an analgesic and anti-inflammatory effect, improves metabolism, changes the body's reactivity, and its immunobiological properties.

Silt mud is used at a temperature of 38-40°C, peat mud at 40-42°C, the duration of the procedure is 10-15-20 minutes, every other day, for a course of 10-12 procedures.

This mud therapy technique is indicated for patients with gastric ulcer in the phase of fading exacerbation, incomplete and complete remission of the disease, with severe pain syndrome, with concomitant diseases in which the use of physical factors on the collar area is indicated.

In case of severe pain, you can use the method of combining mud applications with reflexology (electropuncture). Where it is not possible to use mud therapy, you can use ozokerite and paraffin therapy.

2.9 Diet therapy

Dietary nutrition is the main background of any antiulcer therapy. The principle of fractional (4-6 meals a day) meals must be observed regardless of the phase of the disease.

Basic principles of therapeutic nutrition (principles of “first tables” according to the classification of the Institute of Nutrition): 1. good nutrition; 2. maintaining the rhythm of eating; 3. mechanical; 4. chemical; 5. thermal sparing of the gastroduodenal mucosa; 6. gradual expansion of the diet.

The approach to dietary therapy for peptic ulcer disease is currently marked by a departure from strict to gentle diets. Mainly pureed and non-mashed versions of diet No. 1 are used.

Diet No. 1 includes the following products: meat (veal, beef, rabbit), fish (pike perch, pike, carp, etc.) in the form of steamed cutlets, quenelles, soufflés, beef sausages, boiled sausage, occasionally - lean ham, soaked herring (the taste and nutritional properties of herring increase if it is soaked in whole cow's milk), as well as milk and dairy products (whole milk, dry, condensed milk, fresh non-sour cream, sour cream and cottage cheese). If tolerated well, yogurt and acidophilus milk can be recommended. Eggs and dishes made from them (soft-boiled eggs, steam omelette) - no more than 2 pieces per day. Raw eggs are not recommended, as they contain avidin, which irritates the gastric mucosa. Fats - unsalted butter (50-70 g), olive or sunflower (30-40 g). Sauces - milk, snacks - mild, grated cheese. Soups - vegetarian from cereals, vegetables (except cabbage), milk soups with vermicelli, noodles, pasta (well boiled). You need to salt food in moderation (8-10 g of salt per day).

Fruits, berries (sweet varieties) are given in the form of puree, jelly, if tolerated, compotes and jelly, sugar, honey, jam. Non-acidic vegetable, fruit, and berry juices are indicated. Grapes and grape juices are poorly tolerated and can cause heartburn. If tolerance is poor, juices should be added to cereals, jelly or diluted with boiled water.

Not recommended: pork, lamb, duck, goose, strong broths, meat soups, vegetable and especially mushroom broths, undercooked, fried, fatty and dried meats, smoked meats, salted fish, hard-boiled eggs or scrambled eggs, skim milk, strong tea, coffee, cocoa, kvass, all alcoholic drinks, carbonated water, pepper, mustard, horseradish, onions, garlic, bay leaves, etc.

You should abstain from cranberry juice. For drinks, we can recommend weak tea, tea with milk or cream.

.10 Herbal medicine

For most patients suffering from gastric ulcers, it is advisable to include in complex treatment decoctions and infusions of medicinal herbs, as well as special antiulcer mixtures consisting of many medicinal plants. Herbs and folk recipes used for stomach ulcers:

Collection: Chamomile flowers - 10 g; fennel fruits - 10 gr.; marshmallow root - 10 g; wheatgrass root - 10 g; licorice root - 10 gr. 2 teaspoons of the mixture per 1 cup of boiling water. Infuse, wrap, strain. Take one glass of infusion at night.

Collection: Fireweed leaves - 20 gr.; linden blossom - 20 gr.; chamomile flowers - 10 gr.; fennel fruits - 10 gr. 2 teaspoons of the mixture per glass of boiling water. Leave it wrapped and strain. Take 1 to 3 glasses throughout the day.

Collection: Crayfish necks, roots - 1 part; plantain, leaf - 1 part; horsetail - 1 part; St. John's wort - 1 part; valerian root - 1 part; chamomile - 1 part. A tablespoon of the mixture per glass of boiling water. Steam for 1 hour. Take 3 times a day before meals.

Collection:: Series -100 gr.; celandine -100 gr.; St. John's wort -100 gr.; plantain -200 gr. A tablespoon of the mixture per glass of boiling water. Leave covered for 2 hours, strain. Take 1 tablespoon 3-4 times a day, an hour before or 1.5 hours after meals.

Freshly squeezed juice from cabbage leaves, when taken regularly, cures chronic gastritis and ulcers better than all medications. Preparing juice at home and taking it: the leaves are passed through a juicer, filtered and the juice is squeezed out. Take 1/2-1 glass warmed 3-5 times a day before meals.

Conclusion

So, in the course of my work I found out that:

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Annex 1

Exercise therapy procedure for patients with gastric ulcer (V. A. Epifanov, 2004)

No. Section content Dosage, min Section objectives, procedures 1 Simple and complicated walking, rhythmic, at a calm pace 3-4 Gradual involvement in the load, development of coordination 2 Exercises for arms and legs in combination with body movements, breathing exercises in a sitting position 5-6 Periodic increase in intra-abdominal pressure, increased blood circulation in the abdominal cavity 3 Standing exercises in throwing and catching a ball, throwing a medicine ball (up to 2 kg), relay races, alternating with breathing exercises 6-7 General physiological load, creating positive emotions, developing the function of full breathing 4 Exercises on a gymnastic wall such as mixed hangs 7-8 General tonic effect on the central nervous system, development of static-dynamic stability 5 Elementary lying exercises for the limbs in combination with deep breathing 4-5 Reducing the load, developing full breathing