Stomach ulcer and duodenal ulcer - the most common diseases of internal organs, which, according to world statistics, distributed in approximately 10% of the adult population. According to the Center for Health Statistics of Ukraine, the incidence of peptic ulcer (BU) in our country over the past 10 years has increased by 38,4%.
In recent years, significant progress in diagnosis and therapy of peptic ulcer disease, numerous studies have greatly expanded our understanding of the etiologic structure of the disease and its pathogenetic features. The prevalence of peptic ulcer disease in Ukraine, CIS and other countries still has no tendency to decrease, and the resulting complications are often life threatening ill and require surgical correction.
The most common cause of ulcer is now considered to Helicobacter pylori infection. Helicobacter pylori (HP) induces an inflammatory reaction and damage to the gastric mucosa. In addition, it violates the system of intercellular relationships that govern the system of gastrin, since the formation around her "alkali cloud of ammonium ions removed in the existing rate of inhibition in the acidic environment of secretion of gastrin G-cells.
At the same time, the effects on gastroduodenal mucosa of factors of aggression and decreased functioning of protective factors is a major pathophysiological determinant in the development of peptic ulcer disease. Therefore, antiulcer therapy should include both antisecretory drugs, and drugs intended for HP eradication. Standard eradication therapy is a combination of proton pump inhibitors (H + / K +-ATPase), two antibiotics and bismuth subcitrate.
Despite the advances of modern medical treatment, severity of ulcers, often accompanied by complications or recurrent pattern of illness sometimes do not give the opportunity to take an explicit decision on the choice of treatment. These patients sometimes only surgery can have a significant impact on the course of the pathological process. And if we take into account that peptic ulcer disease - a chronic disease of leaking, which can lead to a variety of life-threatening complications, the treatment of these patients can be both therapeutic and surgical. Very important is the joint decision of specialists and surgical therapeutic profiles of algorithms and standards for the treatment of patients.
Unfortunately, some leading physicians are very aggressive surgical treatment of peptic ulcer. We make common cause in the first place to think about patients, to prevent life-threatening complications, which often has an unfavorable outcome or the cause of functional failure of surgical intervention.
In addition, the choice of treatment strategy in patients with ulcer can not specifically brand viagra affect the existing socio-economic situation where an adequate therapy for an hour Tee patients is very expensive, and far exceeds the cost of surgical treatment. There is also a group of patients refractory to the action of antiulcer drugs. Thus, among all patients with ulcer patients, due to surgical treatment, have a large share.
At the same time a difficult problem that requires further scientific research and practical solutions are complicated forms of the disease, as drug therapy in some patients does not reduce the rate of ulcer complications, but only pushes their appearance at a later date. It is believed that 30 to 50% of patients with gastroduodenal ulcers respond poorly to antisecretory medication, they constitute the main group of patients experiencing complications of peptic ulcer. In such cases, only surgical treatment can have a significant impact on the disease.
What, in our opinion, needs to be done to solve the problem? How can we address this problem by adopting a law on medical insurance?
We believe that, firstly, it would be useful to gastroenterologists, and surgeons to create a unified clinical and statistical classification of peptic ulcer based on the ICD-10 enable the development of clinical diagnosis, taking into account the severity of the disease activity of ulcerative process and the presence of complications. A unified approach to clinical diagnosis, a common understanding of criteria for defining the individual classification attributes, will unify and standardize the distribution of medical resources.
Second, the presence of a single classification approach will generate a list of states that distributes patients for outpatient and inpatient treatment, depending on the level of the medical institution providing care, and disease severity. This approach greatly help solve the problem of the choice of treatment, to determine the list and scope of diagnostic procedures and curative care for a particular patient.
opposite effect
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tactics
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