Gastric ulcer - medical rehabilitation. Methods of rehabilitation of patients with gastric ulcer Rehabilitation measures for gastric ulcer

Page 17 of 18

Clinical examination and principles rehabilitation treatment sick peptic ulcer at the stages of medical rehabilitation
The general direction of healthcare development in our country has been and remains preventive, providing for the creation of favorable healthy conditions life for the population, formation healthy image the life of each person and the entire society, active medical monitoring of the health of each person. The implementation of preventive tasks is related to successful decision many socio-economic problems and, of course, with a radical restructuring of the activities of health authorities and institutions, primarily with the development and improvement of primary health care. This will make it possible to effectively and fully provide clinical examination of the population, to create a unified system for assessing and systematically monitoring the state of human health and the entire population as a whole.
Issues of medical examination require in-depth study and improvement, because its traditional methods are ineffective and do not allow for full-fledged early diagnosis of diseases, clearly identify groups of people for differentiated observation, and fully implement preventive and rehabilitation measures.
The methods of preparation and conduct need to be improved preventive examinations according to the program of general medical examination. Modern technical means make it possible to improve the diagnostic process by providing for the participation of the doctor only at the final stage - the stage of making a formed decision. This makes it possible to increase the efficiency of the prevention department and reduce the time of medical examination to a minimum.
We, together with E. I. Samsoi and co-authors (1986, 1988), M. Yu. Kolomoets, V. L. Tarallo (1989, 1990), have improved the technique early diagnosis diseases of the digestive system, including peptic ulcers, using computers and automated complexes. Diagnostics consists of two stages - nonspecific and specific.
At the first stage (nonspecific) the primary expert review health status of those being examined, dividing them into two streams - healthy and subject to further examination. This stage is implemented by preliminary interviewing the population using an indicative questionnaire (0-1) * in preparation for a preventive examination. Those undergoing clinical examination, answering the questions of the indicative questionnaire (0-1), fill out the technological interview map (TKI-1). Then it is machine processed, based on the results of which individuals at risk are identified according to the pathology of individual nosological units.

*The indicative questionnaire is based on the anamnestic questionnaire “Complex of Programs” (“Basic Examination”) for solving the problems of processing the results of mass dispensary screening examinations of the population using the Iskra-1256 microcomputer of the Regional Computer Science Center of the Ministry of Health of Ukraine (1987) with the inclusion of specially developed methods of patient self-examination , additions and changes to ensure the conduct of mass self-interviewing of the population and filling out cards at home. The medical questionnaire is intended for territorial-district certification of population health, identifying risk groups for diseases and lifestyle using a computer.

The issue of identifying two streams of subjects (healthy and those in need of further examination) is decided on the basis of the computer conclusion on TKI-1 and the results of mandatory studies.
Persons in need of further examination are referred for further examination according to targeted screening programs. One of such programs is a program of targeted mass medical examination for the early detection of common diseases of the digestive system (including peptic ulcers and pre-ulcerative conditions). Those undergoing clinical examination according to a specialized questionnaire (0-2 “p”) fill out the technological map TKI-2 “p”, after which they are automatically processed according to the same principle. The computer assumes a probable
diagnosis(ies) and list additional methods studies of the digestive organs (laboratory, instrumental, x-ray). The participation of the general practitioner of the prevention department is provided for at the final stage of the preventive examination - the stage of making a formed decision, determining the group for dispensary observation. During the preventive examination, the person undergoing medical examination, on the recommendation of the computer, is examined by specialist doctors.
The questionnaires were tested through preventive medical examinations of 4217 people. According to the results of machine processing, a presumptive diagnosis of “healthy” was given to only 18.8% of those interviewed, the conclusion “needs further examination” was given to 80.9% (among them, 77% of those examined needed consultations with specialists therapeutic profile). Analysis of the final results of preventive examinations showed that the computer gave a true positive answer in 62.9% of cases, a true negative one in 29.1%, a false positive one in 2.4%, and a false negative one in 5.8%.
When identifying gastroenterological pathology, the sensitivity of a specialized screening questionnaire turned out to be very high - 96.2% (with a result prediction coefficient of 0.9), because in specified percentage cases, the machine gives the correct answer if the decision is positive, “sick.” At the same time, with a negative answer, the error is 15.6% (with a prediction coefficient of 0.9). As a result, the compliance rate of the diagnostic conclusion is 92.1%, i.e. Out of 100 people, in 8 cases the computer decision to identify gastroenterological pathology based on survey data may be incorrect.
The data presented convinces us of high degree reliability of the developed criteria and allow us to recommend a specialized questionnaire for widespread use in screening target program at the stage of preparation for a preventive medical examination.
As is known, the order of the USSR Ministry of Health No. 770 dated May 30, 1986 provides for the identification of three dispensary groups: healthy (DO; preventively healthy (Dg); patients in need of treatment (Dz). Our experience shows that in relation to patients with peptic ulcer disease, their with pre-ulcerative conditions, as well as for persons with risk factors for the occurrence of these diseases, a more differentiated division of those undergoing medical examination into the second and third health groups is justified (in each of them it is advisable to distinguish 3 subgroups) in order to ensure differentiated approach to carry out preventive and therapeutic measures.
Group II:
On - increased attention (persons who do not make complaints, without deviations from the norm according to the results additional research, but exposed to risk factors);
II b - persons with latent current pre-ulcerative conditions (without complaints, but having deviations from the norm during additional studies);
c - patients with obvious pre-ulcerative conditions, peptic ulcer disease, who do not need treatment.
group:
III a - patients with obvious pre-ulcerative conditions in need of treatment;
III b - patients with uncomplicated peptic ulcer disease in need of treatment;
III c - patients with severe course peptic ulcer, complications and (or) concomitant diseases.
Peptic ulcer disease is one of the diseases in the fight against which preventive rehabilitation measures are crucial.
Without detracting from the importance of the inpatient stage of treatment, it should be recognized that it is possible to achieve stable and long-term remission and prevent recurrence of peptic ulcer disease through long-term (at least 2 years) and continuous restorative stage treatment of the patient after discharge from the hospital. This is evidenced by our own research and the work of a number of authors (E. I. Samson, 1979; P. Ya. Grigoriev, 1986; G. A. Serebrina, 1989, etc.).
We highlight the following stages of post-hospital rehabilitation treatment of patients with peptic ulcer:
rehabilitation department for gastroenterological patients at a hospital for rehabilitation treatment (usually in a suburban area using natural healing factors);
polyclinic (including a day hospital of a polyclinic, department or rehabilitation treatment room of a polyclinic or a rehabilitation center at a polyclinic);
sanatorium-dispensary for industrial enterprises, institutions, collective farms, state farms, educational institutions;
Spa treatment.
We combine all of the above stages of post-hospital rehabilitation treatment into the period of late rehabilitation, and in general the process of medical rehabilitation can be divided into three periods:
- early rehabilitation ( timely diagnosis in the clinic, early intensive treatment);
- late rehabilitation ( postoperative stages treatment);
- dispensary observation in the clinic.
In the system of medical rehabilitation of patients with peptic ulcer disease, the outpatient stage plays a decisive role, since it is in the outpatient clinic that continuous, consistent observation and treatment of the patient is carried out over a long period of time, and continuity of rehabilitation is ensured. The effectiveness of rehabilitation of patients in the clinic is due to the complex impact various means and methods of restorative treatment, including therapeutic nutrition, herbal and physiotherapy, acupuncture, exercise therapy, balneotherapy, psychotherapy with very restrained, maximally differentiated and adequate pharmacotherapy (E. I. Samson, M. Yu. Kolomoets, 1985; M, Yu Kolomoets et al., 1988, etc.).
Correct assessment of the role and significance of the outpatient stage in the rehabilitation treatment of patients contributed to further improvement in last years organizational forms of rehabilitation of patients at the outpatient stage (O. P. Shchepin, 990). One of them is the day hospital of the clinic (DSP). Analysis of our observations on day hospitals at the clinics of the Central Regional Clinical Hospital of the Minsk district of Kiev, the clinic of the 3rd city hospital of Chernivtsi, as well as data from A. M. Lushpa (1987), B. V. Zhalkovsky, L. I. Leibman (1990) show that DSP is most effectively used for the rehabilitation of gastroenterological patients, who make up 70-80% of the total number of patients treated. Among patients with diseases of the digestive system, about half were patients with peptic ulcer disease. Based on the experience of the DSP, we determined the indications for referring patients with peptic ulcer disease to a day hospital. These include:
Uncomplicated peptic ulcer if present ulcerative defect 2 weeks from the start of treatment in a hospital after pain relief.
Exacerbation of uncomplicated peptic ulcer without ulcerative defect (from the beginning of exacerbation), bypassing the inpatient stage.
Long-term non-scarring ulcers in the absence of complications 3-4 weeks after onset inpatient treatment.
Due to the rather long stay of patients in the emergency room during the day (6-7 hours), we consider it advisable to organize one or two meals a day in the emergency room (diet No. 1).
The duration of treatment for patients with peptic ulcer disease at various stages of medical rehabilitation depends on the severity of the course, the presence of complications and concomitant diseases and a number of others clinical features for a specific patient. At the same time, our many years of experience allows us to recommend the following terms as optimal: in the hospital - 20-30 days (or 14 days with subsequent referral of the patient to a day hospital or rehabilitation department for gastroenterological patients at a rehabilitation hospital); in the rehabilitation department of a rehabilitation hospital - 14 days; in a day hospital - from 14 to 20 days; in the rehabilitation treatment department of the clinic or rehabilitation center at the clinic - 14 days; in a sanatorium - 24 days; in a sanatorium at a resort - 24-26 days.
In general, prolonged treatment should continue for at least 2 years in the absence of new exacerbations and relapses. Practically healthy patient can be considered in cases where for 5 years he has not had exacerbations or relapses of peptic ulcer disease.
In conclusion, it should be noted that the problem of treating peptic ulcer disease goes far beyond the scope of medicine and is a socio-economic problem that requires the implementation of a set of measures on a national scale, creating conditions for reducing psychogenic factors, normal nutrition, hygienic conditions work, life, rest.

Organ ulcer gastrointestinal tract occurs quite often. Physical rehabilitation for peptic ulcer disease consists of physical activity, exercises, proper nutrition, massage. This therapy is prescribed to reduce pain, have an antiseptic effect, stop inflammatory phenomena, regulate the motility of the digestive organs, and increase immunity.

Benefits of Physical Rehabilitation

Gastric ulcer suppresses a person’s motor activity, without which the body cannot function normally. Physical exercise in measured quantities evokes pleasant emotions, which are needed for this disease, because... mental condition the patient is not satisfactory. Physical exercise participate in the regulation of the digestive process and work nervous system, which contributes to the normalization of spasmodic muscle contractions.

Thanks to systematic exercises, the following healing processes occur:

the amount of energy increases;
the creation of buffer compounds is increased, protecting the stomach from sudden changes in acid-base balance;
organs are supplied with enzymes and vitamins;
mental state is controlled;
redox reactions improve;
scarring of the ulcer is accelerated;
stool disorders, loss of appetite, and congestive processes in the gastrointestinal tract are prevented.

Stimulation muscle tissue speeds up digestion processes.

The benefits of physical therapy depend on its effectiveness and duration. Moderate muscle tension stimulates functions digestive system, improves the secretory and motor functions of the stomach and duodenum. Methods of physical rehabilitation for peptic ulcers have a beneficial effect on blood circulation and breathing, thereby expanding the body’s ability to resist negative factors.

For peptic ulcers of the stomach and other organs physical exercise have a therapeutic and preventive focus, and also imply an individual approach.

Contraindications to physical activity

The main contraindications include:

periods of exacerbation of stomach ulcers;
open bleeding;
the presence of stenosis (persistent narrowing of the lumen of anatomical structures);
predisposition to bleeding or pathology spreading beyond the organ;
possibility of malignant transformation;
paraprocesses during penetration (spread of pathology beyond the gastrointestinal tract).

Stages of physical rehabilitation

First stage therapy consists of a complex breathing exercises.

Rehabilitation for gastric ulcer occurs in stages:

Recovery during bed rest. Exercise therapy begins on days 2-4 of hospitalization in the absence of all contraindications.
During inpatient treatment, which is subject to patients with an ulcer diagnosed for the first time, as well as complications that have arisen.
During the period of weakening of the disease, at the end of the exacerbation or in the process sanatorium treatment.

Early period

Physical rehabilitation is carried out if there are no contraindications. It lasts up to 14 days. Gymnastics are performed on proper breathing, which regulates inhibition processes in the cortex cerebral hemispheres brain. The exercises are performed on the back, the muscles need to be completely relaxed. Gymnastics reduces the manifestation pain symptoms, normalizes sleep.

In addition, they are used simple exercises for small and medium muscles, which are repeated several times in combination with correct breathing and relaxing movements. Exercise therapy, which entails intra-abdominal hypertension, is prohibited. Classes last a quarter of an hour, exercises are performed slowly.

Second phase

The procedure normalizes intestinal motility.

Physiotherapy used while the patient is undergoing treatment in a hospital to develop correct posture and improve coordination functions. Gymnastics is carried out when there is a significant improvement in the patient’s general well-being. Abdominal wall massage is recommended. The set of exercises is designed to be performed in any position, while the effort is muscular system should increase gradually.

Muscles that make up the wall abdominal cavity, cannot be used. To increase the flexibility of the abdominal barrier (diaphragm), gentle loads on the abdominal muscles are necessary. To normalize blood flow, the most comfortable position for exercise is considered to be lying on your back. Exercises should be performed without unnecessary strain, using a minimum of repetitions.

Introduction

Anatomical, physiological, pathophysiological and clinical features of the disease

1 Etiology and pathogenesis of gastric ulcer

2 Classification

3 Clinical picture and preliminary diagnosis

Methods of rehabilitation of patients with gastric ulcer

1 Physical therapy (physical therapy)

2 Acupuncture

3 Acupressure

4 Physiotherapy

5 Drinking mineral waters

6 Balneotherapy

7 Music therapy

8 Mud therapy

9 Diet therapy

10 Herbal medicine

Conclusion

List of used literature

Applications

Introduction

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

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

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

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

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

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

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

Object of study: gastric ulcer.

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

The tasks are aimed at consideration:

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

Methods of rehabilitation of patients with gastric ulcer.

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

.1 Etiology and pathogenesis of gastric ulcer

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

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

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

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

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

The main factors include:

Disturbances of humoral and neurohormonal mechanisms regulating digestion and tissue reproduction;

Disorders of local digestive mechanisms;

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

Predisposing factors include:

Hereditary constitutional factor. A number of genetic defects have been identified that occur in one or another part of the pathogenesis of this disease;

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

Conditions external environment, first of all, neuropsychic factors, nutrition, bad habits;

Medicinal effects.

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

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

Works by I.P. Pavlova on the role of the nervous system and its higher department - the cortex big brain- in the regulation of all vital functions of the body (ideas of nervism) are reflected in new views on the process of development of peptic ulcer disease: this is the cortico-visceral theory of K.M. Bykova, I.T. Kurtsina (1949, 1952) and a number of works indicating the etiological role of disruption of neurotrophic processes directly in the mucous membrane of the stomach and duodenum in peptic ulcer disease.

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

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

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

Gastrin and cholinergic postganglionic fibers play a special role in the development of peptic ulcers. vagus nerve involved in the regulation of gastric secretion.

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

Prostaglandins play a central role in protecting the epithelium of the gastric mucosa from the action of aggressive factors. The key enzyme in the synthesis of prostaglandins is cyclooxygenase (COX), with

Page 17 of 18

Video: Algorithm for gastrointestinal rehabilitation at home

Clinical examination and principles of rehabilitation treatment of patients with peptic ulcer disease at the stages of medical rehabilitation
The general direction of health care development in our country has been and remains preventive, providing for the creation of favorable healthy living conditions for the population, the formation of a healthy lifestyle for each person and the entire society, and active medical monitoring of the health of each person. The implementation of preventive tasks is associated with the successful solution of many socio-economic problems and, of course, with a radical restructuring of the activities of health authorities and institutions, primarily with the development and improvement of primary health care. This will make it possible to effectively and fully provide clinical examination of the population, to create a unified system for assessing and systematically monitoring the state of human health and the entire population as a whole.
Issues of medical examination require in-depth study and improvement, because its traditional methods are ineffective and do not allow for full-fledged early diagnosis of diseases, clearly identify groups of people for differentiated observation, and fully implement preventive and rehabilitation measures.
The methodology for preparing and conducting preventive examinations under the general medical examination program needs to be improved. Modern technical means make it possible to improve the diagnostic process by providing for the participation of the doctor only at the final stage - the stage of making a formed decision. This makes it possible to increase the efficiency of the prevention department and reduce the time of medical examination to a minimum.
We, together with E. I. Samsoi and co-authors (1986, 1988), M. Yu. Kolomoets, V. L. Tarallo (1989, 1990), have improved the method of early diagnosis of diseases of the digestive system, including peptic ulcers, using a computer and automated complexes. Diagnostics consists of two stages - nonspecific and specific.
At the first stage (nonspecific), a primary expert assessment of the health status of those undergoing medical examination is given, dividing them into two streams - healthy and subject to further examination. This stage is implemented by preliminary interviewing the population using an indicative questionnaire (0-1) * in preparation for a preventive examination. Those undergoing clinical examination, answering the questions of the indicative questionnaire (0-1), fill out the technological interview map (TKI-1). Then it is machine processed, based on the results of which individuals at risk are identified according to the pathology of individual nosological units.

Video: Rehabilitation after a stroke. Doctor I...

The issue of identifying two streams of subjects (healthy and those in need of further examination) is decided on the basis of the computer conclusion on TKI-1 and the results of mandatory studies.
Persons in need of further examination are referred for further examination according to targeted screening programs. One of such programs is a program of targeted mass medical examination for the early detection of common diseases of the digestive system (including peptic ulcers and pre-ulcerative conditions). Those undergoing clinical examination according to a specialized questionnaire (0-2 “p”) fill out the technological map TKI-2 “p”, after which they are automatically processed according to the same principle. The computer assumes a probable
diagnosis (diagnoses) and a list of additional methods for studying the digestive organs (laboratory, instrumental, x-ray). The participation of the general practitioner of the prevention department is provided for at the final stage of the preventive examination - the stage of making a formed decision, determining the group for dispensary observation. During the preventive examination, the person undergoing medical examination, on the recommendation of the computer, is examined by specialist doctors.
The questionnaires were tested through preventive medical examinations of 4217 people. According to the results of machine processing, a presumptive diagnosis of “healthy” was given to only 18.8% of those interviewed, the conclusion “needs further examination” was given to 80.9% (among them, 77% of those examined needed consultations with therapeutic specialists). Analysis of the final results of preventive examinations showed that the computer gave a true positive answer in 62.9% of cases, a true negative one in 29.1%, a false positive one in 2.4%, and a false negative one in 5.8%.
When identifying gastroenterological pathology, the sensitivity of the specialized screening questionnaire turned out to be very high - 96.2% (with a predictive coefficient of the result of 0.9), since in the specified percentage of cases the machine gives the correct answer with a positive decision “sick”. At the same time, with a negative answer, the error is 15.6% (with a prediction coefficient of 0.9). As a result, the compliance rate of the diagnostic conclusion is 92.1%, i.e. Out of 100 people, in 8 cases the computer decision to identify gastroenterological pathology based on survey data may be incorrect.
The presented data convinces of the high degree of reliability of the developed criteria and allows us to recommend a specialized questionnaire for widespread use in a targeted screening program at the stage of preparation for a preventive medical examination.
As is known, the order of the Ministry of Health of the USSR No. 770 dated May 30, 1986 provides for the identification of three dispensary groups: healthy (DO - preventively healthy (Dg) - patients in need of treatment (Dz). Our experience shows that in relation to patients with peptic ulcer their with pre-ulcerative conditions, as well as for persons with risk factors for the occurrence of these diseases, a more differentiated division of those undergoing medical examination into the second and third health groups is justified (in each of them it is advisable to distinguish 3 subgroups) in order to ensure a differentiated approach to the implementation of preventive and therapeutic measures.
Group II:
On - increased attention (persons who do not complain, without deviations from the norm according to the results of additional studies, but exposed to risk factors) -
II b - persons with latent current pre-ulcerative conditions (without complaints, but having deviations from the norm during additional studies) -
c - patients with obvious pre-ulcerative conditions, peptic ulcer disease, who do not need treatment.
group:
III a - patients with obvious pre-ulcerative conditions in need of treatment -
III b - patients with uncomplicated peptic ulcer disease in need of treatment -
III c - patients with severe peptic ulcer disease, complications and (or) concomitant diseases.
Peptic ulcer disease is one of the diseases in the fight against which preventive rehabilitation measures are crucial.
Without detracting from the importance of the inpatient stage of treatment, it should be recognized that it is possible to achieve stable and long-term remission and prevent recurrence of peptic ulcer disease through long-term (at least 2 years) and continuous restorative stage treatment of the patient after discharge from the hospital. This is evidenced by our own research and the work of a number of authors (E. I. Samson, 1979 - P. Ya. Grigoriev, 1986 - G. A. Serebrina, 1989, etc.).
We highlight the following stages of post-hospital rehabilitation treatment of patients with peptic ulcer:
rehabilitation department for gastroenterological patients of a hospital for rehabilitation treatment (usually in a suburban area using natural healing factors) -
polyclinic (including a day hospital of a polyclinic, department or rehabilitation treatment room of a polyclinic or a rehabilitation center at a polyclinic) -
sanatorium-preventorium of industrial enterprises, institutions, collective farms, state farms, educational institutions -
Spa treatment.
We combine all of the above stages of post-hospital rehabilitation treatment into the period of late rehabilitation, and in general the process of medical rehabilitation can be divided into three periods:
- early rehabilitation (timely diagnosis in the clinic, early intensive treatment) -
- late rehabilitation (postoperative stages of treatment) -
- dispensary observation in the clinic.
In the system of medical rehabilitation of patients with peptic ulcer disease, the outpatient stage plays a decisive role, since it is in the outpatient clinic that continuous, consistent observation and treatment of the patient is carried out over a long period of time, and continuity of rehabilitation is ensured. The effectiveness of rehabilitation of patients in the clinic is due to the complex influence of various means and methods of restorative treatment, including therapeutic nutrition, herbal and physiotherapy, acupuncture, exercise therapy, balneotherapy, psychotherapy with very restrained, maximally differentiated and adequate pharmacotherapy (E. I. Samson, M Yu. Kolomoets, 1985-M, Yu. Kolomoets et al., 1988, etc.).
A correct assessment of the role and significance of the outpatient stage in the rehabilitation treatment of patients has contributed to the further improvement in recent years of organizational forms of rehabilitation of patients at the outpatient stage (O. P. Shchepin, 990). One of them is the day hospital of the clinic (DSP). Analysis of our observations on day hospitals at the clinics of the Central Regional Clinical Hospital of the Minsk district of Kiev, the clinic of the 3rd city hospital of Chernivtsi, as well as data from A. M. Lushpa (1987), B. V. Zhalkovsky, L. I. Leibman (1990) show that DSP is most effectively used for the rehabilitation of gastroenterological patients, who make up 70-80% of the total number of patients treated. Among patients with diseases of the digestive system, about half were patients with peptic ulcer disease. Based on the experience of the DSP, we determined the indications for referring patients with peptic ulcer disease to a day hospital. These include:
Uncomplicated peptic ulcer in the presence of a peptic ulcer 2 weeks after the start of treatment in a hospital after pain relief.
Exacerbation of uncomplicated peptic ulcer without ulcerative defect (from the beginning of exacerbation), bypassing the inpatient stage.
Long-term non-scarring ulcers in the absence of complications 3-4 weeks after the start of hospital treatment.
Due to the rather long stay of patients in the emergency room during the day (6-7 hours), we consider it advisable to organize one or two meals a day in the emergency room (diet No. 1).
The duration of treatment for patients with peptic ulcer disease at various stages of medical rehabilitation depends on the severity of the course, the presence of complications and concomitant diseases and a number of other clinical features in a particular patient. At the same time, our many years of experience allows us to recommend the following terms as optimal: in the hospital - 20-30 days (or 14 days with subsequent referral of the patient to a day hospital or the rehabilitation department for gastroenterological patients of the hospital for rehabilitation treatment) - in the rehabilitation department of the hospital for rehabilitation treatment - 14 days - in a day hospital - from 14 to 20 days - in the rehabilitation treatment department of a polyclinic or rehabilitation center at a polyclinic - 14 days - in a sanatorium - 24 days - in a sanatorium at a resort - 24-26 days.
In general, prolonged treatment should continue for at least 2 years in the absence of new exacerbations and relapses. A patient can be considered practically healthy if he has had no exacerbations or relapses of peptic ulcer disease for 5 years.
In conclusion, it should be noted that the problem of treating peptic ulcer disease goes far beyond the scope of medicine and is a socio-economic problem that requires the implementation of a set of measures on a national scale, creating conditions for reducing psychogenic factors, normal nutrition, hygienic working conditions, living conditions, and rest.

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

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

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

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

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

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

2 improvement of redox processes.

3 counteracting constipation and congestion in the intestines;

4 improvement of circulatory and respiratory functions.

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

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

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

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

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