VN PANOVA, V. Ivin, N. Nikolaeva, TP Zorin, 20 th Clinical Hospital, Krasnoyarsk
Opisthorchiasis - a natural focal biogelmintoz prevalent in areas of large Siberian rivers - Ob-Irtysh basin, Novosibirsk Region, Omsk and Tomsk. Tyumen, in the Krasnoyarsk region - is basically a river basin Chulym (Achinsk rn). In 1999, in Krasnoyarsk registered 597 cases of new-onset of opisthorchiasis (according gorSES).
The causative agent of opisthorchiasis is a Siberian cat or a fluke Opistorchis felinneus. Infection occurs by eating infested raw, frozen, salted, or underdone slaboprovarennoy fish carps (ide, pike, carp, gudgeon, etc.). Habitat for worms are the way bile, gall bladder, liver and, rarely, pancreatic duct. Life expectancy of parasites in the absence of adequate treatment for up to 30 years. Pathological process in opisthorchiasis caused, above all, allergic, toxic and mechanical impact of helminths on the human body. In the early (acute) phase of the disease is leading the development of immunopathological reactions of the first type as a result of antigenic exposure of metabolites available larvae during their migration and maturation in the biliary tract and pancreatic ducts. Generalized allergic reactions occur with multiple organ damage (liver, pancreas, stomach, lungs, heart, kidney). Morphological changes in organs are nonspecific, because of the immunological reaction of tissue to antigenic stimulation. In the chronic phase of opisthorchiasis, along with the allergy, the primary importance attached to the mechanical action of worms. Intensity of infection, the large size of the parasites, trauma of the mucous membrane leads to obstruction of the excretory duct development diskineticheskih disorders, inflammatory diseases of the hepatobiliary system, degenerative changes of the liver with the development of connective tissue around the bile ducts. Pathogenic effect opisthorchis, including their toxicity, and neuro-reflex influence, causing disruption of other organs and systems, primarily the gastrointestinal tract, where there are changes from functional disorders to erosive-ulcerative processes.
During opisthorchiasis distinguish acute and chronic phase of the disease, often the disease is of primary chronic course. Along with distinct clinical and laboratory manifestations, there may be asymptomatic or subclinical course of the disease. In this case, the only evidence of intoxication will be insignificant, and eosinophilia. With late diagnosis of the acute phase becomes chronic, which occurs with periods of exacerbation and remission. This phase is characterized by severe organ pathology on the part of the digestive system dominated by signs of lesions of the hepatobiliary system. Developed symptoms of biliary dyskinesia and chronic cholangitis, angioholetsistita, gastritis, duodenitis, pancreatitis, chronic hepatitis. Often there are combined options. Leading syndromes are pain (paroxysmal pain in the upper abdomen, often in the right upper quadrant and epigastric area) and dyspeptic (loss of appetite, nausea and vomiting can be persistent, dry and bitter taste in the mouth). Permanent sign - hepatomegaly. Frequent allergic reactions. With the duration of the disease increases the overall toxicity and asthenia patient.
Specific therapy for opisthorchiasis with praziquantel is conducted (biltricid, azinoks, pikiton), which is effective in both acute and the chronic stage of disease. Drug is given in the course dose of 40-60 mg / kg in three doses at 4 hours, preferably at night (22.00, 2.00, 6.00). After deworming morning held tyubazh Dem'yanov on a daily basis against biltricid, and then weekly for 1,5-2 months. Treatment is usually performed in a hospital on a background diet with choleretic, antispasmodic, hepatoprotectors, if necessary, antihistamines, and detoxifying therapy. Treatment is prescribed, before and after deworming during the month. However, one should take into account the fact that even a successful deworming opisthorchiasis not always lead to recovery of the patient - are formed residual manifestation of opisthorchiasis. The most common of them - chronic cholangitis, dyskinesia of the gallbladder and bile ducts with evidence of proliferation of connective tissue around the bile ducts. In addition, some patients have contraindications for biltricid destination because of its toxicity: 40% of patients with opisthorchiasis, there is a need to re-appoint biltricid, which is also unacceptable for the above reason. All this presents us with a need to find alternative therapies and rehabilitation of opisthorchiasis patients after specific therapy. As such funds were offered to us biologically active additives (BAA) HOLEGON, developed and produced by ART LIFE (Tomsk). The drug, which is based on an extract from the bark of aspen, is based on a Siberian raw materials.
Experimental studies have shown that the dry extract from the bark of aspen has a reliable and high opistorhotsidnostyu comparable to the activity of praziquantel, and almost twice the activity hloksila. Toxicological studies indicate the substantial absence of toxicity of an extract of aspen bark, allergeziruyuschie properties available.
Clinical studies have reliably confirm that the treatment of chronic opisthorchiasis dry aspen bark extract is effective, side effects are absent. In addition, the effect of aspen bark provides a pronounced anti-inflammatory effect.
To speed up the removal of parts fragmentarovannyh parasites and reduce the toxic and allergic effects on the body drug enriched choleretic, antispasmodic and hepatoprotective phytocomplex.
Peppermint (leaf) contributes to outflow and secretion of bile, anti-inflammatory, antispasmodic, astringent, choleretic and antimicrobial actions.
Everlasting Sand (flower basket) is used in medical practice in different etiologies cholecystitis, hepatitis, cholangitis. It increases bile secretion, reduces the concentration of bile acids and bilirubin in the bile, and activates the tone of the gall bladder, stimulates the secretory function of the pancreas and stomach.
Yarrow has a pronounced anti-inflammatory effect.
Valerian (root with rhizome) is effective in increased nervous excitability, spasmodic pain in the stomach and intestines, insomnia, has spasmolytic, choleretic and a slight analgesic effect.
MCC (microcrystalline cellulose) - a source of dietary fiber derived from natural raw materials of plant origin, has the ability to absorb and excrete toxic compounds, regulates intestinal peristalsis, helps normalize the function of the gastrointestinal tract.
Study of the efficacy of complex biologically active additives HOLEGON held in gastroenterological department of City Clinical Hospital є 20.
The purpose of the study - the use of this drug in the treatment of opisthorchiasis. The study involved 15 patients aged from 30 to 68 years, men were 7 women, 8. Diagnosis: chronic holetsistoholangit opisthorchosis genesis. Concomitant chronic pancreatitis was 4 patients, steatosis in 1 patient, giardiasis in 6 patients.
HOLEGON drug used in the treatment during the rehabilitation treatment after a specific treatment of opisthorchiasis biltricid in traditional dosage in patients with rezedualnye manifestation of opisthorchiasis.
The control group of patients was 15 person with the same diagnosis.
All patients complained of pain and heaviness in the right upper quadrant, sometimes paroxysmal character, nausea, often vomiting, dryness and bitterness in the mouth, loss of appetite. In the clinical analysis of blood demonstrated increased sedimentation rate of 20-25 mm / h, leukocytosis up to 8-9 thousand in the biochemical analysis of blood there was a slight increase in bilirubin to 40 units. When ultrasound showed signs of cholecystitis, cholangitis, in a few cases a slight hepatomegaly. In the duodenal contents and koproovoskopii efirformalinovym method at admission were found eggs opisthorchis.
All patients received specific therapy of opisthorchiasis biltricid. Appointed cholagogue preparations - allohol, holenzim; antispasmodics - platifillin, no-spa; tyubazh daily, and then 1 time per week, with the aim of detoxification - gemodez intravenously 3-4 times, diphenhydramine or suprastin with allergic manifestations. In addition, the study group patients received the drug HOLEGON at a dosage of 2 tablets 3 times daily for 7 days.
In this group of patients mentioned the disappearance of dyspeptic symptoms and improving appetite in patients for 3-5 days earlier compared with the control group. normalization of clinical blood tests used for 3 days. At control duodenal intubation and koproovometrii conducted 4-5 months after receiving biltricid, eggs opisthorchis were not detected in any patient, whereas in the control group, two patients helminth eggs were detected again.
When using HOLEGONA says:
- Strengthening of bile secretion.
- Anti-inflammatory effect.
- Improving the patient's state of health.
- Quickly disappearing pain and dyspeptic symptoms. This drug can be used:
- In the treatment of patients with opisthorchiasis manifestations of cholecystitis, cholangitis after specific therapy.
- In cases rezedualnyh manifestations of opisthorchiasis after successful de-worming.
- If necessary, re-worming or contraindications for appointment biltricid - as the drug of choice.
- When holetsistoholangitah neopistorhoznogo genesis.
- The clinical manifestations of opisthorchiasis, the presence of so-called "fish" history and the absence of laboratory confirmation of diagnosis opisthorchiasis.