Polyps in the gastrointestinal tract are common among patients over 40 years of age.
Elena Gennadievna Biryukova, an endoscopist at the Department of Endoscopy and Endoluminal Surgery at the Research Institute of Emergency Medicine named after A. N.V. Sklifosovsky DZM.
What is a polyp?
The term “polyp” is translated from ancient Greek as “many-legged.” In medicine, it is used to identify tumors in various organs. If we talk about the gastrointestinal tract, then we are talking about a benign tumor that protrudes into the lumen of a hollow organ and is connected to it either by a stalk or a wide base. Polyps are found in both the upper gastrointestinal tract (stomach) and the colon. Their size can vary from a few millimeters to 5–8 centimeters.
When performing gastroscopy in people over 50 years of age, polyps are found in up to 6% of cases, and during colonoscopy - up to 40% of patients.
Gastrofarm
Gastrofarm is a medical immunobiological drug, a probiotic that has a protective effect on the mucous membrane of the gastrointestinal tract. It is used for gastritis, stomach and duodenal ulcers, and also as a means for the prevention of dysbacteriosis. Probiotics (eubiotics), unlike antibacterial drugs, do not cause imbalance in the intestinal microflora. An urgent problem of recent times is the total and widespread spread of pathogenic microorganisms that are resistant to traditional antibacterial therapy, and therefore the effectiveness of a number of antibiotics has significantly decreased. Scientific studies have shown that in individuals infected with pathogens that have multiple cross-resistance to antibiotics, infections are much more severe and often result in death. So gradually the postulate crystallized in the medical world: if you can do without antibiotics, don’t use them. In such situations, alternative drugs with a minimum of side effects should be prescribed. In cases where antibiotic therapy cannot be avoided, it is necessary to first conduct biological studies to determine the sensitivity of pathogens to specific antibacterial drugs. Probiotics are live microorganisms, packaged in the form of a medicine, and used to correct bacterial microflora and treat certain diseases. The first to “bless” the use of probiotics in medicine was the Russian biologist I.I. Mechnikov, who at the dawn of the last century proposed using cultures of antagonistic microorganisms to combat pathogenic bacteria. Large-scale research in this area has made it possible to introduce into clinical practice a number of effective probiotic preparations based on live microbial cultures. Being deprived of the negative impact on normal intestinal microflora, which is the “sin” of antibiotics, probiotics find the widest use in the treatment and prevention of dysbacteriosis. At the same time, “live” bacterial preparations are highly effective in the treatment of acute intestinal infections.
A distinctive feature of probiotics should be considered their ability to increase the body’s resistance to the “invasion” of pathogenic bacteria, in some cases exhibit an antiallergic effect, and stimulate digestive function. Along with gastrofarm produced by the Bulgarian pharmaceutical company, on Russian pharmacy counters (or rather, in refrigerators and refrigerated display cabinets, taking into account their storage conditions) you can find such bacterial preparations as bifidum-bacterin, lactobacterin, acylact, bificol, etc. The advantages of probiotics include their harmlessness (even when high doses of the drug are used), as well as the ability to significantly increase the body’s nonspecific resistance. Gastrofarm is a combined bacterial preparation containing dried lactobacilli, as well as lactic acid, proteins and sucrose (a nutrient substrate for bacteria). The drug reduces the pH of the stomach, suppresses the activity of proteolytic enzymes of gastric juice, stimulates the processes of restoration of the mucous membrane of the digestive tract, and regulates digestion processes. Considering the therapeutic “versatility” of lactobacilli, the use of probiotics based on them should significantly improve the general condition of the patient. Lactobacilli are producers of a wide range of substances that inhibit the growth of unwanted microorganisms. These substances include lactic and acetic acids, hydrogen peroxide and specific bacteriocin proteins (including acidophilus, lactocidin, lectroline, lysocine, nisin). Bacteriocins have a destructive effect on microorganisms, having a smaller spectrum of antibacterial activity compared to antibiotics, but having a more pronounced effect. The antimicrobial activity of lactobacilli is believed to be related to their ability to produce hydrogen peroxide and stimulate the immune system.
Gastrofarm is available in tablets. The drug is taken half an hour before meals, chewing the tablet with a small amount of liquid or first crushing it in moderately warm boiled water.
What types of polyps are there?
Polyps are classified according to a number of characteristics: number, size, location, appearance and many others. However, the most important thing for determining further treatment tactics is the division of polyps according to the severity of malignancy potential - the ability to degenerate into cancer.
There are two large groups of polyps:
- 1. Neoplastic
(have a high risk of malignancy). These include true tumors - adenomas. - 2. Non-neoplastic
(with minimal risk): hyperplastic, hamartomas and inflammatory polyps.
It takes about 5-10 years for cancer to arise from a polyp in the gastrointestinal tract, but everything is extremely individual. The potential for malignancy varies; no one can give exact dates or give guarantees.
Today, science knows why polyps appear?
There is no single theory on this matter. There is an assumption that the mechanism of occurrence of polyps is based on a violation of the regeneration (healing) processes of the mucous membrane of internal organs.
Provoking factors include poor nutrition (an abundance of refined foods and a lack of fiber), Helicobacter pylori infection, dysbacteriosis, diverticular intestinal disease, and exposure to radiation.
The hereditary theory of the origin of polyps has been confirmed in relation to a large group of diseases - hereditary polyposis (Gardner's disease, familial adenoma, etc.). In approximately 15% of cases, colorectal cancer is familial.
What symptoms may indicate the presence of polyps in the intestines or stomach?
The main insidiousness of the disease lies in the fact that in most cases it is asymptomatic. However, when villous tumors reach large sizes (2-3 centimeters), the following symptoms may occur:
- - bloody and mucous discharge;
- - pain in the abdomen and anus;
- - constipation or diarrhea;
- - anal itching.
If the polyp begins to bleed, this indicates the process of ulceration, which is no longer an early symptom. And intestinal or duodenal obstruction also indicates that the neoplasm has grown to a large size and completely blocks the lumen. Therefore, unfortunately, the patient cannot somehow “feel” the presence of polyps in the intestines or stomach. Most often, the disease is an accidental discovery during an instrumental examination for another reason.
Gastroenterologist
Gastroenterology is a field of medicine that covers diseases of the gastrointestinal tract and related organs (liver, pancreas, gall bladder). The influence of balanced functioning of the gastrointestinal tract on the health of the body is great. The process of digestion and assimilation of nutrients from food, the coordinated interaction of the liver, gall bladder and proper nutrition determine the tone of the body, active life and ultimately affect the condition of the skin, hair, heart and kidneys.
The scope of activity of a gastroenterologist is multifaceted and interconnected with a number of related areas of medicine. The specialist diagnoses the organs, identifies foci of the disease, prescribes treatment, and, if necessary, proper nutrition. He is responsible for the treatment of diseases such as:
- Gastritis;
- Peptic ulcer of the stomach and duodenum;
- Cholecystitis;
- Cholelithiasis;
- Pancreatitis;
- Colitis;
- Cirrhosis of the liver;
- Ileitis;
- Proctitis.
Along with the most common diseases listed, there are a number of specialized areas of activity of a gastroenterologist, when highly specialized knowledge in the field of oncology, surgery, etc. is required. For example, the scope of activity of a hepatologist is liver diseases and everything connected with them, a gastroenterologist oncologist specializes in tumor processes, a gastroenterologist surgeon supervises surgical interventions in the gastrointestinal tract, etc.
What examinations are necessary for early detection of polyps?
The only way to early diagnose polyps is mass screening, even in the absence of any complaints. A fecal occult blood test, which is included in the list of free examinations during the annual medical examination, is the main non-invasive method to suspect the presence of villous tumors and cancer. But the “gold standard” for diagnosing polyps is an endoscopic examination of the colon, which can detect almost any formation (less than 0.5 centimeters in size).
The best prevention of the appearance of polyps in the gastrointestinal tract is regular examinations, including gastroscopy and colonoscopy.
How effective is treatment via the Internet?
In recent years, “popular” medicine has been developing at hyperbolic speeds. Hundreds of websites are appearing, explaining the causes of diseases, performing remote diagnostics, prescribing treatment, and advertising so-called “folk remedies” for illnesses. So, by looking at a site of this kind, you can conduct a self-diagnosis within a few minutes, identify the disease, and immediately receive a “treatment prescription.” Without tests and examinations, easily, quickly and free of charge, a “doctor” without education or qualifications recommends diets, medications, and cleansing of the body. Such self-medication, at best, will not have any effect on the body, at worst, it will aggravate the situation. It’s one thing when a specialist with a medical education provides popular information to show the essence of the problem, talk about existing treatment methods in Russia or abroad, medicinal and herbal preparations, their effects on the body as a whole or on certain systems and organs, and warns about possible consequences in the absence of treatment, etc. It’s another matter when correspondence recommendations and advertising of dosage forms are provided in the form of a “prescription”.
In this regard, the role of a gastroenterologist as an educator is strengthened: it is necessary to explain to the population that refusal of professional medical care, if necessary, is fraught with serious negative consequences.
It is impossible to recommend treatment in absentia based on reports from site users, much less prescribe medications. Perhaps a person mistakenly identifies the disease. If the patient has a number of chronic concomitant diseases, for example, diabetes, heart and vascular diseases, an incorrectly prescribed drug can provoke a sharp deterioration in health, and sometimes lead to death. Before transferring information from medical sites to yourself, make sure that you are dealing with certified specialists in their field. When advertising a treatment method or medications, a competent gastroenterologist will definitely indicate that before treatment it is necessary to consult with the attending physician and conduct an examination. Be carefull!
What surgical methods are used to remove polyps?
Depending on how the polyp is attached, various surgical techniques are used to remove it.
If the polyp is located on a stalk, then an endoscopic loop is placed on it and cut off using the electrocoagulation method in a special frequency mode. In the case when the polyp is located on a wide base, several options for surgery are possible:
- 1. As a rule, for tumors up to 1 centimeter, the “cold loop” method is used - without the use of diathermocoagulation.
- 2. To remove larger polyps, they resort to the use of electrocoagulation. In order to avoid bleeding and perforation, lifting of the formation is carried out: a special solution is injected into the submucosal layer, which lifts the mucous membrane above the surface of the wall, and a loop is placed around the polyp on externally unchanged tissue. Both techniques can be used on an outpatient basis for certain sizes of polyps without signs of malignancy.
Part II. Drug treatment of gastritis and gastroduodenitis. Other factors
Part II. Chronic gastritis and gastroduodenitis (end)
V.F. Privorotsky, N.E. Luppova Treatment of gastritis and gastroduodenitis Drug treatment (end)
2. Normalization of the motor function of the upper gastrointestinal tract is carried out with prokinetic drugs, mainly dopamine antagonists. They activate the contraction of the stomach and its transport function, and increase the tone of the LES.
1st generation drugs include metoclopramide (cerucal, raglan), the disadvantage of which is the ability to penetrate the blood-brain barrier and produce undesirable side antidopaminergic effects on the central nervous system in the form of extrapyramidal disorders. This limits the use of metoclopramide in pediatric practice.
Motilium
- second generation drug. Its prokinetic activity is superior to that of metoclopramide, and it does not have the side effects of the latter. Prescribed 0.25 mg/kg body weight 3-4 times a day 15-20 minutes before meals.
3. Increasing the protective properties of the gastric mucosa. The group of drugs that activate the protective properties of coolant includes medicinal substances with different mechanisms of action.
The cytoprotective effect of drugs can be achieved: by increasing the production of protective mucus (liquiriton, licorice root, carbenoxolone, biogastron), by improving the regeneration of the mucous membrane (methacyl, sea buckthorn oil, rose hip oil, solcoseryl, acgovegin, dalargin). Antipeptic drugs have a cytoprotective effect.
Antipeptic drugs. In the pathogenesis of diseases of the stomach and duodenum, in addition to HCl, proteolytic enzymes play an important role. Activation of pepsinogen into pepsin occurs with increased and continuous acid formation, which causes damage to the coolant and mucous membrane of the duodenum. Antipeptic drugs can inhibit the proteolytic effect of gastric enzymes. In addition, these drugs also have a cytoprotective effect. In the acidic environment of the stomach, they form a protective film on the damaged mucous membrane, protecting it from the aggressive effects of acid and pepsin.
De-nol is a cytoprotective drug that, in addition to the listed properties, has the ability to increase blood flow in the gastroduodenal mucosa and increase local endogenous synthesis of PG. As a result, the secretion of mucus and bicarbonate ions increases, which causes a kind of “antisecretory” effect. The drug is widely used in eradication regimens due to its bactericidal properties, which makes it possible to enhance the antibacterial effect of the regimen as a whole. In addition, to date there are no HP strains resistant to de-nol. Prescribed 1/2-1 tablet 4 times (1-2 tablets 2 times) a day 30-40 minutes before meals and at night.
Sucralfate (alsukral, venter). Aluminum, which is part of the drug, ensures its reparative activity and normalizes the processes of evacuation of contents from the stomach. Sucrose sulfate, interacting with the proteins of damaged tissues, forms a protective layer at the site of ulcers and erosion. The antacid effect of the drug is insignificant. Prescribed 1 tablet (0.5-1.0 g) 4 times a day 40-60 minutes before meals and at night.
True cytoprotectors (synthetic analogs of PG) are misoprostol, enprostil, etc. in pediatric practice they are used only in exceptional cases.
4. Helicobacter pylori eradication
We do not consider it advisable to carry out eradication therapy to all patients with HP-positive CGD, regardless of age. The absolute indications for its implementation, in our opinion, are:
1) HP-associated erosive form of gastroduodenitis;
2) CGD with atrophy (subatrophy) of the glands;
3) any endoscopic and morphological variants of CGD in children with a hereditary burden of ulcerative disease and gastric cancer.
Relative indications are:
1) any HP-associated variants of CGD, occurring with severe clinical symptoms and (or) extensive contamination of the gastric mucosa by HP;
2) any HP-associated variants of gastroduodenal pathology in patients who wish to undergo a course of eradication therapy.
The question of the need for eradication therapy in such situations should be decided individually. In all other cases of detection of HP in children, there are, as a rule, no convincing grounds for anti-Helicobacter therapy.
Drugs and regimens for eradication therapy are given in the corresponding section of the BU.
5. Normalization of autonomic homeostasis in children with GDD diseases is carried out according to the principles set out in the corresponding section of GERD.
6. Treatment of concomitant diseases occurs in accordance with the nature of the existing pathology.
Physical therapy treatment is a desirable component of a comprehensive treatment program. It is indicated during any period of the disease. In the acute stage of severe pain, electrophoresis of novocaine, papaverine, and zinc sulfate is prescribed to the epigastric area, including the pyloroduodenal zone.
In the stage of incomplete remission, applications of mud, paraffin, and ozokerite are effective. Considering the importance of the ANS in regulating the activity of the upper gastrointestinal tract, methods for correcting autonomic imbalance are also used, which were already mentioned in the GERD section.
The use of herbal medicine or mineral waters is indicated when the exacerbation subsides or during remission.
For CGD with increased acid-forming function of the stomach, the following herbal preparations are recommended;
1. Celandine (grass) - 10.0 g;
common yarrow (herb) - 30.0 g;
chamomile (flowers) - 25 g;
St. John's wort (herb) - 39 g.
Take 1/3-2/3 cup of decoction 3 times a day 30 minutes before meals.
2. Common fennel (fruit) - 30.0 g; .
chamomile (flowers) - 30.0 g;
cordate linden (flowers) - 40.0 g.
Take 1/3-2/3 cup of infusion 3 times a day 30 minutes before meals.
It is also possible to use herbal mixtures proposed in the GERD section.
For balneological treatment, waters of low and medium mineralization with a predominance of hydrocarbonate ions are usually used - “Borjomi”, “Luzhanskaya”, “Smirnovskaya”, “Essentuki 4”, “Essentuki 17”, etc.
To reduce the increased secretory function of the stomach, mineral water is prescribed at the rate of 3-5 ml/(kg/day) 1.5-2 hours before meals.
If necessary, stimulate the secretory function of the stomach, mineral water is taken in the same amount 20-30 minutes before meals.
A desirable attribute of the rehabilitation program for children with acid-related diseases is sanatorium-resort treatment (see section GERD).
Clinical examination
The issues of medical examination of patients with CG and CGD in pediatric practice have not yet been fully worked out. Previous recommendations require revision to take into account modern requirements.
The frequency of examinations of the child by a local pediatrician and (or) gastroenterologist is determined by clinical and endoscopic data and should be at least 2 times a year.
The need for FEGDS is determined individually, based on clinical and anamnestic data, the results of previous endoscopic studies and the duration of clinical remission.
The secretory function of the stomach is constitutionally determined, and acidity levels in most children have fairly stable values, which makes it possible to avoid the appointment of pH measurements more than once every 2-3 years.
The ideology of anti-relapse therapy is also being revised. The prescription of antacids, antisecretory drugs, prokinetics, etc. during the period of stable clinical and morphological remission is, as a rule, not indicated. Prophylactic administration of these drugs does not guarantee a relapse-free course of the disease. It should be remembered that the prescription of antacids and cytoprotectors is mandatory while taking ulcerogenic drugs.
Autumn-spring courses of herbal and vitamin therapy and balneotherapy can be considered as anti-relapse therapy.
In cases where CGD occurs with frequent relapses, the above therapy should be enhanced by antacids with reparative properties.
The issue of deregistration can be resolved only if a stable three-year clinical and morphological remission is achieved.
Clinical examples
Sasha S., 14 years old, was admitted with complaints of intense, aching-stabbing pain in the abdomen (epigastric region, around the navel), of average duration (up to 1.5-2 hours), usually before meals or after 1.5-2 hours after meals, sometimes in the morning before breakfast. In the latter case, eating partially relieved the pain syndrome. The pain intensified after eating sour, spicy and fried foods (over the past 2 months the boy was on a diet with partial elimination of them). To relieve pain, I sometimes used antispasmodics and antacids (with a short-term effect).
Dyspeptic complaints: periodically there is belching, heartburn (according to the child, when overeating in the evening), a feeling of rapid satiety, a tendency to constipation.
The complex of “general” complaints is represented by severe asthenic syndrome.
From the anamnesis it is known that the boy has been ill for 3 years and has not been previously examined or treated. Among the factors that trigger an exacerbation, he names errors in diet and violation of the diet, as well as physical activity (practices martial arts). The frequency of exacerbations is 2-3 times a year, seasonality is not clearly visible, but in the summer the child’s well-being improves significantly.
Heredity is burdened by CGD (paternal grandfather) and DU (mother and maternal aunt).
Early history was unremarkable. I was not sick until I was 3 years old. Past diseases: ARVI (1-2 times a year), acute bronchitis, follicular tonsillitis, traumatic hemarthrosis of the right knee joint, rubella, chicken pox. There is no allergic history.
An objective examination showed that the child’s condition was satisfactory. The boy has a correct physique, satisfactory nutrition, and developed muscles of the upper shoulder girdle. The skin and visible mucous membranes are clean. The tongue is covered with a white coating, more at the root. Peripheral lymph nodes are not enlarged. Heart sounds are clear, rhythmic, 62 beats per minute; systolic murmur at the apex of the heart, moderate intensity. Blood pressure 100/b0 mm Hg. Art. Vesicular breathing. The abdomen is soft, accessible to superficial palpation in all parts. With deep palpation, pain is detected in the epigastric region, pyloroduodenal zone, right hypochondrium, Mayo-Robson point. Mendelian and cystic symptoms (Ortner, Kehr, Murphy) are positive. The liver and spleen are not enlarged in size, the sigma is not spasmodic. Stool, according to words, is daily, less often - every other day, formalized, without pathological signs. Urination is not impaired.
As a result of the survey, the following was revealed:
1) hemogram, biochemical blood test, general urine test - without any features;
2) coprogram - muscle fibers without striations (+), fatty acids (+), extracellular starch (++);
3) intragastric pH-metry
- the acid-forming function of the stomach is increased (pH range 1.2 - 1.4) while maintaining the compensatory capabilities of the antrum (pH 6.5-6.8), the rate of acid formation is increased;
4) Ultrasound - signs of biliary dyskinesia (BDSD), reactive state of the pancreatic parenchyma (echo-positive signals in the tail area with an increase in its size);
5) FEGDS - superficial fundal gastritis, erosive antral gastritis (8 “acute” erosions up to 0.3 cm in diameter), superficial bulbitis, cardia insufficiency;
6) help test (++);
7) Ultrasound of the heart - an accessory chord in the left ventricle was detected;
assessment of the initial autonomic tone - parasympathicotonia.
Based on the totality of the child’s complaints, clinical history, and laboratory and instrumental data, the following diagnoses were made:
Basic diagnosis: chronic gastroduodenitis (superficial fundal gastritis, erosive antrum gastritis, superficial bulbitis), ulcer-like variant, HP (+), with increased acid-forming function, exacerbation phase.
Concomitant diagnosis: biliary dyskinesia of the hypertensive type; reactive pancreatitis with moderate excretory pancreatic insufficiency; minor cardiac anomaly (accessory chord in the left ventricle).
Treatment.
1. Diet - table 1-in.
2. Semi-bed rest.
3. Drug therapy: anti-Helicobacter triple regimen:
- Kvamatel - 20 mg 2 times a day - 2 weeks, then 20 mg - in the evening - 1 week, before meals;
— de-nol — 2 tables. 2 times a day - 2 weeks, before meals;
— flemoxin-solutab — 1 tablet. (500 mg) 2 times a day for 7 days, before or after meals.
When switching to a single dose of quamatela - phosphalugel, 1 sachet 3 times a day - 2 weeks, before meals;
— mezim-forte (3500 IU), 1 table. 3 times a day - 2 weeks, before meals;
- galstena 10 drops. 3 times a day - 4 weeks, after meals.
A control FEGDS was performed on an outpatient basis 3 weeks after the first study. All erosions were epithelialized, the inflammatory background of the gastric mucosa decreased somewhat; help test (+/-).
During treatment, the child’s well-being improved significantly: spontaneous abdominal pain and dyspeptic symptoms disappeared, and palpation pain decreased.
School attendance and preventive vaccinations are allowed. An exemption from physical education lessons and training was given for 1 month with a gradual introduction to the usual training rhythm.
Anya P., 13 years old, contacted a local gastroenterologist with complaints of abdominal pain (around the navel), stabbing and aching, lasting up to 30-40 minutes, occurring 20-30 minutes after eating, not depending on the nature of the food eaten, passing on one's own. There is pronounced belching, a feeling of heaviness in the stomach, and rapid satiety. Periodically there is bloating and rumbling in the stomach. Appetite is reduced. Signs of asthenia are moderately expressed.
From the anamnesis it is known that the girl has been ill for 1.5 years. She contacted the local pediatrician twice: a diagnosis of diarrhea was made, and choleretic herbal medicine was prescribed without significant improvement. Exacerbations of the disease occur 2-3 times a year and are seasonal (spring - autumn). Heredity for gastrointestinal diseases is not burdened.
Early history was unremarkable. I was not sick until I was 1 year old. She grew and developed according to her age. Past diseases: ARVI (2-3 times a year), bronchopneumonia (at 5 years old), enterobiasis (at 6 years old), chicken pox, scarlet fever. There is no allergic history.
An objective examination showed that the child’s condition was satisfactory. The skin and visible mucous membranes are clean. The tongue is covered with a white coating. Peripheral lymph nodes are not enlarged. Heart sounds are clear, rhythmic, 70 beats per minute. BP 110/75 mm pr. Art. Vesicular breathing. The abdomen is soft, accessible to superficial palpation in all parts. With deep palpation, pain is detected in the epigastric region, pyloroduodenal zone, left and right hypochondrium. Mendelian and cystic symptoms (Ortner, Kehr, Murphy) are positive. The liver and spleen are not enlarged in size, the sigma is not spasmodic. The stool, according to words, is daily, formed, without pathological signs. Urination is not impaired.
As a result of the outpatient examination, the following was revealed: 1) hemogram, general urine test - without features, 2) coprogram - muscle fibers without striations (++), fatty acids (++), intracellular starch (++), scraping for enterobiasis ( -); 3) intragastric pH-metry - the acid-forming function of the stomach is preserved (pH range 1.7-1.8) while maintaining the compensatory capabilities of the antrum (pH 6.7-7.0), 4) Ultrasound - an increase in the sagittal size of the liver, signs of phlebotomy , 5) FGDS - superficial widespread gastritis, superficial bulbitis, cardia insufficiency, grade I reflux esophagitis, grade II GHD, b) helpiltest (-), 7) assessment of the initial autonomic tone - parasympathicotonia, examination by an ENT doctor - diagnosis: chronic tonsillitis (compensated).
Based on the totality of the child’s complaints, clinical history and laboratory and instrumental data, the following diagnoses were made:
The main diagnosis is: chronic gastroduodenitis (superficial pangastritis, superficial bulbitis, stage II GHD), gastritis-like variant, HP (-), with preserved acid-forming function, in the acute phase.
Concomitant diagnosis: reflux esophagitis degree I; biliary dyskinesia of the hypertensive type. Chronic tonsillitis (compensated).
Treatment.
1. Diet - table 1-in.
2. Semi-bed rest.
3. Drug therapy: Vikalin - 3 weeks, Motilium - 3 weeks, Chofitol - 3 weeks, then Mezim-Forte 2 weeks, Laminolact - 4 weeks, Complivit - 3 weeks.
Under the influence of the treatment, the girl’s well-being improved, the pain syndrome was relieved, pain on palpation disappeared, and dyspeptic symptoms decreased. School attendance and preventive vaccinations are allowed. Physical education classes in the preparatory group are allowed. Further observation by a district gastroenterologist and local pediatrician is indicated.
The examples given are taken from life and illustrate significant differences in key characteristics in two different children with the same, at first glance, diagnosis. As can be seen from the clinical examples, treatment tactics in each case were structured differently, in accordance with the individual picture of the disease. Deciphering all these features hidden under the abbreviation CGD is the task of the pediatrician and allows one to avoid erroneous judgments about the homogeneity of this disease.
What method is used to remove large polyps?
Finally, submucosal dissection is used to remove giant lesions en bloc. The operation is performed under general anesthesia and may take several hours. Afterwards, the hospital stay takes from one to three days.
!!! Regardless of which method was chosen to remove the polyp, after extraction it is sent for histological examination in order to determine the nature of the neoplasm and exclude oncology.
The probability of relapse (re-appearance) of hyperplastic polyps in the stomach is quite high, while in the colon such phenomena are isolated.
