Translation from Russian to English Language
Publication: Reflexology Journal, Issue No: 3 (7), 2005, pp. 43-47
Authors: Kochurova I., Cimmerman I., Vladimirsky E. Perm State Medical Academy, Department of faculty therapy, clinical pharmacology, physiotherapy and traditional methods of treatment
Article name: Pathogenetic Principles of SCENAR-therapy in Multiple Therapy of Duodenal Ulcer
Key words: SCENAR, gastroenterology, duodenal ulcer
Summary: We tried one of the new physical methods based on low-frequency pulse electrotherapy – SCENAR-therapy – as an alternative opportunity of duodenal ulcer management as it normalizes disturbed mechanisms of the body’s adaptive regulation and self-regulation. The influence of SCENAR-therapy on the clinical and functional gastric index of 72 duodenal ulcer patients was studied. Positive SCENAR-therapy effects were revealed in the majority of the patients. The combination of the conservative drug management and SCENAR-therapy shortens ulcer healing, promotes eradication of Helicobacter pylori, and improves the condition of gastro duodenal mucous.
Pathogenetic Principles of SCENAR-therapy in Multiple Therapy of Duodenal Ulcer
Nowadays SCENAR-therapy is in common practice in physiotherapy. SCENAR-therapy is a sort of low-frequency impulse electrotherapy and can be referred to the methods of reflex anesthesia (as the methods of electro acupuncture and transdermal electric stimulation of nerves). Their analgetic effect is connected with activation of endogenous antinociceptive system. Today, we’ve got various arguments of participation of antinociceptive transmitter systems in the mechanisms of reflex anesthesia . The role of opioid, serotonin and noradrenergic systems in realization of reflex analgesia is proved here (F.Cervero, 1995). For treatment procedure conduction by these methods is recommended to choose areas, which are reflexively connected with sickly areas for the purpose of activation mechanisms of segmental inhibition, and also to influence on zones, which are distant from sickly area, for mobilization of central antinociceptive processes.
Parallel with peripheral effect, which is determined by peripheral of biologically active substances , the SCENAR-therapy method has central effect, mobilizing regulative mechanisms of system of organism recovery . In many respects, it’s connected with the episodes of brain electrical activity synchronization at the leading role of forward hypothalamus, which coordinates the activity of vegetative nervous system . After stimulation the heightened slow-wave activity and parasympathetic tonus can be kept for one day (the aftereffect). In papers of L.X.Garkavy and joint authors , there was proved that such electrophysiological picture correlates with antistress reaction of training of the animals and human being. Exactly after its development, these researchers join the forming of SCENAR-therapy effects. The mechanism of SCENAR-therapy impact is not studied enough. Taking into account the broad pathology spectrum, the researchers make guess-work about the non-specific character of its therapeutic action, i.e. about the active participation of reciprocal non-specific adaptive organism reactions [3, 8].
The mechanism of SCENAR-therapy impact, by data of some authors, is explained as nervous-reflex mechanism with activation of neurohumoral element through the local, segmental and generalized reactions [5, 17], and also from the position of the theory of functional systems forming (after P.K. Anohin) [8, 18]. Recently, some of the researchers have tried to examine various forms of vital activity and also the condition of disease in terms of informative principle [8, 20]. They admit that the basis of disease is formed by dyscrasia (disorder of substances, energies and information), some it becomes evident that one of the tendency of treatment is normalization of the indexes. The medical effects of many modern physiotherapy methods are pointed to activation of protecting organism mechanisms by principle of self-regulation, and some methods of traditional medicine provides the recovery of such homeostasis indexes as energy and information. So the SCENAR-therapy can be examined as the method of orthodox medicine (the section of electrotherapy) on the one side, but the principles and methodology brings it together with traditional methods . Among the main medical effects of SCENAR-therapy we can marked my(o)neurostimulative, analgetic, trophic, local vasoactive, immunomodulatory and etc.
It’s marked, that SCENAR-therapy, parallel with elimination of disorders, determined by the main disease, produces positive shifts from the direction of attendant pathology. Such wide spectrum of SCENAR-therapy impact is explained by the fact that for various diseases, without reference to localization of pathologic process, there can be reactions of the same type, supporting the mobilizing of pathogenesis mechanisms and increasing of organism resistance .Finally, the effect of SCENAR-therapy is formed under the participation of various regulative organism systems, they are: nervous, hormonal, immune, etc [6, 18]. Among the pantoclinical effects of SCENAR-therapy, it’s important to point out the activity inhibition of ??? product, producing the antimitotic and cytotoxic actions on alive cells and tissues [16, 23].After the course of SCENAR-therapy is pointed the increasing of activity of catalase and the whole peroxidase activity within 3 and 1,5 times correspondingly, and the decreasing of malonic dialdehyde (???) within 25-30%.
The influence of SCENAR-therapy on common adaptive possibilities of organism is appeared in tonus optimization of sympathetic and parasympathetic departments of vegetative nervous system (VNS) . So, the SCENAR-therapy mobilizes the mechanisms, controlling the processes of regeneration, adaptation and regulation, both on local and common levels. These provide the appropriate answer of the organism on the influence of various external agents, demanding the corresponding reactions. In this connection, the SCENAR-therapy method can be applied for various pathologic conditions with the purpose of stimulation of the adaptation processes and the elimination of functional disorders (at their reversibility) .
Nowadays SCENAR-therapy is a success in treating of radicular syndrome for the patient with spinal osteochondrosis, the diseases of peripheral nervous system, neurososes, CAD, arterial hypertension and etc.
At once, there is little information of SCENAR therapy possibilities in treating of alimentary organs diseases, including duodenal ulcer. Among the patients with gastroenterological profile, the effect of SCENAR-therapy is marked during the treating of stomach ulcer and duodenal ulcer , and exacerbation of chronic gastritis [19, 22], acalculous cholecystitis with biliary dyskinesia , chronic pancreatitis , during combined treatment of viral hepatitis ; at the syndrome of irritated bowels , and during the post-surgical period after cholecystectomy .
N.N.Hazova and joint authors  give the results of therapeutic effectiveness of SCENAR-therapy method in treating of duodenal ulcer and chronic erosive gastroduodenitis (of children) in combination with the antisecretory (omeprasol), anthelion bacillus (metronidazole) drugs, antacids and reparants (sea-buckthorn oil). 95% of patients have the scarring of ulcerative defect after 20 days of treating.
The clinical effect was appeared by time reducing of pain syndrome (in 1-2 days), the decreasing of dyspepsia (in 2-3 days), the liquidation of palpational sickliness (in 5-7 days) and the normalization of gastrointestinal tract motion activity (quick elimination of gastroduodenitial and duodenogastric refluxes.
The improvement of condition and spirits and the normalization of dream and appetite became evident with most of children after 2-3 procedures of SCENAR-therapy. There is also described the positive effect in case of duodenal ulcer recidivating complicated by bleeding.
In a number of separate clinical researches was shown, that for the patients with stomach and duodenal ulcer, SCENAR-therapy provides the considerable decreasing of subject symptomatology at the expense of spasmolytic and analgesic action and leads to quick forming of scar, the treatment time reducing and remission prolongation . At the same time, the pain syndrome is stopped usually in 2-3 days, but dyspeptic one – 3-4 days afterwards.
The disappearance of ulcer defect may be observed in 21 days for 89-92% of cases. The peculiarity of healing effect of SCENAR-therapy in case of recurrent stomach ulcer is the closing of ulcer defect by the type of marginal epithelization, and some times without rough connecting-woven scar formation . G.V.Subbotina observes after history of SCENAR-monotherapy in case of stomach and duodenal ulcer recurrent. She marked the lack of any reccurents (clinical and endoscopic data) for two years after the course of treating .
The main recommended zones of treating impact during SCENAR-therapy for patients with duodenal ulcer are: epigastric area and segmental reflex zones .
The mode of impact is labial-steady with light compression under the frequency 50-70 Hz and 120-150Hz; the duration of medical séance (exposition)is about 30 minutes; the course is 10-12 procedures daily or every other day . The electro puncture method is also used on appropriate biologically active points .
P.P.Lashedko points out the possibility of using SCENAR-therapy with the aim of decreasing of curculatory-microrculatory hypoxia degree and prevention of its development to the patients with erosive-ulcer defects of mucous of stomach and duodenum. At the same time it’s recommended to start the treating within the next few hours after operation, the procedures must be done every day or two times a day and the impact on the projection area of solar plexus must be also done .
Starting from the stomach ulcer pathogenesis conception , in keeping with it in its development take part not only local factors of pathogenesis (acido peptic and infectious), but also the disfunctions of adaptive regulation and self-regulation mechanisms, stomach functions on various levels, starting with gastroduodenitial self-regulation system and ending with corticosubcortical relations, the using of SCENAR-therapy during the stomach ulcer recurrent is pathogenetically justified.
At the same time, the specific mechanisms of SCENAR-therapy medical impact during the stomach ulcer recurrent, particular, the character of its influence on acid-forming and motor function of stomach, contamination mucous coat of stomach Hp-infection, the activity and intensity of associated with SU chronic gastritis, vegetative and psycho emotional status of patients, the condition of lipid peroxidation and cerebral hemodynamics are not studied well. In this connection, we developed the research of SCENAR-therapy medical impact effectiveness during the stomach ulcer recurrent, first of all from the position of its influence on common pathogenetic factors of ulcer-forming [1, 10, and 26].
Task of the Research
To study the possible mechanisms of SCENAR-therapy medical impact on the patients with stomach and duodenal ulcer and estimate its clinical effectiveness both as monotherapy and as a complex with traditional pharmacotherapeutic means (antisecretory and anthelion bacterium) during duodenal ulcer recurrent.
Materials and Methods
72 patients (56 man and 16 women) with clinical and endoscopic signs of duodenal ulcer at the age of 16-65 years (average age was 27,8±1,4years) were examined. They were divided into 3 groups. The first group (26 patients) was treated with the SCENAR-monotherapy, by the devices “SCENAR-97.1” and “SCENAR-97.4” in continuous and individually dosated regimen during 30 minutes (the course is consisted of 10 séances). The 2nd group (21 patients) got SCENAR-therapy against in common with antisecretory therapy (omeprazole 40mg/day, for 2 weeks), the 3rd group (25patients) – got SCENAR-therapy in conjunction with “threefold” 7-daily scheme of eradicative therapy (omeprazole 40mg/day, clarithromycin 1000mg/day, amoxicillin 2000mg/day).
In all groups the impact was done on the epigastric area by segmental-reflex method and transcerebrally by the common influence method . The control group consisted of 25 patients with DU, who got just traditional antiulcer pharmacotherapy.
The duration of disease averages 6,87±1,13 years (from 1 to 30 years). 23 patients (31,94%) suffer this disease for the first time, and the slight and medium-weight clinical course was made with 49 patients (68,06%). The patients with complicated duodenal ulcer course were not included. As for attendant diseases, arterial hypertension were detected at 3 patients (4,2%), chronic bronchitis were detected at 2 patients (2,8%) and vegetative dystonia – at 11 patients. Initially by ???, 59 (819%) of patients suffer from single ulcers, and 13 (18,1%)- from double (“mirror”) ulcers. At the same time the average proportions of duodenal ulcers were 0,75±0,04cm. The estimation of clinical symptoms were made before treating (the presence of pain syndrome and its’ intensity, dyspepsical effects in the form of heartburn, eructation, nausea and vomiting), ???, endogastric express-pH- metria (with pH registration in cardiac orifice, body and antral department of ulcer). During the treating were estimated the dynamics of clinical symptoms – first from 2-weeks therapy course, and then – every week, up to the absolute scarring of ulcer defect, the endoscopic control after the condition of mucous coat of stomach and ??? were made, morphologically and with the help of quick urease test were estimated the quality of its contamination Hp, the activity and intensity of inflammatory process. The secretory and motor function of stomach were investigated in dynamics, the vegetative and psycho emotional status of patient were also investigated.
Results and Discussions
The overwhelming majority of patients before the course of (medical) treatment complained on day and night pains in epigastric, dyspepsical effects of various quality of intensity: heartburn – 55 (76,4%), eructation and vomiting – 13 (18,1%) and 4 (5,6%) of patients. The including of SCENAR-therapy in complex of medical measures was determined by more quick in comparison with control, the liquidation of pain, dyspepsical and asthenovegetative syndromes. In control group the pain syndrome reduction occurred in 2-3 days after, the asthenovegetative effect continued for 4 days longer, the liquidation time of objective clinical symptoms of disease recurrent (local palpatory pain, Mendel’s symptom and the symptom of muscular defense).The quickest liquidation of dyspepsical effect occurred in group of patient who have got SCENAR-therapy with omeprazolon. The asthenovegetative complaints reduced and eliminated in this group (in 3-6 days). SCENAR-monotherapy influenced positively on intensity of pain syndrome.
The essential decreasing of epigastric pain was evident in 2 days (after 1-2 procedures). The analgesic effect of SCENAR-therapy is explained by its possibility for activation of fine peptide nerve fiber and mediates changing in brain tissue of biologically-active materials, which have antinociceptive qualities (glutamic and aspartic acids, serotonin etc.) [6,28], and also by elimination of gastric dismotor, which underlines the pain syndrome during duodenal ulcer. The important criterion of treating was endoscopic research (???-control) of gastro duodenal zone condition (table 1). The scheme of treating with using of SCENAR-monotherapy and its combination with “triple” eradicable therapy allowed to have the quickest speed of ulcer defect scarring.
So, in two weeks of treating the ulcer wasn’t defined in 1st group at 65,38% of patients and at 64% in 3rd group, and after 3 weeks, there are the whole healing with all the patients. At the same time in control group the ulcer defect eliminated at 48% and 76% of patients in 2 and 3 weeks.
The time of duodenal ulcers scarring
|The group of patients||In 2 weeks
|In 3 weeks
|I group(n=26)||17 (65,38%)||26 (100%)||16,2± 0,68
|II group (n=21)||12 (57,14%)||19 (90,48%)||17,12± 1,05
|III group (n=25)||16 (64%)||25 (100%)||16,52± 0,69
|The control n=25)||12 (48%)||19 (76 %)||19,32±1,16|
As a whole, the average time of ulcer scarring in groups with using of SCENAR-therapy is shorter on 3-4days in comparison with control (on average 16,71±0,47 days), here some of the patients as opposed to control group had epithelization of ulcer defect without forming of rough connecting-woven scar. Against a background of treating the diffuse gastroduodenitis of 76,4% of patients transformed in focal one, and mucous tunic was absolutely normal for 4 patients (5,6%). Under the results of quick urease test, breathing test and histological research of biopsy material (methylene blue coloring), most of patients (83,3%) have contamination mucous coat of stomach Hp-infection. The course of SCENAR-therapy didn’t lead to Hp eradication in 1st and 2nd group, but the quality of mucous coat of stomach Hp colonization after the SCENAR-therapy reduced incidentally (p>0,05). At the same time as for the 3rd group, the Hp-infection eradication began by the results both of urease, breathing test and morphological data. As for the 3rd group after the therapy there were occurred the semination in pyloric department mucous coat of stomach Hp-infection (4 patients – 16%)-by the results of quick urease test, and by morphological test – with 3 patients (12%). So, the positive eradication was seen in 88% of cases in 3rd group.
Before the treating most of the patients (84,7%) had the evident hyperacidity of body and antral department of stomach, the moderate hyperacidity (15,3 % of patients) and norm acidity in 2,8%. After the course of SCENAR-monotherapy the increasing of pH in body and antral department of stomach are registered, the increasing of pH level in all departments of stomach (p,0,001) is marked when SCENAR-therapy was in conjunction with omeprasol and “triple” scheme of Hp eradication. The immature zone (the place of transition of subacid pH (6,0-4,0)value up to sharply acid (pH<3,0) didn’t undergo any essential changing. There became reliable decreasing of zone of maximal acidity in all investigated groups. The combined therapy in the conjunction with antisecretory and anthelicobacterian
Substances provided the defined abscopal effect on the acid-forming processes in stomach, but the pH-metria indicators in basic groups didn’t differ from one in control group. The including of SCENAR-therapy in combined treatment of duodenal ulcer recurrent had “modulatory” impact on the condition of stomach motor function. When the stomach motor activity is initially decreased, the growth of frequency indicators of stomach motor oscillations, their average amplitude and total intensity of stomach biopotentials came to 31,4%, 75,4 % and 139,1 % conformably, and finally they’ve got normal condition. During the initial hyper kinesis, there are marked the decreasing of electrogastrography indicators half as less again (p<0,001). There are discovered the possibility of SCENAR-influence to remove the manifestations of dyskinesia, which has been proved by the increasing of symmetric (from 34% to 91%) and single modal (from 49% to 96%) variational curve amplitude (VCA) in all the investigated groups.
During the studying the VNS condition the parasympathetic tonus of nervous system prevailed in most cases (76,3% of patients), and sympathetic one- in others (13,9%-of patients). Including the hyper vagotonia, which was evident for 43,1% of patients and hyper sympathicatonia (5,6% of patients) . Vegetative reactivity (VR) for most of patients (39.3%) was unnatural; this proved the predomination parasympathetic tonus of nervous system. The redundant VR was marked at 10,7% of patients and was connected with initial sympathicatonia. There was detected the overstrain of both department of nervous system during the security of action (SA), and 68,4% of patients showed the disfunction of balance and correlation between them. The including of SCENAR-therapy in treating of duodenal ulcer recurrent led to the normalization of not only initially unnatural but also initially redundant vegetative reactions (p<0,05), and also provided the decreasing of heightened indicators either of clinostatic (p<0,02) or orthostatic (p<0,05) probes. Here at the background of pharmacotherapy (control) the vegetative status hasn’t change much.
The including of SCENAR-therapy in combined treatment during the duodenal ulcer recurrent, positively influences on clinical course and functional condition of gastro duodenal zone, stimulates reparative processes and decreases the inflammation activity of mucous coat of stomach. In mechanisms of medical influence of SCENAR-therapy, there such predominating factors as the activation of indicators of “defiance” and the impact on common mechanisms of adaptive regulation of gastro duodenal zone self-regulation .
Al the researches let us talk about SCENAR-therapy as the effective method of duodenal ulcer recurrent treatment, either like monotherapy or as a component in combined medicine treatment.
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