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• Introduction
• 1. Anatomical, physiological, pathophysiological and clinical features of the course of the disease
• 1.1 Etiology and pathogenesis of gastric ulcer
• 1.2 Classification
• 1.3 Clinical picture and provisional diagnosis
• 2. Methods of rehabilitation of patients with gastric ulcer
• 2.1 Therapeutic exercise (LFK)
• 2.2 Acupuncture
• 2.3 Acupressure
• 2.4 Physiotherapy
• 2.5 Drinking mineral waters
• 2.6 Balneotherapy
• 2.7 Music therapy
• 2.8 Mud treatment
• 2.9 Diet therapy
• 2.10 Phytotherapy
• 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 (ulcus ventriculi et duodenipepticum, morbus ulcerosus) is a common chronic relapsing disease, prone to progression, with a polycyclic course, the characteristic features of which are seasonal exacerbations, accompanied by the appearance of an ulcer in the mucous membrane, and the development of complications that threaten the life of the patient. A feature of the course of gastric ulcer is the involvement of other organs of the digestive apparatus in the pathological process, which requires timely diagnosis for the preparation of medical complexes for patients with peptic ulcer, taking into account concomitant diseases. Peptic ulcer of the stomach affects people of the most active, able-bodied age, causing temporary and sometimes permanent disability.

High morbidity, frequent relapses, long-term disability of patients, as a result of which significant economic losses - all this makes it possible to classify the problem of peptic ulcer as one of the most urgent in modern medicine.

A special place in the treatment of patients with peptic ulcer is rehabilitation. Rehabilitation is the restoration of health, functional state and ability to work, disturbed by diseases, injuries or physical, chemical and social factors. The World Health Organization (WHO) gives a very close definition of rehabilitation: “Rehabilitation is a set of activities designed to enable people with impaired functions as a result of illness, injury and birth defects to adapt to the new conditions of life in the society in which they live” .

According to WHO, rehabilitation is a process aimed at comprehensive assistance to the sick and disabled in order to achieve the maximum possible physical, mental, professional, social and economic usefulness for this 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 the 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.

Tasks are directed to 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 course of the disease

1.1 Etiology and pathogenesis of gastric ulcer

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

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

Aggression factors include: an increase in the 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, the secretion of bicarbonates (“alkaline flush”); mucosal resistance: proliferative index of the mucosa of the gastroduodenal zone, local immunity of the mucosa 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 stomach cavity decrease.

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

The main factors include:

Violations 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 established that are realized in various links in the pathogenesis of this disease;

Helicobacter pylori invasion. Some researchers in our country and abroad attribute Helicobacter pylori infection to the main cause of peptic ulcer;

Environmental conditions, first of all, neuropsychic factors, nutrition, bad habits;

medicinal effects.

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

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

Works by I.P. Pavlov 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) are reflected in new views on the development of peptic ulcer: this is the cortico-visceral theory of K.M. Bykova, I.T. Kurtsina (1949, 1952) and a number of works pointing to the etiological role of disorders of neurotrophic processes directly in the mucous membrane of the stomach and duodenum in peptic ulcer.

According to the cortico-visceral theory, peptic ulcer is the result of disturbances in the cortico-visceral relationship. Progressive in this theory is the evidence of a two-way connection between the central nervous system and internal organs, as well as the consideration of peptic ulcer from the point of view of a disease of the whole organism, in the development of which a violation 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 disturbed.

Currently, there are several fairly convincing facts showing that one of the main etiological factors in the development of peptic ulcer is a violation of nervous trophism. An ulcer arises and develops as a result of a disorder of 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 due to the high regenerative capacity and anabolic processes in the gastric mucosa. The active protein-synthetic function is easily disturbed and may be an early sign of dystrophic processes aggravated by the aggressive peptic action of gastric juice.

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

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

There is an assumption that histamine is involved in the implementation of 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 for prostaglandin synthesis is cyclooxygenase (COX), present in the body in two forms, COX-1 and COX-2.

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

Thus, summarizing the above, we can conclude that the main links in the pathogenesis of peptic ulcer are neuroendocrine, vascular, immune factors, acid-peptic aggression, a protective muco-hydrocarbonate barrier of the gastric mucosa, helicobacter pylori 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 have been proposed. In foreign literature, the term "peptic ulcer" is more often used and a peptic ulcer of the stomach and duodenum is distinguished. 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 the purpose of accounting and statistics, however, for use in clinical practice, it should be significantly expanded.

The following classification of peptic ulcer is proposed.

I. General characteristics of the disease (WHO nomenclature)

1. Stomach ulcer (531)

2. Peptic ulcer of the duodenum (532)

3. Peptic ulcer of unspecified localization (533)

4. Peptic gastrojejunal ulcer after gastric resection (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 during the year)

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

1. Aggravation (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. Dimensions of the ulcer: a) small (less than 0.5 cm); b) medium (0.5--1 cm); c) large (1.1--3 cm); d) giant (more than 3 cm).

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

4. Localization of the ulcer:

a) stomach: A: 1) cardia, 2) subcardial region, 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 violations of the 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, the following formulation of the diagnosis can be proposed: gastric ulcer, first detected, 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 provisional diagnosis

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

A typical clinical picture is characterized by a clear relationship between the occurrence of pain and food intake. There are early, late and "hungry" pains. Early pain appears 1/2-1 hour after eating, gradually increases in intensity, lasts 1 1/2-2 hours and subsides as the gastric contents are evacuated. Late pain occurs 1 1/2-2 hours after eating at the height of digestion, and "hungry" pain - after a significant period of time (6-7 hours), i.e. on an empty stomach, and stops after eating. Close to "hungry" night pain. 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, a typical clinical picture of gastric ulcer includes various dyspeptic phenomena. Heartburn is a common symptom of the disease, occurs 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 very 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 disturb the patient even more than pain.

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

A similar clinical picture in individuals with a previously undiagnosed diagnosis is more likely to suggest peptic ulcer disease.

Typical ulcer 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). Nevertheless, 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. In some patients with mediogastric peptic ulcer, a decrease in appetite and weight loss are observed, which is not typical for pyloroduodenal ulcers.

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

Laboratory studies have a relative, indicative value in the recognition of peptic ulcer.

The study of gastric secretion is necessary not so much for the diagnosis of the disease, but for the detection of functional disorders of the stomach. Only a significant increase in acid production detected during fractional gastric probing (the rate of basal secretion of HCl over 12 mmol/h, the rate of HCl 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 .

Additional information can be obtained by examining intragastric pH. Peptic ulcer, 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 medium in the antrum (pH 0.9--2.5). The establishment of true achlorhydria practically excludes this disease.

A clinical blood test in uncomplicated forms of peptic ulcer usually remains normal, only a number of patients have erythrocytosis due to increased erythropoiesis. Hypochromic anemia may indicate bleeding from gastroduodenal ulcers.

A positive reaction of feces to occult blood is often observed during exacerbations of peptic ulcer. 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.).

To date, it is possible to confirm the diagnosis of gastric ulcer using X-ray and endoscopic methods.

gastric ulcer acupressure music therapy

2. Methods of rehabilitation of patients with gastric ulcer

2.1 Therapeutic exercise (LFK)

Physiotherapy exercises (exercise therapy) for peptic ulcer disease contributes to the regulation of excitation and inhibition processes in the cerebral cortex, improves digestion, blood circulation, respiration, redox processes, positively affects the neuropsychic state of the patient.

When performing physical exercises, the stomach area is spared. 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 procedure of therapeutic exercises should not exceed 10-15 minutes. In the prone position, exercises for the arms and legs with a limited range of motion are performed. Exercises that actively involve the abdominal muscles and increase intra-abdominal pressure are excluded.

With the cessation of acute phenomena, physical activity is gradually increased. To avoid exacerbation, do it carefully, taking into account the patient's response to exercise. Exercises are performed in the initial 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 done carefully if they aggravate the pain. Complaints often do not reflect the objective state, and the ulcer can progress with subjective well-being (disappearance of pain, etc.).

In this regard, in the treatment of patients, the abdominal area should be spared and very carefully, gradually increase the load on the abdominal muscles. It is possible to gradually expand the patient's motor mode by increasing the total load when performing most exercises, including exercises in diaphragmatic breathing and exercises for the abdominal muscles.

Contraindications to the appointment of exercise therapy are: bleeding; generating ulcer; acute perivisceritis (perigastritis, periduodenitis); chronic perivisceritis, subject to the occurrence of acute pain during exercise.

The exercise therapy complex for patients with gastric ulcer is presented in Appendix 1.

2.2 Acupuncture

Gastric ulcer from the point of view of its occurrence, development, as well as from the standpoint of the development of effective methods of treatment is a major problem. Scientific searches for reliable methods of treating peptic ulcer are 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 the reflexogenic zones, where the acupuncture points are located, contributes to the normalization of the functional state of the central nervous system, the hypothalamus, maintaining homeostasis and faster normalization of the disturbed activity of organs and systems, stimulates oxidative processes, improves microcirculation (by synthesizing biologically active substances), blocks pain impulses. In addition, acupuncture increases the adaptive capacity of the body, eliminates prolonged excitation in various centers of the brain 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 indicators of laboratory, radiological, endoscopic studies give the right to objectively evaluate the applied method of acupuncture, its advantages, disadvantages, develop indications for differentiated treatment of patients with peptic ulcer. They showed a pronounced analgesic effect in patients with persistent pain symptoms.

An analysis of the parameters of the motor function of the stomach also revealed a clear positive effect of acupuncture on tone, peristalsis and gastric evacuation.

Acupuncture treatment of patients with gastric ulcer has a positive effect on the subjective and objective picture of the disease, relatively quickly eliminates pain and dyspepsia. 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. The acupressure is based on the same principle as when carrying out the method of acupuncture, moxibustion (zhen-jiu therapy) - with the only difference that BAT (biologically active points) are affected by a finger or brush.

To resolve the issue of the use of acupressure, a detailed examination and the establishment of an accurate diagnosis are necessary. This is especially important in chronic stomach ulcers due to the risk of malignant transformation. Acupressure is unacceptable for ulcerative bleeding and is possible no earlier than 6 months after its termination. A contraindication is also cicatricial narrowing of the output section of the stomach (pyloric stenosis) - a gross organic pathology, in which one does not have to wait for 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 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 in 7-10 days. Before seasonal exacerbations of peptic ulcer, prophylactic courses of 5-7 sessions every other day are recommended.

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

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

2.4 Physiotherapy

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

Basic principles of the use of physiotherapy in the treatment of patients with peptic ulcer:

a) selection of soft operating procedures;

b) the use of small dosages;

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

d) their rational combination with other therapeutic measures.

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

Impulse currents of low frequency according to the method of electrosleep;

Central electroanalgesia by tranquilizing technique (with the help of LENAR devices);

UHF on the collar zone; galvanic collar and bromoelectrophoresis.

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

2.5 Drinking mineral waters

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

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

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

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

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

2.6 Balneotherapy

External application of mineral waters in the form of baths is an active background therapy for patients with gastric ulcer. They have a beneficial effect on the state of the central and autonomic nervous system, 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, sodium baths are indicated for patients with gastric ulcer, any severity of the course of the disease in the phase of fading exacerbation, incomplete and complete remission of the disease.

Radon baths are also actively used. They are available at the resorts of the gastrointestinal profile (Pyatigorsk, Essentuki, etc.). For the treatment of this category of patients, radon baths are used at low concentrations - 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. Radon baths with concentrations of 20 and 40 nCi/l are the most effective in terms of influencing trophic processes in the stomach. They are indicated at any stage of the disease, patients in the phase of fading exacerbation, incomplete and complete remission, concomitant lesions of the nervous system, blood vessels and other diseases in which radon therapy is indicated.

Patients with peptic ulcer disease with concomitant diseases of the joints of the central and peripheral nervous system, organs of the female genital area, especially in 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. In nature, pure iodine-bromine water does not exist. Artificial iodine-bromine baths are used at a temperature of 36-37 ° C for a duration of 10-15 minutes, for a course of treatment 8-10 baths, released every other day, it is advisable to alternate with applications of peloids, or physiotherapy procedures, the choice of which is determined both by the general condition of 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, recuperate; vigorous and rhythmic raises the tone, improves mood. Music will relieve irritation, nervous tension, activates thought processes and increases efficiency.

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 higher areas of being. Even more than 1000 years ago, Avicenna recommended diet, work, laughter and music as a treatment.

According to the 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;

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

5) should not fall asleep;

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

2.8 Mud therapy

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

Silt mud is used at temperatures 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 method of mud treatment 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 region is indicated.

With a sharp pain syndrome, 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) must be observed regardless of the phase of the disease.

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

The approach to diet therapy for peptic ulcer disease is currently marked by a move away from strict to sparing diets. Mainly mashed and non-mashed diet options No. 1 are used.

The composition of diet No. 1 includes the following products: meat (veal, beef, rabbit), fish (perch, pike, carp, etc.) in the form of steam cutlets, quenelles, soufflé, beef sausages, boiled sausage, occasionally - low-fat 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, powdered, condensed milk, fresh non-acidic cream, sour cream and cottage cheese). With good tolerance, yogurt, acidophilic milk can be recommended. Eggs and dishes from them (soft-boiled eggs, steam scrambled eggs) - no more than 2 pieces per day. Raw eggs are not recommended, as they contain avidin, which irritates the stomach lining. Fats - unsalted butter (50-70 g), olive or sunflower (30-40 g). Sauces - dairy, snacks - mild cheese, grated. Soups - vegetarian from cereals, vegetables (except cabbage), milk soups with vermicelli, noodles, pasta (well cooked). Salt food should be moderate (8-10 g of salt per day).

Fruits, berries (sweet varieties) are given in the form of mashed potatoes, jelly, with tolerance compotes and jelly, sugar, honey, jam. Non-acidic vegetable, fruit, berry juices are shown. Grapes and grape juices are not well tolerated and can cause heartburn. In case of poor tolerance, 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, skimmed milk, strong tea, coffee, cocoa, kvass, all alcoholic drinks, carbonated water, pepper, mustard, horseradish, onion, garlic, bay leaf, etc.

Cranberry juice should be avoided. From drinks, weak tea, tea with milk or cream can be recommended.

2.10 Phytotherapy

For most patients suffering from gastric ulcer, it is advisable to include decoctions and infusions of medicinal herbs in the complex treatment, as well as special anti-ulcer preparations consisting of many medicinal plants. Fees and folk recipes used for stomach ulcers:

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

2. Collection: Fireweed leaves - 20 gr.; lime blossom - 20 gr.; chamomile flowers - 10 gr.; fennel fruits - 10 gr. 2 teaspoons of the mixture per cup of boiling water. Insist wrapped, strain. Take 1 to 3 glasses throughout the day.

3. Collection: Cancer 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 in a glass of boiling water. Steam 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 in a glass of boiling water. Insist wrapped for 2 hours, strain. Take 1 tablespoon 3-4 times a day, one 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. Making juice at home and taking it: the leaves are passed through a juicer, filtered and squeezed out the juice. Take in a warm form, 1/2-1 cup 3-5 times a day before meals.

Conclusion

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

2. Physiotherapy, acupressure, physiotherapy, music therapy, balneotherapy, mud therapy, diet therapy, phytotherapy a pia, acupuncture and other physical methods are integral, integral parts of rehabilitation and interventions for patients with stomach ulcer. Their main the goal is to develop a longer period of disease remission. Each method used in treatment has its own specific effect. I However, today they consider the most effective use of acupressure and music therapy, due to the neurogenic nature of the disease. The use of acupressure and music allows you to eliminate 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 are represented by a fairly wide range of effects, which should be more actively used today, when l Medicinal possibilities are limited by the high cost of drugs. In addition, non-pharmacological treatment approaches have a pronounced overall effect, which cannot be achieved with a narrowly targeted action of drugs, so using them in combination, you can get a comprehensive effect of the impact.

List of used literature

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

2. A.P. Alabastrov, M.A. Butov. Possibilities of alternative non-drug therapy of 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: Folio, 2001. - 231 p.

4. Belaya N.A. Massotherapy. Teaching aid. - 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. Ulcer disease. - M.: Medicine, 2000. - 294 p.

8. Virsaladze K.S. Epidemiology of peptic ulcer of the stomach and duodenum // Clinical Medicine, 2000. - No. 10. - P. 33-35.

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

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

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

12. Ermakov E.V. Clinic of peptic ulcer of the stomach and duodenum. - M.: Ter. archive, 1981. - No. 2. - S. 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. - Irkutsk, 2001. - 295 p.

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

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

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

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

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

20. Therapeutic exercise and medical control / Ed. IN AND. Ilyinich. - M.: Academy, 2003. - 284 p.

21. Therapeutic exercise and medical control / Ed. V.A. Epifanova, G.A. Apanasenko. - M.: Medicine, 2004. - 277 p.

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

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

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

25. Lebedeva, R.P. Treatment of peptic ulcer \\ Topical issues of gastroenterology, 2002.- No. 3. - S. 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 - S. 12-18

28. Magzumov B.Kh. Social genetic aspects of the study of the incidence of gastric ulcer and duodenal ulcer. - Tashkent: Sov. health care, 1979.- No. 2. - S. 33-43.

29. Minushkin O.N. Peptic ulcer of the stomach and its treatment \\ Russian Medical Journal. - 2002. - No. 15. - S. 16 - 25

30. Rastaporov A.A. Treatment of peptic ulcer of the stomach and duodenum 12 \\ Russian Medical Journal. - 2003. - No. 8 - S. 25 - 27

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

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

33. Ponomarenko G.N., Vorobyov M.G. Guide to Physiotherapy. - 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. Status and prospects for the development of gastroenterological care for the population. - M.: Ter. archive, 1973.- No. 4. - S. 3-8.

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

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

39. Troim N.F. Ulcer disease. Medical business - M .: Progress, 2001. - 283 p.

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

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

42. Physical rehabilitation / Ed. S.N. Popov. - Rostov n / a: Phoenix, 2003. - 158 p.

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

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

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

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

47. Shcherbakov P.L. Peptic ulcer of the stomach // Russian Medical Journal, 2001 - No. 1 - S. 32-45.

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

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

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

Attachment 1

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

		Dosage, min	Section tasks, procedures
	Walking simple and complicated, rhythmic, at a calm pace		Gradual retraction into loading, development of coordination
	Exercises for arms and legs in Op. e taniya with movements of the body, breathing exercises in the position e sitting		Periodic increase in intra-abdominal pressure, increased blood circulation in the abdomen noah cavity
	Standing exercises in throwing and lo in le ball, throwing a medicine ball (up to 2 kg), relay races, alternating with breathing exercises		General physiological load, the creation of positive emo tions, the development of the function of complete respiration
	Exercises on the gymnastic wall like mixed hangs		General tonic effect on the central nervous system, development of static-dynamic stability vivacity
	Elementary lying exercises for limbs in combination with ch at lateral breathing		Load reduction, full development th breath

Annex 2

BAP scheme for acupressure in gastric ulcer

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Basic data on peptic ulcer of the stomach and duodenum, their etiology and pathogenesis, clinical picture, complications. Features of diagnostics. Characteristics of the complex of rehabilitation measures for the recovery of patients with peptic ulcer.

An integrated approach with the obligatory consideration of the individual characteristics of the course of the process is an unshakable principle for the treatment and rehabilitation of peptic ulcer. The most effective treatment for any disease is the one that most effectively eliminates the cause that causes it. In other words, we are talking about a targeted impact on those changes in the body that are responsible for the development of an ulcerative defect in the mucous membrane of the stomach and duodenum.

The peptic ulcer treatment program includes a complex of diverse activities, the ultimate goal of which is the normalization of gastric digestion and the correction of the activity of regulatory mechanisms responsible for the disorganization of the secretory and motor functions of the stomach. This approach to the treatment of the disease provides a radical elimination of the changes that have occurred in the body. Treatment of patients with peptic ulcer should be complex and strictly individualized. During the period of exacerbation, treatment is carried out in a hospital.

Comprehensive treatment and rehabilitation patients with peptic ulcer of the stomach and duodenum include: drug treatment, diet therapy, physiotherapy and hydrotherapy, drinking mineral water, exercise therapy, therapeutic massage and other therapeutic agents. The antiulcer course also includes the elimination of factors contributing to the recurrence of the disease, provides for the optimization of working and living conditions, the categorical prohibition of smoking and alcohol consumption, the prohibition of taking medications with an ulcerogenic effect.

Drug therapy has as its purpose:

1. Suppression of excess production of hydrochloric acid and pepsin or their neutralization and adsorption.

2. Restoration of the motor-evacuation function of the stomach and duodenum.

3. Protection of the mucous membrane of the stomach and duodenum and treatment of helicobacteriosis.

4. Stimulation of the processes of regeneration of cellular elements of the mucous membrane and relief of inflammatory-dystrophic changes in it.

The basis of drug treatment of exacerbations of peptic ulcer is the use of anticholinergics, ganglioblockers and antacids, with the help of which the effect on the main pathogenetic factors is achieved (decrease in pathological nervous impulses, inhibitory effect on the pituitary-adrenal system, decrease in gastric secretion, inhibition of the motor function of the stomach and duodenum, etc. .).

Alkalizing agents (antacids) are widely included in the medical complex and are divided into two large groups: soluble and insoluble. Soluble antacids include: sodium bicarbonate, as well as magnesia oxide and calcium carbonate (which react with hydrochloric acid of gastric juice and form soluble salts). Alkaline mineral waters (Borjomi, Jermuk springs, etc.) are widely used for the same purpose. Reception of antacids should be regular and repeated during the day. The frequency and timing of admission are determined by the nature of the violation of the secretory function of the stomach, the presence and time of occurrence of heartburn and pain. Most often, antacids are prescribed an hour before a meal and 45-60 minutes after a meal. The disadvantages of these antacids include the possibility of changing the acid-base state with prolonged use in large doses.

An important therapeutic measure is diet therapy. Therapeutic nutrition in patients with gastric ulcer must be strictly differentiated depending on the stage of the process, its clinical manifestations and associated complications. The basis of dietary nutrition in patients with peptic ulcer of the stomach and duodenum is the principle of sparing the stomach, that is, creating maximum rest for the ulcerated mucosa. It is advisable to use products that are weak stimulants of sap secretion, quickly leave the stomach and slightly irritate its mucous membrane.

Currently, special anti-ulcer rations for therapeutic nutrition have been developed. The diet must be followed for a long time and after discharge from the hospital. During the period of exacerbation, products that neutralize hydrochloric acid are prescribed. Therefore, at the beginning of treatment, a protein-fat diet, restriction of carbohydrates is needed.

Meals should be fractional and frequent (5-6 times a day); diet - complete, balanced, chemically and mechanically sparing. Diet food consists of three successive cycles lasting 10-12 days (diet No. 1a, 16, 1). With severe neuro-vegetative disorders, hypo- and hyperglycemic syndromes, the amount of carbohydrates in the diet is limited (up to 250-300 g), with trophic disorders, concomitant pancreatitis, the amount of protein increases to 150-160 g, with severe acidism, preference is given to products with antacid properties : milk, cream, soft-boiled eggs, etc.

Diet number 1a - the most sparing, rich in milk. Diet No. 1a includes: whole milk, cream, cottage cheese steam soufflé, egg dishes, butter. As well as fruits, berries, sweets, kissels and jelly from sweet berries and fruits, sugar, honey, sweet berry and fruit juices mixed with water and sugar. Sauces, spices and appetizers are excluded. Drinks - rosehip broth.

Being on a diet number 1a, the patient must comply with bed rest. She is kept for 10 - 12 days, then they switch to a more stressful diet No. 1b. On this diet, all dishes are cooked pureed, boiled in water or steamed. Food is liquid or mushy. It contains various fats, chemical and mechanical irritants of the gastric mucosa are significantly limited. Diet No. 1b is prescribed for 10-12 days, and the patient is transferred to diet No. 1, which contains proteins, fats and carbohydrates. Dishes that stimulate gastric secretion and chemically irritate the gastric mucosa are excluded. All dishes are prepared boiled, mashed and steamed. Diet No. 1 for a patient with a stomach ulcer should receive a long time. You can switch to a varied diet only with the permission of a doctor.

Application of mineral waters occupies a leading place in the complex therapy of diseases of the digestive system, including peptic ulcer.

Drinking treatment is practically indicated for all patients with peptic ulcer in remission or unstable remission, without a sharp pain syndrome, in the absence of a tendency to bleeding and in the absence of persistent narrowing of the pylorus.

Assign mineral waters of low and medium mineralization (but not higher than 10-12 g / l), containing no more than 2.5 g / l of carbon dioxide, bicarbonate sodium, bicarbonate-sulphate sodium water, as well as water with a predominance of these ingredients, but more complex cationic composition, pH from 6 to 7.5.

Drinking treatment should be started already from the first days of the patient's admission to the hospital, however, the amount of mineral water for admission during the first 2-3 days should not exceed 100 ml. In the future, with good tolerance, the dose can be increased to 200 ml 3 times a day. With increased or normal secretory and normal evacuation function of the stomach, water is taken in a warm form 1.5 hours before meals, with reduced secretion - 40 minutes -1 hour before meals, with a slowdown in evacuation from the stomach 1 hour 45 minutes - 2 hours before food.

In the presence of pronounced dyspeptic symptoms, mineral water, especially hydrocarbonate, can be used more often, for example 6-8 times a day: 3 times a day 1 hour 30 minutes before meals, then after meals (after about 45 minutes) at the height of dyspeptic symptoms and, Finally, before bed.

In some cases, when taking mineral water before meals, heartburn intensifies in patients, and pain appears. Such patients sometimes well tolerate the intake of mineral water 45 minutes after a meal.

Often, this method of drinking treatment has to be resorted to only in the first days of the patient's admission, in the future, many patients switch to taking mineral water before meals.

Persons with peptic ulcer in the stage of remission or unstable remission of the disease, in the presence of dyskinesia and concomitant inflammatory phenomena from the large intestine are shown: microclysters and cleansing enemas from mineral water, intestinal douches, siphon lavages of the intestines.

Gastric lavage is prescribed only according to indications, for example, in the presence of pronounced phenomena of concomitant gastritis. Various types of mineral and gas baths are widely used in the treatment of patients with peptic ulcer. The method of choice is oxygen, iodine-bromine and mineral baths. Carbonic baths are contraindicated for patients with peptic ulcer disease with severe symptoms of vegetative dyskinesia. One of the methods of treatment of patients with peptic ulcer in remission is pelotherapy.

The most effective types of mud therapy include mud applications on the anterior abdominal wall and lumbar region (temperature 40°C, exposure 20 minutes), every other day, alternating with baths. The course of treatment is 10-12 mud applications. With contraindications to mud applications, diathermo mud or galvanic mud on the epigastric region is recommended.

Various methods are widely used psychotherapy - hypnotherapy, autogenic training, suggestion and self-hypnosis. With the help of these methods, it is possible to influence psychopathological disorders - asthenia, depression, as well as neurovegetative and neurosomatic functional-dynamic disorders of the stomach.

During the hospital period of rehabilitation, exercise therapy, therapeutic massage, and physiotherapy are used.

Therapeutic physical culture prescribed after the subsidence of acute manifestations of the disease.

Tasks of exercise therapy:

Normalization of the tone of the central nervous system and cortico-visceral relationships,

Improvement of the psycho-emotional state;

Activation of blood and lymph circulation, metabolic and trophic processes in the stomach, duodenum and other digestive organs;

Stimulation of regenerative processes and acceleration of ulcer healing;

Reducing spasm of the muscles of the stomach; normalization of secretory and motor functions of the stomach and intestines;

Prevention of congestion and adhesive processes in the abdominal void.

Massotherapy prescribed to reduce the excitation of the central nervous system, improve the function of the autonomic nervous system, normalize the motor and secretory activity of the stomach and other parts of the gastrointestinal tract; strengthening the abdominal muscles, strengthening the body. Apply segmental-reflex and classical massage. They act on the paravertebral zones D9-D5, C7-C3. At the same time, in patients with gastric ulcer, these zones are massaged only on the left, and with duodenal ulcer - on both sides. The area of ​​the collar zone D2-C4, belly is also massaged.

Physiotherapy prescribed from the first days of the patient's stay in the hospital, its tasks:

Decreased excitability of the central nervous system, - improvement of the regulatory function of the autonomic nervous system;

Elimination or reduction of pain, motor and secretory disorders;

Activation of blood and lymph circulation, trophic and regenerative processes in the stomach, stimulation of ulcer scarring.

First, medical electrophoresis, electrosleep, solux, UHF therapy, ultrasound are used, and when the exacerbation process subsides, diadynamic therapy, microwave therapy, magnetotherapy, UV radiation, paraffin-ozocerite applications, coniferous, radon baths, circular shower, aeroionotherapy.

The post-hospital period of rehabilitation is carried out in a clinic or sanatorium. Apply exercise therapy, therapeutic massage, physiotherapy, occupational therapy.

Recommended sanatorium treatment (Crimea, etc.), during which: walks, swimming, games; in winter - skiing, skating, etc.; diet therapy, drinking mineral water, taking vitamins, UV radiation, contrast shower.

According to the WHO definition, rehabilitation is the combined and coordinated application of social, medical, pedagogical and professional activities with the aim of preparing and retraining the individual to achieve his optimal ability to work.

Rehabilitation tasks:

• 1. Improve the overall reactivity of the body;
• 2. Normalize the state of the central and autonomic systems;
• 3. Provide analgesic, anti-inflammatory, trophic effect on the body;
• 4. Maximize the period of remission of the disease.

Comprehensive medical rehabilitation is carried out in the system of hospital, sanatorium, dispensary and polyclinic stages. An important condition for the successful functioning of a staged rehabilitation system is the early start of rehabilitation measures, the continuity of stages, provided by the continuity of information, the unity of understanding the pathogenetic essence of pathological processes and the foundations of their pathogenetic therapy. The sequence of stages can be different depending on the course of the disease.

An objective assessment of the results of rehabilitation is very important. It is necessary for the current correction of rehabilitation programs, the prevention and overcoming of unwanted side effects, the final assessment of the effect when moving to a new stage.

Thus, considering medical rehabilitation as a set of measures aimed at eliminating changes in the body that lead to a disease or contribute to its development, and taking into account the knowledge gained about pathogenetic disorders in asymptomatic periods of the disease, 5 stages of medical rehabilitation are distinguished.

The preventive stage aims to prevent the development of clinical manifestations of the disease by correcting metabolic disorders (Appendix B).

The activities of this stage have two main directions: elimination of the identified metabolic and immune disorders by dietary correction, the use of mineral waters, pectins of marine and terrestrial plants, natural and reshaped physical factors; the fight against risk factors that can largely provoke the progression of metabolic disorders and the development of clinical manifestations of the disease. It is possible to count on the effectiveness of preventive rehabilitation only by supporting the measures of the first direction with the optimization of the habitat (improving the microclimate, reducing dust and gas content in the air, leveling the harmful effects of geochemical and biogenic nature, etc.), combating hypodynamia, overweight, smoking, and others. bad habits.

Stationary stage of medical rehabilitation, except for the first important task:

• 1. Saving the patient's life (provides for measures to ensure minimal tissue death as a result of exposure to a pathogenic agent);
• 2. Prevention of disease complications;
• 3. Ensuring the optimal course of reparative processes (Appendix D).

This is achieved by replenishing with a deficit in circulating blood volume, normalizing microcirculation, preventing tissue swelling, conducting detoxification, antihypoxant and antioxidant therapy, normalizing electrolyte disturbances, using anabolics and adaptogens, and physiotherapy. With microbial aggression, antibiotic therapy is prescribed, immunocorrection is carried out.

The polyclinic stage of medical rehabilitation should ensure the completion of the pathological process (Appendix E).

For this, therapeutic measures are continued aimed at eliminating the residual effects of intoxication, microcirculation disorders, and restoring the functional activity of body systems. During this period, it is necessary to continue therapy to ensure the optimal course of the restitution process (anabolic agents, adaptogens, vitamins, physiotherapy) and develop the principles of dietary correction, depending on the characteristics of the course of the disease. An important role at this stage is played by purposeful physical culture in the mode of increasing intensity.

The sanatorium-and-spa stage of medical rehabilitation completes the stage of incomplete clinical remission (Appendix G). Therapeutic measures should be aimed at preventing the recurrence of the disease, as well as its progression. To implement these tasks, predominantly natural therapeutic factors are used to normalize microcirculation, increase cardiorespiratory reserves, stabilize the functioning of the nervous, endocrine and immune systems, organs of the gastrointestinal tract and urinary excretion.

The metabolic stage includes conditions for the normalization of structural and metabolic disorders that existed after the completion of the clinical stage (Appendix E).

This is achieved with the help of long-term dietary correction, the use of mineral waters, pectins, climatotherapy, therapeutic physical culture, and balneotherapy courses.

The results of the implementation of the principles of the proposed scheme of medical rehabilitation by the authors are predicted to be more effective than the traditional one:

• - the allocation of the stage of preventive rehabilitation allows the formation of risk groups and the development of preventive programs;
• - the allocation of the stage of metabolic remission and the implementation of measures of this stage will make it possible to reduce the number of relapses, prevent the progression and chronicity of the pathological process;
• -- staged medical rehabilitation with the inclusion of independent stages of preventive and metabolic remission will reduce the incidence and improve the health of the population.

Directions of medical rehabilitation include drug and non-drug directions:

Medical direction of rehabilitation.

Drug therapy in rehabilitation is prescribed taking into account the nosological form and the state of the secretory function of the stomach.

Take before meals

Most medications are taken 30 to 40 minutes before meals, when they are best absorbed. Sometimes - 15 minutes before a meal, not earlier.

Half an hour before meals, you should take antiulcer drugs - d-nol, gastrofarm. They should be taken with water (not milk).

Also, half an hour before meals, you should take antacids (almagel, phosphalugel, etc.) and choleretic agents.

Reception at mealtime

During meals, the acidity of gastric juice is very high, and therefore significantly affects the stability of drugs and their absorption into the blood. In an acidic environment, the effect of erythromycin, lincomycin hydrochloride and other antibiotics is partially reduced.

Gastric juice preparations or digestive enzymes should be taken with food, as they help the stomach digest food. These include pepsin, festal, enzistal, panzinorm.

Along with food, it is advisable to take laxatives to be digested. These are senna, buckthorn bark, rhubarb root and joster fruits.

Reception after meals

If the medicine is prescribed after a meal, wait at least two hours to obtain the best therapeutic effect.

Immediately after eating, they take mainly drugs that irritate the mucous membrane of the stomach and intestines. This recommendation applies to drug groups such as:

• - painkillers (non-steroidal) anti-inflammatory drugs - Butadion, aspirin, aspirin cardio, voltaren, ibuprofen, askofen, citramon (only after meals);
• - acute agents are components of bile - allochol, lyobil, etc.); taking after meals is a prerequisite for these drugs to “work”.

There are so-called anti-acid drugs, the intake of which should be timed to coincide with the moment when the stomach is empty, and hydrochloric acid continues to be released, that is, an hour or two after the end of the meal - magnesium oxide, vikalin, vikair.

Aspirin or askofen (aspirin with caffeine) is taken after a meal, when the stomach has already begun to produce hydrochloric acid. Due to this, the acidic properties of acetylsalicylic acid (which provokes irritation of the gastric mucosa) will be suppressed. This should be remembered by those who take these pills for headaches or colds.

Regardless of food

Regardless of when you sit down at the table, take:

Antibiotics are usually taken regardless of food, but dairy products must also be present in your diet. Along with antibiotics, nystatin is also taken, and at the end of the course, complex vitamins (for example, supradin).

Antacids (gastal, almagel, maalox, talcid, relzer, phosphalugel) and antidiarrheals (imodium, intetrix, smecta, neointestopan) - half an hour before meals or one and a half to two hours after. At the same time, keep in mind that antacids taken on an empty stomach act for about half an hour, and taken 1 hour after eating - for 3-4 hours.

Fasting

Taking the medicine on an empty stomach is usually in the morning 20-40 minutes before breakfast.

Medicines taken on an empty stomach are absorbed and absorbed much faster. Otherwise, acidic gastric juice will have a destructive effect on them, and there will be little use from medicines.

Patients often ignore the recommendations of doctors and pharmacists, forgetting to take a pill prescribed before meals, and transferring it to the afternoon. If the rules are not followed, the effectiveness of drugs inevitably decreases. To the greatest extent, if, contrary to the instructions, the drug is taken during meals or immediately after it. This changes the rate of passage of drugs through the digestive tract and the rate of their absorption into the blood.

Some drugs may break down into their component parts. For example, penicillin is destroyed in an acidic gastric environment. Breaks down into salicylic and acetic acids aspirin (acetylsalicylic acid).

Reception 2 - 3 times a day if the instructions indicate "three times a day", this does not mean breakfast - lunch - dinner at all. The medicine must be taken every eight hours so that its concentration in the blood is evenly maintained. It is better to drink the medicine with plain boiled water. Tea and juices are not the best remedy.

If it is necessary to resort to cleansing the body (for example, in case of poisoning, alcohol intoxication), sorbents are usually used: activated carbon, polyphepan or enterosgel. They collect toxins "on themselves" and remove them through the intestines. They should be taken twice a day between meals. At the same time, fluid intake should be increased. It is good to add herbs with a diuretic effect to the drink.

Day or night

Sleeping pills should be taken 30 minutes before bedtime.

Laxatives - bisacodyl, senade, glaxena, regulax, gutalax, forlax - are usually taken at bedtime and half an hour before breakfast.

Ulcer remedies are taken early in the morning and late in the evening to prevent hunger pains.

After the introduction of the candle, you need to lie down, so they are prescribed for the night.

Emergency funds are taken regardless of the time of day - if the temperature has risen or colic has begun. In such cases, adherence to the schedule is not important.

The key role of the ward nurse is the timely and accurate delivery of medicines to patients in accordance with the prescriptions of the attending physician, informing the patient about medicines, and monitoring their intake.

Among the non-drug methods of rehabilitation are the following:

1. Diet correction:

The diet for gastric ulcer is used as prescribed by the doctor sequentially, with surgical intervention it is recommended to start with a diet - 0.

Purpose: Maximum sparing of the mucous membrane of the esophagus, stomach - protection from mechanical, chemical, thermal factors of food damage. Providing an anti-inflammatory effect and preventing the progression of the process, preventing fermentation disorders in the intestines.

characteristics of the diet. This diet provides a minimum amount of food. Since it is difficult to take it in a dense form, food consists of liquid and jelly-like dishes. The number of meals is at least 6 times a day, if necessary - around the clock every 2-2.5 hours.

Chemical composition and calorie content. Proteins 15 g, fats 15 g, carbohydrates 200 g, calories - about 1000 kcal. Table salt 5 g. The total weight of the diet is not more than 2 kg. Food temperature is normal.

Sample set

Fruit juices - apple, plum, apricot, cherry. Berry juices - strawberry, raspberry, blackcurrant. Broths - weak from lean meats (beef, veal, chicken, rabbit) and fish (perch, bream, carp, etc.).

Cereal broths - rice, oatmeal, buckwheat, corn flakes.

Kissels from various fruits, berries, their juices, from dried fruits (with the addition of a small amount of starch).

Butter.

Tea (weak) with milk or cream.

Approximate one-day diet menu number 0

• 8 hours - fruit and berry juice.
• 10 o'clock - tea with milk or cream with sugar.
• 12 hours - fruit or berry jelly.
• 14 hours - a weak broth with butter.
• 4 p.m. - lemon jelly.
• 6 p.m. - rosehip decoction.
• 20:00 - tea with milk and sugar.
• 22 hours - rice water with cream.

Diet number 0A

It is prescribed, as a rule, for 2-3 days. Food consists of liquid and jelly-like dishes. In the diet 5 g of protein, 15-20 g of fat, 150 g of carbohydrates, energy value 3.1-3.3 MJ (750-800 kcal); table salt 1 g, free liquid 1.8-2.2 liters. The food temperature is not higher than 45 °C. Up to 200 g of vitamin C is introduced into the diet; other vitamins are added as prescribed by the doctor. Eating 7 - 8 times a day, for 1 meal they give no more than 200 - 300 g.

• - Allowed: low-fat meat broth, rice broth with cream or butter, strained compote, liquid berry jelly, rosehip broth with sugar, fruit jelly, tea with lemon and sugar, freshly prepared fruit and berry juices diluted 2-3 times sweet water (up to 50 ml per reception). When the condition improves on the 3rd day, add: soft-boiled egg, 10 g of butter, 50 ml of cream.
• - Excluded: any dense and puree-like dishes, whole milk and cream, sour cream, grape and vegetable juices, carbonated drinks.

Diet No. 0B (No. 1A surgical)

It is prescribed for 2-4 days after diet No. 0-a, from which diet No. 0-b differs in addition in the form of liquid pureed cereals from rice, buckwheat, oatmeal, boiled in meat broth or water. In the diet 40-50 g of protein, 40-50 g of fat, 250 g of carbohydrates, energy value 6.5-6.9 MJ (1550-1650 kcal); 4-5 g sodium chloride, up to 2 liters of free liquid. Food is given 6 times a day, no more than 350-400 g per reception.

Diet No. 0B (No. 1B surgical)

It serves as a continuation of the expansion of the diet and the transition to physiologically complete nutrition. Puree soups and cream soups, steamed dishes of mashed boiled meat, chicken or fish, fresh cottage cheese mashed with cream or milk to the consistency of thick sour cream, steamed cottage cheese dishes, sour-milk drinks, baked apples, well-mashed fruit and vegetable purees, up to 100 g of white crackers. Milk is added to tea; give milk porridge. In the diet 80-90 g of protein, 65-70 g of fat, 320-350 g of carbohydrates, energy value 9.2-9.6 MJ (2200-2300 kcal); sodium chloride 6-7 g. Food is given 6 times a day. The temperature of hot dishes is not higher than 50 °С, cold - not less than 20 °С.

Then there is an expansion of the diet.

Diet number 1a

Indications for diet No. 1a

This diet is recommended for the maximum limitation of mechanical, chemical and thermal aggression on the stomach. This diet is prescribed for exacerbation of peptic ulcer, bleeding, acute gastritis and other diseases that require maximum sparing of the stomach.

Purpose of diet No. 1a

Reducing the reflex excitability of the stomach, reducing interoceptive irritations emanating from the affected organ, restoring the mucous membrane by sparing the function of the stomach as much as possible.

General characteristics of diet No. 1a

Exclusion of substances that are strong causative agents of secretion, as well as mechanical, chemical and thermal irritants. Food is cooked only in liquid and mushy form. Steamed, boiled, pureed, pureed dishes in a liquid or mushy consistency. In Diet No. 1a for patients who have undergone cholecystectomy, only mucous soups, eggs in the form of steam protein omelettes are used. Caloric content is reduced mainly due to carbohydrates. The amount of food taken at a time is limited, the frequency of intake is at least 6 times.

The chemical composition of diet No. 1a

Diet No. 1a is characterized by a decrease in the content of proteins and fats to the lower limit of the physiological norm, a strict limitation of the impact of various chemical and mechanical stimuli on the upper gastrointestinal tract. With this diet, carbohydrates and salt are also limited.

Proteins 80 g, fats 80 - 90 g, carbohydrates 200 g, table salt 16 g, calories 1800 - 1900 kcal; retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg, ascorbic acid 100 mg; calcium 0.8 g, phosphorus 1.6 g, magnesium 0.5 g, iron 0.015 g. The temperature of hot dishes is not higher than 50-55 ° C, cold - not lower than 15-20 ° C.

• - Mucous soups from semolina, oatmeal, rice, pearl barley with the addition of egg-milk mixture, cream, butter.
• - Meat and poultry dishes in the form of mashed potatoes or steam soufflé (meat cleaned from tendons, fascia and skin is passed through a meat grinder 2-3 times).
• - Fish dishes in the form of a steam soufflé from low-fat varieties.
• - Dairy products - milk, cream, steamed soufflé from freshly prepared grated cottage cheese; fermented milk drinks, cheese, sour cream, ordinary cottage cheese are excluded. Whole milk with good tolerance is drunk up to 2-4 times a day.
• - Soft-boiled eggs or in the form of a steam omelette, no more than 2 per day.
• - Dishes from cereals in the form of liquid porridge in milk, porridge from cereal (buckwheat, oatmeal) flour with the addition of milk or cream. You can use almost all cereals, with the exception of barley and millet. Butter is added to the finished porridge.
• - Sweet dishes - kissels and jelly from sweet berries and fruits, sugar, honey. You can also make juices from berries and fruits, diluting them with boiled water in a 1: 1 ratio before drinking.
• - Fats - fresh butter and vegetable oil added to dishes.
• - Drinks: weak tea with milk or cream, juices from fresh berries, fruits, diluted with water. Of the drinks, decoctions of wild rose and wheat bran are especially useful.

Excluded foods and dishes of diet No. 1a

Bread and bakery products; broths; fried foods; mushrooms; smoked meats; fatty and spicy dishes; vegetable dishes; various snacks; coffee, cocoa, strong tea; vegetable juices, concentrated fruit juices; fermented milk and carbonated drinks; sauces (ketchup, vinegar, mayonnaise) and spices.

Diet number 1b

Indications for diet No. 1b

Indications and purpose as for diet No. 1a. The diet is fractional (6 times a day). This table is for less sharp, in comparison with table No. 1a, limitation of mechanical, chemical and thermal aggression on the stomach. This diet is indicated for mild exacerbation of gastric ulcer, in the stage of remission of this process, with chronic gastritis.

Diet No. 1b is prescribed at subsequent stages of treatment with the patient remaining in bed. The timing of diet No. 1b is very individual, but on average they range from 10 to 30 days. Diet number 1b is also used subject to bed rest. The difference from diet number 1a is a gradual increase in the content of essential nutrients and caloric content of the diet.

Bread is allowed in the form of dried (but not toasted) crackers (75-100 g). Pureed soups are introduced, replacing mucous membranes; milk porridge can be consumed more often. Homogenized canned food for baby food from vegetables and fruits and dishes from beaten eggs are allowed. All recommended products and dishes from meat and fish are given in the form of steam soufflé, quenelles, mashed potatoes, cutlets. After the products are boiled to softness, they are rubbed to a mushy state. Food must be warm. The rest of the recommendations are the same as for diet No. 1a.

The chemical composition of diet No. 1b

Proteins up to 100 g, fats up to 100 g (30 g vegetable), carbohydrates 300 g, calories 2300 - 2500 kcal, salt 6 g; retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg, ascorbic acid 100 mg; calcium 0.8 g, phosphorus 1.2 g, magnesium 0.5 g, iron 15 mg. The total amount of free liquid is 2 liters. The temperature of hot dishes is up to 55 - 60 ° C, cold - not lower than 15 - 20 ° C.

The role of a nurse in dietary correction:

The dietitian monitors the work of the catering department and compliance with the sanitary and hygienic regime, monitors the implementation of dietary recommendations when the doctor changes the diet, checks the quality of the products when they arrive at the warehouse and kitchen, and controls the correct storage of the food supply. With the participation of the head of production (chef) and under the guidance of a dietitian, draws up a daily menu-layout in accordance with the card file of dishes. Carries out periodic calculation of the chemical composition and calorie content of diets, control of the chemical composition of actually prepared dishes and diets (protein, fat, carbohydrates, vitamins, minerals, energy value, etc.) by selectively sending individual dishes to the laboratory of the State Sanitary and Epidemiological Supervision Center. Controls the bookmarking of products and the release of dishes from the kitchen to the departments, according to the orders received, carries out the grading of finished products. Carries out control over the sanitary condition of dispensing and canteens at departments, inventory, utensils, as well as the implementation of distributing rules of personal hygiene by employees. Organizes classes with paramedical workers and kitchen staff on therapeutic nutrition. Controls the timely conduct of preventive medical examinations of catering workers and the exclusion from work of persons who have not passed a preliminary or periodic medical examination.

Diet number 1

General information

Indications for diet number 1

Peptic ulcer of the stomach in the stage of fading exacerbation, during the period of recovery and remission (the duration of dietary treatment is 3-5 months).

The purpose of diet No. 1 is to accelerate the processes of reparation of ulcers and erosions, further reduce or prevent inflammation of the gastric mucosa.

This diet contributes to the normalization of the secretory and motor-evacuation function of the stomach.

Diet No. 1 is designed to meet the physiological needs of the body for nutrients in stationary conditions or in outpatient conditions during work that is not associated with physical activity.

General characteristics of diet No. 1

The use of diet No. 1 is aimed at providing a moderate sparing of the stomach from mechanical, chemical and thermal aggression with a restriction in the diet of dishes that have a pronounced irritating effect on the walls and receptor apparatus of the upper gastrointestinal tract, as well as indigestible foods. Exclude dishes that are strong causative agents of secretion and chemically irritate the gastric mucosa. Both very hot and very cold dishes are excluded from the diet.

The diet for diet No. 1 is fractional, up to 6 times a day, in small portions. It is necessary that the break between meals should not be more than 4 hours, a light dinner is allowed an hour before bedtime. At night, you can drink a glass of milk or cream. Food is recommended to chew thoroughly.

The food is liquid, mushy and denser in boiled and mostly pureed form. Since the consistency of food is very important in dietary nutrition, they reduce the amount of foods rich in fiber (such as turnips, radishes, radishes, asparagus, beans, peas), fruits with skins and unripe berries with rough skins (such as gooseberries, currants, grapes). , dates), bread made from wholemeal flour, foods containing coarse connective tissue (such as cartilage, poultry and fish skin, sinewy meat).

Dishes are cooked boiled or steamed. After that, they are crushed to a mushy state. Fish and coarse meats can be eaten whole. Some dishes can be baked, but without a crust.

The chemical composition of diet No. 1

Proteins 100 g (of which 60% of animal origin), fats 90-100 g (30% vegetable), carbohydrates 400 g, table salt 6 g, calories 2800-2900 kcal, ascorbic acid 100 mg, retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg; calcium 0.8 g, phosphorus at least 1.6 g, magnesium 0.5 g, iron 15 mg. The total amount of free fluid is 1.5 liters, food temperature is normal. Salt is recommended to be limited.

• - Wheat bread from the highest grade flour of yesterday's baking or dried; rye bread and any fresh bread, pastry and puff pastry products are excluded.
• - Soups on a vegetable broth from mashed and well-boiled cereals, dairy, vegetable puree soups seasoned with butter, egg-milk mixture, cream; meat and fish broths, mushroom and strong vegetable broths, cabbage soup, borscht, okroshka are excluded.
• - Meat dishes - steamed and boiled from beef, young low-fat lamb, trimmed pork, chickens, turkeys; fatty and sinewy varieties of meat, poultry, duck, goose, canned meat, smoked meats are excluded.
• - Fish dishes are usually low-fat varieties, without skin, in pieces or in the form of cutlets; cooked with water or steam.
• - Dairy products - milk, cream, non-acidic kefir, yogurt, cottage cheese in the form of a soufflé, lazy dumplings, pudding; dairy products with high acidity are excluded.
• - Cereals from semolina, buckwheat, rice, boiled in water, milk, semi-viscous, mashed; millet, barley and barley groats, legumes, pasta are excluded.
• - Vegetables - potatoes, carrots, beets, cauliflower, boiled in water or steam, in the form of soufflé, mashed potatoes, steam puddings.
• - Appetizers - boiled vegetable salad, boiled tongue, doctor's sausage, dairy, dietary, aspic fish on vegetable broth.
• - Sweet dishes - fruit puree, kissels, jelly, pureed compotes, sugar, honey.
• - Drinks - weak tea with milk, cream, sweet juices from fruits and berries.
• - Fats - butter and refined sunflower oil added to dishes.

Excluded foods and dishes of diet No. 1

Two food groups should be excluded from your diet.

• - Foods that cause or increase pain. These include: drinks - strong tea, coffee, carbonated drinks; tomatoes, etc.
• - Products that strongly stimulate the secretion of the stomach and intestines. These include: concentrated meat and fish broths, decoctions of mushrooms; fried foods; meat and fish stewed in own juice; meat, fish, tomato and mushroom sauces; salted or smoked fish and meat products; meat and fish canned food; salted, pickled vegetables and fruits; spices and seasonings (mustard, horseradish).

In addition, the following are excluded: rye and any fresh bread, pastry products; dairy products with high acidity; millet, barley, barley and corn grits, legumes; white cabbage, radish, sorrel, onion, cucumbers; salted, pickled and pickled vegetables, mushrooms; sour and fiber-rich fruits and berries.

It is necessary to focus on the feelings of the patient. If, when eating a certain product, the patient feels discomfort in the epigastric region, and even more so nausea, vomiting, then this product should be discarded.

Control work on physical rehabilitation Physical rehabilitation for peptic ulcer of the stomach and duodenum

INTRODUCTION

peptic ulcer rehabilitation

The problem of diseases of the gastrointestinal tract is the most relevant at the moment. Among all diseases of organs and systems, peptic ulcer ranks second after coronary heart disease.

The purpose of the work: to study the methods of physical rehabilitation for peptic ulcer of the stomach and duodenum.

Research objectives:

1. To study the main clinical data on gastric and duodenal ulcers.

2. To study methods of physical rehabilitation for peptic ulcer of the stomach and duodenum.

At the present stage, the whole complex of rehabilitation measures gives excellent results in the recovery of patients with peptic ulcer. More and more methods are included in the rehabilitation process from oriental medicine, alternative medicine and other industries. The best effect and stable remission occurs after the use of psychoregulatory agents and elements of auto-training.

L.S. Khodasevich gives the following interpretation of peptic ulcer - this is a chronic disease characterized by dysfunction and the formation of an ulcer in the wall of the stomach or duodenum.

Studies by L. S. Khodasevich (2005) showed that peptic ulcer is one of the most common diseases of the digestive system. Peptic ulcer affects up to 5% of the adult population. The peak incidence is observed at the age of 40-60 years, in urban residents the incidence is higher than in rural areas. Every year, 3,000 people die from this disease and its complications. Peptic ulcer develops more often in men, mainly under the age of 50 years. S. N. Popov emphasizes that in Russia there are more than 10 million such patients with almost annual recurrences of ulcers in about 33% of them. Peptic ulcer occurs in people of any age, but more often in men aged 30-50 years. I. A. Kalyuzhnova claims that most often this disease affects males. Localization of the ulcer in the duodenum is typical for young people. The urban population suffers from peptic ulcer disease more often than the rural population.

L.S. Khodasevich cites the following possible complications of peptic ulcer: perforation (perforation) of the ulcer, penetration (into the pancreas, the wall of the large intestine, liver), bleeding, periulcerous gastritis, perigastritis, periulcerous duodenitis, periduodenitis; stenosis of the inlet and outlet of the stomach, stenosis and deformity of the duodenal bulb, malignancy of the stomach ulcer, combined complications.

G chapter 1. Basic clinical data on peptic ulcer of the stomach and duodenum

1.1 Etiology and pathogenesis of gastric ulcer and duodenal ulcer colon

According to Khodasevich L. S. (2005), the term "peptic ulcer" is characterized by the formation of sites of destruction of the mucous membrane of the digestive tract. In the stomach, it is localized more often on the lesser curvature, in the duodenum - in the bulb on the back wall. A. D. Ibatov believes that the factors contributing to the onset of PU are prolonged and / or repetitive emotional overstrain, genetic predisposition, the presence of chronic gastritis and duodenitis, contamination of Helicobacter pylori, eating disorders, smoking and drinking alcohol.

In the educational dictionary-reference book by O. V. Kozyreva, A. A. Ivanov, the concept of "ulcer" is characterized as a local loss of tissue on the surface of the skin or mucous membrane, the destruction of their main layer, and a wound that heals slowly and is usually infected with foreign microorganisms.

S.N. Popov believes that various lesions of the NS (acute psychotraumas, physical and especially mental overstrain, various nervous diseases) contribute to the development of PU. It should also be noted the importance of the hormonal factor, and especially histamine and serotonin, under the influence of which the activity of the acid-peptic factor increases. Of certain importance is the violation of the diet and food composition. In recent years, an increasing place is given to the infectious (viral) nature of this disease. Hereditary and constitutional factors also play a certain role in the development of PU.

L.S. Khodasevich identifies two stages in the formation of a chronic ulcer:

- erosion - a superficial defect resulting from necrosis of the mucous membrane;

- acute ulcer - a deeper defect that captures not only the mucous membrane, but also other membranes of the stomach wall.

S.N. Popov believes that at present the formation of a stomach ulcer or duodenal ulcer occurs as a result of changes in the ratio of local factors of "aggression" and "protection"; at the same time, there is a significant increase in “aggression” against the background of a decrease in “protection” factors. (decrease in the production of mucobacterial secretion, slowing down the processes of physiological regeneration of the surface epithelium, a decrease in blood circulation in the microcirculatory bed and nervous trophism of the mucous membrane; inhibition of the main mechanism of sanogenesis - the immune system, etc.).

L.S. Khodasevich cites the differences between the pathogenesis of gastric ulcers and pyloroduodenal ulcers.

Pathogenesis of pyloroduodenal ulcers:

- impaired motility of the stomach and duodenum;

- hypertonicity of the vagus nerve with an increase in the activity of the acid-peptic factor;

- an increase in the level of adrenocorticotropic hormone of the pituitary gland and adrenal glucocorticoids;

- a significant predominance of the acid-peptic factor of aggression over the factors of protection of the mucous membrane.

The pathogenesis of gastric ulcer:

- suppression of the functions of the hypothalamic-pituitary system, a decrease in the tone of the vagus nerve and the activity of gastric secretion;

- weakening of mucosal protective factors

1.2 Clinical presentation, classification and complications of peptic ulcer stomach and duodenal ulcers

In the clinical picture of the disease, S. N. Popov notes pain syndrome, which depends on the location of the ulcer, dyspeptic syndrome (nausea, vomiting, heartburn, change in appetite), which, like pain, can have a rhythmic character, signs of gastrointestinal bleeding may be observed or a clinic of peritonitis with perforation of the ulcer.

The leading symptom, according to S. N. Popov and L. S. Khodasevich, is a dull, aching pain in the epigastric, most often in the epigastric region, usually occurring 1–1.5 hours after eating with a stomach ulcer and 3 hours later with duodenal ulcer, the pain in which is usually localized to the right of the midline of the abdomen. Sometimes there are pains on an empty stomach, as well as night pains. Gastric ulcer is usually observed in patients older than 35 years, duodenal ulcer in young people. There is a typical seasonality of spring exacerbations. During the course of PUD, S. N. Popov distinguishes four phases: exacerbation, fading exacerbation, incomplete remission and complete remission. The most dangerous complication of PU 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.

P.F. Litvitsky describes in more detail the manifestations of PU. PUD is manifested by pain in the epigastric region, dyspeptic symptoms (belching with air, food, nausea, heartburn, constipation), asthenovegetative manifestations in the form of decreased performance, weakness, tachycardia, arterial hypotension, moderate local pain and muscle protection in the epigastric region, and ulcers can debut perforation or bleeding.

DU is manifested by pain prevailing in 75% of patients, vomiting at the height of pain, bringing relief (pain reduction), indefinite dyspeptic complaints (belching, heartburn, bloating, food intolerance in 40-70%, frequent constipation), palpation is determined by pain in epigastric region, sometimes with some resistance of the abdominal muscles, asthenovegetative manifestations, and also note periods of remission and exacerbation, the latter lasting several weeks.

In the educational dictionary-reference book by O. V. Kozyreva, A. A. Ivanov, an ulcer is distinguished:

- duodenal - duodenal ulcer. It proceeds with periodic pain in the epigastric region, appearing after a long time after eating, on an empty stomach or at night. Vomiting does not occur (if stenosis has not developed), very often there is increased acidity of gastric juice, hemorrhages;

- gastroduodenal - GU and duodenal ulcer;

- stomach - YABZH;

- perforated ulcer - an ulcer of the stomach and duodenum, perforated into the free abdominal cavity.

P.F. Litvitsky and Yu. S. Popova give a classification of PU:

- Most of the first type ulcers occur in the body of the stomach, namely in the area called the place of least resistance, the so-called transitional zone, located between the body of the stomach and the antrum. The main symptoms of an ulcer of this localization are heartburn, belching, nausea, vomiting, which brings relief, pain that occurs 10-30 minutes after eating, which can radiate to the back, left hypochondrium, left half of the chest and / or behind the sternum. Ulcer of the antrum of the stomach is typical for young people. It is manifested by "hungry" and night pains, heartburn, less often - vomiting with a strong sour smell.

- Gastric ulcers that occur together with a duodenal ulcer.

- Ulcers of the pyloric canal. In their course and manifestations, they are more like duodenal ulcers than stomach ulcers. The main symptoms of an ulcer are sharp pains in the epigastric region, constant or occurring randomly at any time of the day, may be accompanied by frequent severe vomiting. Such an ulcer is fraught with all sorts of complications, primarily pyloric stenosis. Often, with such an ulcer, doctors are forced to resort to surgical intervention;

- High ulcers (subcardial region), localized near the esophageal-gastric junction on the lesser curvature of the stomach. It is more common in older people over 50 years of age. The main symptom of such an ulcer is pain that occurs immediately after eating in the area of ​​​​the xiphoid process (under the ribs, where the sternum ends). Complications characteristic of such an ulcer are ulcerative bleeding and penetration. Often in its treatment it is necessary to resort to surgical intervention;

- Duodenal ulcer. In 90% of cases, duodenal ulcer is localized in the bulb (thickening in its upper part). The main symptoms are heartburn, "hungry" and night pains, most often in the right side of the abdomen.

S.N. Popov also classifies ulcers by type (single and multiple), by etiology (associated with Helicobacter pylori and not associated with H.R.), by clinical course (typical, atypical (with atypical pain syndrome, painless, but with other clinical manifestations, asymptomatic)), by the level of gastric secretion (with increased secretion, with normal secretion and with reduced secretion), by the nature of the course (for the first time detected PU, recurrent course), by the stage of the disease (exacerbation or remission), by the presence of complications (bleeding , perforation, stenosis, malignancy).

The clinical course of PU, explains S. N. Popov, may be complicated by bleeding, perforation of the ulcer into the abdominal cavity, narrowing of the pylorus. With a long course, cancerous degeneration of the ulcer may occur. In 24-28% of patients, ulcers can occur atypically - without pain or with pain resembling another disease (angina pectoris, osteochondrosis, etc.), and is detected by chance. PU can also be accompanied by gastric and intestinal dyspepsia, asthenoneurotic syndrome.

Yu.S. Popova describes in more detail the possible complications of peptic ulcer:

- Perforation (perforation) of an ulcer, that is, the formation of a through wound in the wall of the stomach (or 12PC), through which undigested food, together with acidic gastric juice, enters the abdominal cavity. Often the perforation of the ulcer occurs as a result of drinking alcohol, overeating or physical overexertion.

- Penetration - a violation of the integrity of the stomach, when the gastric contents spill into the nearby pancreas, omentum, intestinal loops or other organs. This happens when, as a result of inflammation, the wall of the stomach or duodenum fuses with the surrounding organs (adhesions form). Attacks of pain are very strong and are not removed with the help of medications. Treatment requires surgery.

- Bleeding may occur during an exacerbation of the ulcer. It may be the beginning of an exacerbation or open at a time when other symptoms of an ulcer (pain, heartburn, etc.) have already appeared. It is important to note that ulcer bleeding can occur both in the presence of a severe, deep, advanced ulcer, and in a fresh, small ulcer. The main symptoms of bleeding ulcers are black stools and coffee grounds-colored vomit (or vomit of blood).

In case of emergency, when the patient's condition becomes dangerous, with ulcerative bleeding, surgical intervention is undertaken (a bleeding wound is sutured). Often, ulcer bleeding is treated with medication.

- A subphrenic abscess is a collection of pus between the diaphragm and adjacent organs. This complication of PU is very rare. It develops during the period of exacerbation of PU as a result of perforation of the ulcer or the spread of infection through the lymphatic system of the stomach or duodenum.

- Obstruction of the pyloric section of the stomach (pyloric stenosis) - anatomical distortion and narrowing of the sphincter lumen, resulting from scarring of the ulcer of the pyloric canal or the initial section of the duodenum. This phenomenon leads to difficulty or complete cessation of the evacuation of food from the stomach. Pyloric stenosis and related disorders of the digestive process lead to disorders of all types of metabolism, which leads to depletion of the body. The main method of treatment is surgery.

peptic ulcer rehabilitation

1.3 Diagnosis of peptic ulcer of the stomach and duodenum

The diagnosis of PU is made to patients most often during the period of exacerbation, says Yu. S. Popova. The first and main symptom of an ulcer is severe spasmodic pain in the upper abdomen, in the epigastric region (above the navel, at the junction of the costal arches and the sternum). Pain with an ulcer - the so-called hungry, tormenting the patient on an empty stomach or at night. In some cases, pain can occur 30-40 minutes after eating. In addition to pain, there are other symptoms of an exacerbation of peptic ulcer. These are heartburn, sour belching, vomiting (appears without prior nausea and brings temporary relief), increased appetite, general weakness, fatigue, mental imbalance. It is also important to note that during an exacerbation of peptic ulcer, as a rule, the patient suffers from constipation.

The methods used by modern medicine to diagnose ulcers largely coincide with the methods for diagnosing chronic gastritis. X-ray and fibrogastroscopic studies determine the anatomical changes in the organ, and also answer the question of which functions of the stomach are impaired.

Yu.S. Popova offers the first, simplest methods for examining a patient with a suspected ulcer - these are laboratory tests of blood and feces. A moderate decrease in the level of hemoglobin and erythrocytes in a clinical blood test reveals hidden bleeding. Fecal analysis "Stool occult blood test" should reveal the presence of blood in it (from a bleeding ulcer).

Gastric acidity in PU is usually increased. In this regard, an important method for diagnosing PU is the study of the acidity of gastric juice by Ph-metry, as well as by measuring the amount of hydrochloric acid in portions of gastric contents (gastric contents are obtained by probing).

The main method for diagnosing stomach ulcers is FGS. With the help of FGS, the doctor can not only verify the presence of an ulcer in the patient's stomach, but also see how large it is, in which particular section of the stomach it is located, whether it is a fresh or healing ulcer, whether it bleeds or not. In addition, FGS allows diagnosing how well the stomach works, as well as taking a microscopic piece of the gastric mucosa affected by an ulcer for analysis (the latter allows, in particular, to establish whether the patient is affected by H.P.).

Gastroscopy, as the most accurate research method, allows you to establish not only the presence of an ulcer, but also its size, and also helps to distinguish an ulcer from cancer, to notice its degeneration into a tumor.

Yu.S. Popova emphasizes that fluoroscopic examination of the stomach allows not only diagnosing the presence of an ulcer in the stomach, but also assessing its motor and excretory functions. Data on the violation of the motor abilities of the stomach can also be considered indirect signs of an ulcer. So, if there is an ulcer located in the upper parts of the stomach, there is an accelerated evacuation of food from the stomach. If the ulcer is located low enough, food, on the contrary, lingers in the stomach longer.

1.4 Treatment and prevention of gastric and duodenal ulcers duodenal ulcer

In the complex of rehabilitation measures, according to S. N. Popov, drugs, motor mode, exercise therapy and other physical methods of treatment, massage, and therapeutic nutrition should be used first of all. Exercise therapy and massage improve or normalize neuro-trophic processes and metabolism, helping to restore the secretory, motor, absorption and excretory functions of the digestive canal.

S.N. Popov also argues that patients with an exacerbation of uncomplicated PU are usually treated on an outpatient basis. Complex therapy is used, similar to the treatment of chronic gastritis, diet therapy, drug therapy, physiotherapy, spa treatment (in remission), exercise therapy. Some authors believe that diet therapy, LH, massage, physiotherapy and hydrotherapy are used for treatment. In addition, Yu. S. Popova believes that it is important to create for the patient the calm psychological atmosphere he needs, to exclude nervous and physical overload, and, if possible, negative emotions.

The causes, signs, diagnostic methods and possible complications of PU are somewhat different, depending on which particular section of the stomach or duodenum the exacerbation is localized, explains O. V. Kozyreva.

According to N. P. Petrushkina, the treatment of the disease should begin with a rational diet, diet and psychotherapy (to eliminate adverse pathogenetic factors). In the acute period, with severe pain syndrome, drug treatment is recommended.

1.4.1 Treatment with medication Popova Yu.S. emphasizes that treatment is always prescribed by the doctor individually, taking into account many important factors. These include the characteristics of the patient's body (age, general health, the presence of allergies, concomitant diseases), and the characteristics of the course of the disease itself (in which part of the stomach the ulcer is located, what it looks like, how long the patient has been suffering from PUD).

In any case, the treatment of an ulcer will always be complex, says Yu. S. Popova. Since the causes of the disease are malnutrition, infection of the stomach with a specific bacterium, and stress, the correct treatment should be aimed at neutralizing each of these factors.

The use of medications for exacerbation of peptic ulcer is necessary. Medicines that help reduce the acidity of gastric juice, protect the mucous membrane from the negative effects of acid (antacids), restore normal motility of the stomach and duodenum, are combined with medicines that stimulate the healing of ulcers and restore the mucous membrane. For severe pain, antispasmodics are used. In the presence of psychological disorders, stress, sedatives are prescribed.

1.4.2 Diet Therapy Yu. S. Popova explains that therapeutic nutrition in case of PU should provide the gastric mucosa and duodenum with maximum rest, it is important to exclude mechanical and thermal damage to the gastric mucosa. All food is pureed, the temperature of which is from 15 to 55 degrees. In addition, during an exacerbation of PU, the use of products that provoke an increased secretion of gastric juice is unacceptable. Fractional nutrition - every 3-4 hours, in small portions. The diet should be complete, focus on vitamins A, B and C. The total amount of fat should not be more than 100-110 g per day.

1.4.3 Physiotherapy According to G. N. Ponomarenko, physiotherapy is prescribed to reduce pain and provide an antispastic effect, stop the inflammatory process, stimulate regenerative processes, regulate the motor function of the gastrointestinal tract, and increase immunity. Local air cryotherapy is used, exposing the back and abdomen to cold air for about 25-30 minutes; pelotherapy in the form of mud applications on the anterior abdominal cavity; radon and carbonic baths; magnetotherapy, which affects the immune processes positively. Contraindications to physiotherapy are severe ulcerative disease, bleeding, individual intolerance to physiotherapy methods, gastric polyposis, ulcer malignancy, and general contraindications for physiotherapy.

1.4.4 Phytotherapy N. P. Petrushkina explains that phytotherapy is included in complex treatment later. In the process of phytotherapy of GU and DPC, with an increase in the activity of the acid-peptic factor, neutralizing, protecting and regenerating groups of drugs are used. With a long-term ulcerative defect, antiulcer, herbal preparations are used (sea buckthorn oil, rosehip oil, carbenoxolone, alanton).

In case of YABZH with increased secretory activity of the stomach, it is recommended to collect medicinal herbs: plantain leaves, chamomile flowers, cudweed grass, rose hips, yarrow grass, licorice roots.

For the treatment of GU and DPC, the author also suggests such herbal preparations as: fennel fruits, marshmallow root, licorice, chamomile flowers; herb celandine, yarrow, St. John's wort and chamomile flowers. The infusion is usually taken before meals, at night, or to relieve heartburn.

1.4.5 Massage Of the means of exercise therapy for diseases of the abdominal organs, massage is indicated - therapeutic (and its varieties - reflex-segmental, vibrational), says V. A. Epifanov. Massage in the complex treatment of chronic diseases of the gastrointestinal tract is prescribed to have a normalizing effect on the neuroregulatory apparatus of the abdominal organs in order to help improve the function of the smooth muscles of the intestines and stomach, and strengthen the abdominal muscles.

According to V. A. Epifanov, during the massage procedure, one should act on the paravertebral (Th-XI - Th-V and C-IV - C-III) and reflexogenic zones of the back, the region of the cervical sympathetic nodes, and the stomach.

Massage is contraindicated in the acute stage of diseases of the internal organs, in diseases of the digestive system with a tendency to bleeding, tuberculous lesions, neoplasms of the abdominal organs, acute and subacute inflammatory processes of the female genital organs, pregnancy.

1.4.6 Prevention To prevent exacerbations of PU, S. N. Popov offers two types of therapy (maintenance therapy: antisecretory drugs in half the dose; prophylactic therapy: when symptoms of exacerbation of PU appear, antisecretory drugs are used for 2-3 days. Therapy is stopped when symptoms completely disappear) with patients observing the general and motor regimens, as well as a healthy lifestyle. A very effective means of primary and secondary prevention of PU is sanatorium treatment.

For the prevention of the disease, Yu. S. Popova recommends observing the following rules:

- sleep 6-8 hours;

- refuse fatty, smoked, fried foods;

- during pain in the stomach, it is necessary to be examined by a specialist doctor;

- take mashed, easily digestible food 5-6 times a day: cereals, kissels, steam cutlets, sea fish, vegetables, scrambled eggs;

- treat bad teeth in order to chew food well;

- avoid scandals, because after a nervous strain, pain in the stomach intensifies;

- do not eat very hot or very cold food, as this can contribute to the occurrence of esophageal cancer;

- Do not smoke and do not abuse alcohol.

To prevent gastric and duodenal ulcers, it is important to be able to cope with stress and maintain your mental health.

CHAPTER 2 Methods of physical rehabilitation for peptic ulcer of the stomach and duodenum

2.1 Physical rehabilitation at the inpatient stage of treatment

Hospitalization is subject, according to A. D. Ibatov, patients with newly diagnosed PU, with exacerbation of PU and in the event of complications (bleeding, perforation, penetration, pyloric stenosis, malignancy). Given that the traditional means of treating PU are warmth, rest and diet.

At the stationary stage, half-bed or bed rest is prescribed, respectively (with severe pain syndrome). Diet - table No. 1a, 1b, 1 according to Pevzner - provides mechanical, chemical and thermal sparing of the stomach [Appendix B]. Eradication therapy is carried out (if Helicobacter pylori is detected): antibiotic therapy, antisecretory therapy, agents that normalize gastric and duodenal motility. Physiotherapy includes electrosleep, sinusoidal-modeled currents on the stomach area, UHF therapy, ultrasound on the epigastric area, novocaine electrophoresis. With a stomach ulcer, oncological alertness is necessary. If malignancy is suspected, physiotherapy is contraindicated. Exercise therapy is limited to UGG and LH in a gentle mode.

V.A. Epifanov claims that LH is used after the acute period of the disease. Exercises should be done carefully if they aggravate the pain. Complaints often do not reflect the objective state, an ulcer can progress even with subjective well-being (disappearance of pain, etc.). You should spare the abdominal area and very carefully, gradually increase the load on the abdominal muscles. It is possible to gradually expand the patient's motor mode by increasing the total load when performing most exercises, including diaphragmatic breathing, for the abdominal muscles.

According to I. V. Milyukova, during exacerbations, frequent changes in rhythm, a fast pace of even simple exercises, muscle tension can cause or aggravate pain and worsen the general condition. During this period, monotonous exercises are used, performed at a slow pace, mainly in the lying position. In the remission phase, exercises are performed in the IP standing, sitting and lying down; the amplitude of movements increases, you can use exercises with shells (weighing up to 1.5 kg).

When a patient is transferred to a ward regimen, A. D. Ibatov claims, a second period of rehabilitation is prescribed. The tasks of the first are added to the tasks of household and labor rehabilitation of the patient, restoring the correct posture when walking, improving 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. Exercises are performed in the prone position, sitting, kneeling, standing with gradually increasing effort for all muscle groups, still excluding the abdominal muscles. The most acceptable is the supine position: it allows you to increase the mobility of the diaphragm, has a gentle effect on the abdominal muscles and improves blood circulation in the abdominal cavity. Patients perform exercises for the abdominal muscles without tension, with a small number of repetitions. After the disappearance of pain and other signs of exacerbation, in the absence of complaints and in general satisfactory condition, a free regimen is prescribed, emphasizes V. A. Epifanov. In LH classes, exercises are used for all muscle groups (sparing the abdominal area and excluding sudden movements) with increasing effort from various IPs. They include exercises with dumbbells (0.5-2 kg), stuffed balls (up to 2 kg), exercises on the gymnastic wall and bench. Diaphragmatic breathing of maximum depth. Walking up to 2-3 km per day; walking up the stairs up to 4-6 floors, outdoor walks are desirable. The duration of the LH class is 20−25 minutes.

2.2 Physical rehabilitation at the outpatient stage of treatment

At the polyclinic stage, patients are monitored according to the third group of dispensary registration. With YABZh, patients are examined from 2 to 4 times a year by a general practitioner, gastroenterologist, surgeon, and oncologist. Annually, as well as during exacerbation, gastroscopy and biopsy are performed; fluoroscopy - according to indications, clinical blood test - 2-3 times a year, analysis of gastric juice - 1 time in 2 years; analysis of feces for occult blood, examination of the biliary system - according to indications. During examinations, the diet is corrected, if necessary, anti-relapse therapy is carried out, rational employment and indications for referral to sanatorium treatment are determined. With PUD, the patient is invited for periodic examinations 2-4 times a year, depending on the frequency of exacerbations. In addition, patients undergo oral cavity sanitation, dental prosthetics. Physiotherapeutic procedures include: electrosleep, microwave therapy on the stomach area, UHF therapy, ultrasound.

2.3 Physical rehabilitation at the sanatorium stage of treatment

An indication for spa treatment is gastric ulcer and duodenal ulcer in remission, incomplete remission or fading exacerbation, if there is no motor insufficiency of the stomach, a tendency to bleeding, penetration and suspicion of the possibility of malignant degeneration. Patients are sent to local specialized sanatoriums, gastroenterological resorts with mineral drinking water (to the Caucasus, Udmurtia, Nizhneivkino, etc.) and mud resorts. Sanatorium-resort treatment includes therapeutic nutrition according to the diet table No. 1 with the transition to tables No. 2 and No. 5 [Appendix B]. Treatment is carried out with mineral waters taken warm in portions of 50-100 ml 3 times a day, with a total volume of up to 200 ml. The time of admission is determined by the state of the secretory function of the stomach. They take non-carbonated low- and medium-mineralized mineral waters, mostly alkaline: Borjomi, Smirnovskaya, Essentuki No. 4. With preserved and increased secretion, water is taken 1-1.5 hours before meals. Balneological procedures include sodium chloride, radon, coniferous, pearl baths (every other day), thermotherapy: mud and ozocerite applications, mud electrophoresis. In addition, sinusoidally simulated currents, CMW therapy, UHF therapy, and diadynamic currents are prescribed. Exercise therapy is carried out according to a gentle tonic regimen using UGG, sedentary games, dosed walking, swimming in open water. A therapeutic massage is also used: behind - segmental massage in the back from C-IV to D-IX on the left, in front - in the epigastric region, the location of the costal arches. 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 by the end of the treatment.

Patients are treated during the period of remission, the volume and intensity of PH training increases: they widely use OUU, DU, coordination exercises, allow outdoor and some sports games (badminton, table tennis,), relay races. Health paths are recommended, walks in winter - skiing (the route should exclude ascents and descents with a steepness exceeding 15-20 degrees, the walking style is alternate). There are no power, speed-strength exercises, static efforts and tensions, jumps and hops, exercises at a fast pace in the LH procedure. IP sitting and lying down.

CONCLUSION

PU takes the second place in the incidence of the population after coronary artery disease. Many cases of gastric and duodenal ulcers, gastritis, duodenitis, and possibly some cases of gastric cancer are etiologically associated with Helicobacter pylori infection. However, the majority (up to 90%) of infected carriers of H.P. no symptoms of disease are found. This gives reason to believe that PU is a neurogenic disease that has developed against the background of prolonged psycho-emotional overstrain. Statistics show that urban residents are more prone to PU than rural residents. A less significant factor in the occurrence of PU is malnutrition. I think everyone will agree with me that against the backdrop of stress, emotional overload in work and life, people often, without noticing it, tend to tasty, not healthy food, and someone abuses tobacco products and alcohol. In my opinion, if the situation in the country had not been tense, as it is at the moment, then the incidence would be clearly lower. During the Great Patriotic War, soldiers were subject to various diseases of the gastrointestinal tract from martial law in the country, from malnutrition and tobacco abuse. The soldiers were also subject to hospitalization and rehabilitation. Seventy years later, the factors for the occurrence of PU have remained the same.

For the treatment of peptic ulcer, first of all, drug therapy is used to suppress the infectious factor (antibiotics), to stop bleeding (if necessary), therapeutic nutrition, to prevent complications, a motor mode is used with the use of physical means of rehabilitation: UGG, LH, DU, relaxation exercises, which are special, and other forms of conducting classes. Physiotherapeutic procedures are also prescribed (electrosleep, novocaine electrophoresis, etc.). It is very important that during the rehabilitation period the patient be at rest, if possible, ensure silence, limit TV viewing to 1.5-2 hours a day, walk in the open air 2-3 km per day.

After the relapse stage, the patient is transferred to a gastroenterologist's clinic, followed up for 6 years, with periodic treatments in sanatoriums or resorts to ensure stable remission. In the sanatorium, patients are treated with mineral waters, various types of massage, skiing, cycling, swimming in open water, games.

Physical rehabilitation for any disease plays an important role for the full recovery of a person after an illness. This allows you to save a person's life, teach him to cope with stress, teach and educate him in a conscious attitude in doing physical exercises in order to maintain his health, instill a stereotype about a healthy lifestyle, which helps a person not to be ill again in the future.

LIST OF ABBREVIATIONS

N.R. - Helicobacter pylori (Helicobacter pylori) UHF - decimeter wave (therapy) DPC - duodenum DU - breathing exercises GIT - gastrointestinal tract CHD - coronary heart disease PI - initial position PH - therapeutic exercises exercise therapy - therapeutic physical culture NS - nervous system ORU - general developmental exercises OUU - general strengthening exercises CMV - centimeter wave (therapy) ESR - erythrocyte sedimentation rate FGS - UHF fibrogastroscopy - ultrahigh frequency (therapy) UGG - morning hygienic gymnastics HR - heart rate ECG - electrocardiography PUD - peptic ulcer PUD - peptic ulcer GU - gastric ulcer

REFERENCES

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APPS

Annex A

Outline of therapeutic exercises for ulcer b diseases of the stomach and duodenum

The date of the: 11.11.11

Subject: Full name., 32 years old Diagnosis: duodenal ulcer, gastroduodenitis, superficial gastritis;

Stage of the disease: relapse, subacute (fading exacerbation) Motor mode: extended bed rest Venue: ward Method of conducting: individual Duration of the lesson: 12 minutes Tasks of the lesson:

1. contribute to the regulation of nervous processes in the cerebral cortex, increase the psycho-emotional state;

2. contribute to the improvement of the functions of digestion, redox processes, regeneration of the mucous membrane, improvement of the functions of respiration and blood circulation;

3. to ensure the prevention of complications and congestion, to help improve overall physical performance;

4. continue teaching diaphragmatic breathing, relaxation exercises, auto-training elements;

5. to cultivate a conscious attitude to the implementation of special physical exercises at home in order to prevent the recurrence of the disease and prolong the period of remission.

Appendix Table

Parts of the lesson	Private tasks		Dosage	Organization-method. instructions
Introductory preparation of the body for the upcoming load	Checking heart rate and respiratory rate	1) IP lying on your back. Measurement of heart rate and respiratory rate	Heart rate for 15"" NPV for 30""	Show measuring area
	Learn diaphragmatic breathing	1) IP lying on your back, arms along the body, legs bent at the knees. Diaphragmatic breathing: 1. inhale - the abdominal wall rises, 2. exhale - retract		The pace is slow to imagine how the air comes out of the lungs.
	Improve peripheral circulation.	2) IP lying on your back, arms along the body. Simultaneous flexion and extension of the feet and hands into a fist		Average pace Breathing voluntary
	Stimulate blood circulation in the lower extremities	3) IP lying on your back Alternately bending the legs without taking your feet off the bed 1. exhale - flexion, 2. inhale - extension		The pace is slow
	Stimulate blood circulation in the upper limbs	4) IP lying on your back, arms along the body 1. inhale - spread your arms to the sides, 2. exhale - return to IP		The pace is slow
Main Solving general and special tasks	Strengthen the abdominal and pelvic floor muscles	5) IP lying on your back, legs bent at the knees. 1. spread your knees to the sides, connecting the soles, 2. return to the IP
	Improve blood circulation in internal organs	6) IP sitting on the bed, legs lowered, hands on the belt. 1. exhale - turn the body to the right, arms to the sides, 2. inhale - return to IP, 3. exhale - turn the body to the left, arms to the sides, 4. inhale - return to IP		The pace is slow Amplitude is incomplete Spare the epigastric region
	Strengthen pelvic floor muscles and improve bowel function	7) IP lying on your back. Slowly bend your legs and put your feet to the buttocks, leaning on your elbows and feet 1. raise the pelvis 2. return to the PI		The pace is slow Don't hold your breath
Conclude. load reduction, restoration of heart rate and respiratory rate	General relaxation	8) IP lying on your back. Relax all muscles		Close eyes Turning on the elements of auto-training
	Checking heart rate and respiratory rate	1) IP lying on your back. Measurement of heart rate and respiratory rate	Heart rate for 15"" NPV for 30""

Diet tables according to Pevzner

Table number 1. Indications: peptic ulcer of the stomach and duodenum in the stage of subsiding exacerbation and in remission, chronic gastritis with preserved and increased secretion in the stage of subsiding exacerbation, acute gastritis in the subsiding stage. Characteristics: physiological content of proteins, fats and carbohydrates, salt restriction, moderate restriction of mechanical and chemical irritants of the mucous membrane and the gastrointestinal tract receptor apparatus, stimulants of gastric secretion, substances that linger in the stomach for a long time. Culinary processing: all dishes are cooked in boiled, mashed or steamed form, some dishes are allowed in baked form. Energy value: 2,600-2,800 kcal (10,886-11,723 kJ). Composition: proteins 90-100 g, fats 90 g (of which 25 g of plant origin), carbohydrates 300-400 g, free liquid 1.5 l, sodium chloride 6-8 g. Daily diet weight 2.5-3 kg. Diet - fractional (5-6 times a day). The temperature of hot dishes is 57-62 ° C, cold - not lower than 15 ° C.

Table No. 1a. Indications: exacerbation of peptic ulcer of the stomach and duodenum in the first 10-14 days, acute gastritis in the first days of the disease, exacerbation of chronic gastritis (with preserved and increased acidity) in the first days of the disease. Characteristics: the physiological content of proteins and fats, the restriction of carbohydrates, a sharp restriction of chemical and mechanical stimuli of the mucous membrane and the receptor apparatus of the gastrointestinal tract. Culinary processing: all products are boiled, rubbed or steamed, dishes of liquid or mushy consistency. Energy value: 1,800 kcal (7,536 kJ). Composition: proteins 80 g, fats 80 g, (of which 15-20 g vegetable), carbohydrates 200 g, free liquid 1.5 l, sodium chloride 6-8 g. The weight of the daily diet is 2-2.5 kg. Diet - fractional (6-7 times a day). The temperature of hot dishes - 57-62 ° C, cold - not lower than 15 ° C.

Table No. 1b. Indications: exacerbation of peptic ulcer of the stomach and duodenum in the next 10-14 days, acute gastritis and exacerbation of chronic gastritis in the following days. Characteristics: the physiological content of proteins, fats and restriction of carbohydrates, chemical and mechanical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract are significantly limited. Culinary processing: all dishes are cooked boiled or steamed, the consistency of the dishes is liquid or mushy. Energy value: 2,600 kcal (10,886 kJ). Composition: proteins 90 g, fats 90 g (of which 25 g vegetable fat), carbohydrates 300 g, free liquid 1.5 l, salt 6-8 g. Daily diet weight - 2.5-3 kg. Diet: fractional (5-6 times a day). The temperature of hot dishes - 57-62 ° C, cold - not lower than 15 ° C.

Table No. 2. Indications: acute gastritis, enteritis and colitis during the recovery period, chronic gastritis with secretory insufficiency, enteritis, colitis during remission without concomitant diseases. General characteristics: physiologically complete diet, rich in extractive substances, with rational culinary processing of products. Foods and dishes that linger in the stomach for a long time, are difficult to digest, irritate the mucous membrane and the receptor apparatus of the gastrointestinal tract are excluded. The diet has a stimulating effect on the secretory apparatus of the stomach, improves the compensatory-adaptive reactions of the digestive system, and prevents the development of the disease. Culinary processing: dishes can be boiled, baked, stewed, and also fried without breadcrumbs in breadcrumbs or flour and without forming a rough crust. Energy value: 2800−3100 kcal. Composition: proteins 90-100 g, fats 90-100 g, carbohydrates 400-450 g, free liquid 1.5 l, sodium chloride up to 10-12 g. Daily diet weight - 3 kg. Diet - fractional (4-5 times a day). The temperature of hot dishes - 57-62? C, cold - below 15 ° C.

Peptic ulcer of the stomach (PU) and 12 duodenal ulcers are chronic recurrent diseases prone to progression, the main manifestation of which is the formation of a fairly persistent ulcer in the stomach or duodenum.

Peptic ulcer of the stomach is a fairly common disease that affects 7-10% of the adult population. It should be noted a significant "rejuvenation" of the disease in recent years.

Etiology and pathogenesis. In the last 1.5-2 decades, the point of view on the origin and causes of peptic ulcer has changed. The expression “no acid, no ulcer” was replaced by the discovery that the main cause of this disease is Helicobacter pylori (HP), i.e. an infectious theory of the origin of peptic ulcer of the stomach and duodenum appeared. At the same time, the development and recurrence of the disease in 90% of cases is associated with Helicobacter pylori.

The pathogenesis of the disease is considered, first of all, as an imbalance between the "aggressive" and "protective" factors of the gastroduodenal zone.

The "aggressive" factors include the following: increased secretion of hydrochloric acid and pepsin; altered response of the glandular elements of the gastric mucosa to nervous and humoral influences; rapid evacuation of acidic contents into the duodenal bulb, accompanied by an "acid strike" on the mucous membrane.

Also, "aggressive" effects include: bile acids, alcohol, nicotine, a number of drugs (non-steroidal anti-inflammatory drugs, glucocorticoids, Heliobacter invasion).

Protective factors include gastric mucus, secretion of alkaline bicorbanate, tissue blood flow (microcirculation), regeneration of cellular elements. Questions of sanogenesis are the main ones in the problem of peptic ulcer, in the tactics of its treatment and especially in the prevention of relapses.

Peptic ulcer is a polyetiological and pathogenetically multifactorial disease that proceeds cyclically with alternating periods of exacerbation and remission, is characterized by frequent recurrence, individual characteristics of clinical manifestations, and often acquires a complicated course.

Psychological personality factors play an important role in the etiology and pathogenesis of peptic ulcer.

The main clinical signs of peptic ulcer disease (pain, heartburn, belching, nausea, vomiting) are determined by the localization of the ulcer (cardiac and mesogastric ulcers, pyloric gastric ulcers, duodenal ulcers and postbulbar ulcers), concomitant diseases of the gastrointestinal tract, age, degree of metabolic disorders processes, the level of secretion of gastric juice, etc.

The goal of anti-ulcer treatment is to restore the mucous membrane of the stomach and duodenum (scarring of the ulcer) and to maintain a long-term relapse-free course of the disease.

The complex of rehabilitation measures includes: drug therapy, therapeutic nutrition, protective regimen, exercise therapy, massage and physiotherapeutic methods of treatment.

Since peptic ulcer suppresses and disorganizes the patient's motor activity, the means and forms of exercise therapy are an important element in the treatment of the ulcer process.

It is known that the implementation of dosed, adequate to the state of the patient's body, physical exercises improves cortical neurodynamics, thereby normalizing cortico-visceral relationships, which ultimately leads to an improvement in the patient's psycho-emotional state.

Physical exercises, activating and improving blood circulation in the abdominal cavity, stimulate redox processes, increase the stability of acid-base balance, which has a beneficial effect on the scarring of the ulcer.

At the same time, there are contraindications to the appointment of therapeutic exercises and other forms of exercise therapy: a fresh ulcer in the acute period; ulcer with periodic bleeding; the threat of perforation of the ulcer; an ulcer complicated by stenosis in the stage of compensation; severe dyspeptic disorders; severe pain.

Tasks of physical rehabilitation for peptic ulcer disease:

1. Normalization of the neuropsychological status of the patient.

2. Improvement of redox processes in the abdominal cavity.

3. Improvement of the secretory and motor function of the stomach and duodenum.

4. Development of the necessary motor qualities, skills and abilities (muscle relaxation, rational breathing, elements of autogenic training, proper coordination of movements).

The therapeutic and restorative effect of physical exercises will be higher if special physical exercises are performed by those muscle groups that have a common innervation in the corresponding spinal segments as the affected organ; therefore, according to Kirichinsky A.R. (1974) the choice and justification of the applied special physical exercises are closely related to the segmental innervation of the muscles and certain digestive organs.

In LH classes, in addition to general developmental exercises, special exercises are used to relax the abdominal and pelvic floor muscles, a large number of breathing exercises, both static and dynamic.

In diseases of the gastrointestinal tract, i.p. during exercise. The most favorable will be i.p. lying with bent legs in three positions (on the left, on the right side and on the back), kneeling, standing on all fours, less often standing and sitting. The starting position on all fours is used to limit the impact on the abdominal muscles.

Since in the clinical course of peptic ulcer there are periods of exacerbation, subsiding exacerbation, a period of scarring of the ulcer, a period of remission (possibly short-term) and a period of long-term remission, it is rational to carry out physiotherapy exercises taking into account these periods. The names of motor modes accepted in most diseases (bed, ward, free) do not always correspond to the condition of a patient with peptic ulcer.

Therefore, the following motor modes are preferable: sparing, sparing training, training and general tonic (general strengthening) modes.

Gentle (mode with low physical activity). I.p. - lying on your back, on the right, left side, with bent legs.

First, the patient must be taught the abdominal type of breathing with a slight amplitude of movement of the abdominal wall. Muscle relaxation exercises are also used to achieve complete relaxation. Then exercises are given for the small muscles of the foot (in all planes), followed by exercises for the hands and fingers. All exercises are combined with breathing exercises in a ratio of 2:1 and 3:1 and massage of the muscle groups involved in the exercises. After 2-3 sessions, exercises for medium muscle groups are connected (monitor the patient's reaction and his pain sensations). The number of repetitions of each exercise is 2-4 times. In this mode, it is necessary for the patient to instill the skills of autogenic training.

Forms of exercise therapy: UGG, LG, self-study.

Monitoring the patient's response to heart rate and subjective sensations.

The duration of the lessons is from 8 to 15 minutes. The duration of the sparing motor regimen is about two weeks.

Balneo and physiotherapy procedures are also used. Gentle-training mode (mode with medium physical activity) calculated for 10-12 days.

Purpose: restoration of adaptation to physical activity, normalization of vegetative functions, activation of redox processes in the body as a whole and in the abdominal cavity in particular, improvement of regeneration processes in the stomach and duodenum, fight against congestion.

I.p. - lying on your back, on your side, standing on all fours, standing.

In LH classes, exercises are used for all muscle groups, the amplitude is moderate, the number of repetitions is 4-6 times, the pace is slow, the ratio of control to ORU is 1:3. Exercises for the abdominal muscles are limited and cautious (monitor pain and manifestations of dyspepsia). When slowing down the evacuation of food masses from the stomach, exercises on the right side should be used, with moderate motor skills - on the left.

Breathing exercises of a dynamic nature are also widely used.

In addition to LH classes, dosed walking and walking at a slow pace are used.

Forms of exercise therapy: LH, UGG, dosed walking, walking, self-study.

A relaxing massage is also used after exercises on the abdominal muscles. The duration of the lesson is 15-25 minutes.

Training mode (high physical activity mode) is used at the end of the process of scarring of the ulcer and therefore is carried out either before discharge from the hospital, and more often in sanatorium-resort conditions.

Classes acquire a training character, but with a pronounced rehabilitation orientation. The range of used exercises of the LH is expanding, especially due to exercises on the muscles of the abdominal press and back, exercises with objects, on simulators, in the aquatic environment are added.

In addition to LH, dosed walking, health path, therapeutic swimming, outdoor games, elements of sports games are used.

Along with the expansion of the motor regimen, control over exercise tolerance and the state of the body and gastrointestinal tract should also improve through medical and pedagogical observations and functional studies.

It is necessary to strictly adhere to the basic methodological rules when increasing physical activity: gradualness and consistency in its increase, combination of exercise with rest and breathing exercises, ratio to ORU 1:3, 1:4.

Of the other rehabilitation means, massage and physiotherapy (balneotherapy) are used. The duration of the lessons is from 25 to 40 minutes.

General toning (general strengthening) mode.

This mode pursues the goal: complete restoration of the patient's working capacity, normalization of the secretory and motor function of the gastrointestinal tract, increased adaptation of the cardiovascular and respiratory systems of the body to physical exertion.

This motor mode is used both at the sanatorium and at the outpatient stages of rehabilitation.

The following forms of exercise therapy are used: UGG and LH, in which the emphasis is on strengthening the muscles of the trunk and pelvis, on the development of coordination of movements, exercises to restore the strength of the patient. Massage is used (classical and segmental-reflex), balneotherapy.

More attention in this period of rehabilitation is given to cyclic exercises, in particular, walking as a means of increasing the body's adaptation to physical activity.

Walking is brought up to 5-6 km per day, the pace is variable, with pauses for breathing exercises and heart rate control.

In order to create positive emotions, various relay races, exercises with the ball are used. The simplest sports games: volleyball, towns, croquet, etc.

Mineral water.

Patients with peptic ulcer of the stomach and duodenum with high acidity are prescribed low and medium mineralized drinking mineral waters - carbonic and hydrocarbonate, sulfate and chloride waters (Borjomi, Jermuk, Slavic, Smirnovskaya, Moscow, Essentuki No. 4, Pyatigorsk Narzan), water tº 38Cº is taken 60-90 minutes before meals 3 times a day for ½ and ¾ cups a day, for 21-24 days.

Physiotherapeutic agents.

Baths are prescribed - sodium chloride (hydrochloric), carbonic, radon, iodine-bromine, it is advisable to alternate them every other day with applications of peloids to the epigastric region. For patients with localized ulcers in the stomach, the number of applications is increased to 12-14 procedures. With severe pain syndrome, SMT (sinusoidal modulated currents) is used. A high therapeutic effect is observed when using ultrasound.

Control questions and tasks:

1. Describe in general diseases of the digestive system, violations of which functions of the digestive tract are possible in this case.

2. Therapeutic and restorative effect of physical exercises in diseases of the gastrointestinal tract.

3. Characteristics of gastritis, their types, causes.

4. The difference between gastritis depending on secretory disorders in the stomach.

5. Tasks and methods of therapeutic exercises in case of reduced secretory function of the stomach.

6. Tasks and methods of therapeutic exercises with increased secretory function of the stomach.

7. Characteristics of gastric ulcer and duodenal ulcer, etiopathogenesis of the disease.

8. Aggressive and protective factors affecting the gastric mucosa.

9. Clinical course of gastric and duodenal ulcer and its outcomes.

10. Tasks of physical rehabilitation in gastric and duodenal ulcers.

11. The method of therapeutic gymnastics in a sparing mode of physical activity.

12. The technique of therapeutic exercises in a gentle training mode.

13. The method of therapeutic gymnastics in training mode.

14. Tasks and methods of exercise therapy in general tonic mode.