Loopback Syndrome

Adjacent loop syndrome is a pathological condition that develops after Billroth- II stomach resection , manifested by a feeling of heaviness in the right hypochondrium and vomiting of bile after eating. The frequency of this syndrome, according to various authors, ranges from 0.8 to 51.9%.

Etiology, pathogenesis of afferent loop syndrome

Acute syndrome of the leading loop develops with complete obstruction and, as a rule, in the early postoperative period. The reasons are most often various mechanical factors and only sometimes the atony of the afferent loop. Chronic afferent loop syndrome is most often the result of functional disorders – duodenal hypotension, its dyskinesia, anastomosis spasm and abduction loop. With peptic ulcer of gastro – enteroanastomosis , when the ulcerative infiltrate compresses the outlet loop, a secondary chronic syndrome of the leading loop of a mechanical nature may develop. Kinks and adhesions in the area of ​​the anastomosis can lead to it.

Clinical Loop Syndrome Clinic

With a mild severity of the syndrome, rare spitting up or mild vomiting of bile is observed 15 minutes to 2.5 hours after eating. Patients often do not attach any importance to these phenomena, the ability to work is preserved. The syndrome of moderate severity is manifested by bursting, quite intense pain in the right hypochondrium after eating and vomiting of bile, which occurs quite often, as well as a decrease in body weight and a significant decrease in working capacity. The severe severity of the afferent loop syndrome is characterized by profuse vomiting of bile after each meal. Vomiting is usually preceded by excruciating pain in the right hypochondrium and epigastric region. Patients are exhausted, their ability to work is reduced. In most patients , the afferent loop syndrome develops in the 1st year after surgery, and in some, even within the 1st month.

Diagnosis of the afferent loop syndrome

Diagnosis of the afferent loop syndrome should be based primarily on the clinical picture. The X-ray method of research, which primarily reveals organic pathology and some functional changes in the stomach stump, leading and removing loops, the anastomotic region, has a certain significance in recognizing the syndrome. Refluxing the contrast medium into the lead loop (reflux) cannot be a reliable sign of the lead loop syndrome, since it occurs only in 20-30% of patients with clear clinical signs of this syndrome.

Therapeutic nutrition for functional disorders of the stomach

Functional disorders of the stomach are manifested by a violation of its individual functions, a change in the position and tone of the stomach. The causes of the disorder of certain functions of the stomach may be nutritional, nervous or humoral factors.
A violation of the secretory function of the stomach can not always be regarded as a disease. This function, like other functions of the stomach, is subject to known fluctuations depending on the state of the neuro-glandular apparatus of the stomach and regulatory mechanisms. Violations of the secretory function of the stomach include hypersecretion and hyposocretion . In clinical practice, the principle of differentiation of the secretory function of the glandular apparatus of the stomach according to the level of free hydrochloric acid has been established.
The principles of constructing dietary treatment for patients suffering from hypersecretion and increased acidity of gastric juice are based on creating rest for an “irritated stomach” by maximizing mechanical, chemical and thermal sparing of its mucous membrane. Showing foods and dishes related to weak pathogens of secretion and quickly leaving the stomach, depending on the consistency of the poor. Liquid and mushy beggars evacuate from the stomach faster than solid.
Spicy snacks, fried foods, extractive substances, meat, fish, vegetables, mushrooms, spices, savory snacks, canned food, coffee, alcohol, spices, marinades, carbonated drinks, and ice cream are prohibited.

General characteristics of the diet

The diet is mixed, physiologically complete, with a normal content of proteins, fats and carbohydrates. Food is given in liquid and mushy form with the restriction of dishes containing many cell walls.
Culinary processing. All dishes are cooked boiled or steamed, mashed. The chemical composition and calorie content. Proteins 100-110 g (at least 60% of animal origin), fats 100 g (of which 1/3 are vegetable), carbohydrates 400-450 g. Calories 3000-3200 kcal. The amount of free fluid is 1.5 liters. Salt – 12 g. The mass of the daily diet is about 3 kg. Fractional diet (5-6 times a day). A list of recommended foods and dishes. Bread and bakery products. Yesterday’s or dried wheat bread, as well as crackers. Soups Cereals, dairy, mashed. Meat and fish dishes. Meat of low-fat varieties (beef, veal, chicken) in boiled or steam form, mashed (cutlets, dumplings, meatballs, soufflé, roll, etc.). Non-rigid and lean meat is allowed in a boiled form with a piece. Low-fat (mainly river) fish, boiled or steam in pureed form and a piece. Dishes and side dishes from vegetables. Potatoes, carrots and beets boiled in water, in mashed form. Dishes and side dishes from cereals and pasta. Porridges and puddings semolina, rice, buckwheat and oatmeal crouy , boiled vermicelli, melkonarublennye pasta. Dishes from eggs. Soft-boiled eggs, steam omelet. Fruits, berries, sweet foods and sweets. Sweet varieties of berries and fruits, sugar, honey. Stewed fruit compotes, baked apples, jelly, mousse, jelly. Milk, dairy products. Whole , condensed milk , cream, fresh non-sour cream, fresh low-fat cottage cheese. Snacks Uncooked cheese. Beverages. Tea is weak with milk. Fruit and berry juices (from sweet varieties of fruits and berries), diluted with water, weak. Fats. Unsalted butter, olive, sunflower, well refined. A sample menu is given in table. The technique of dietary therapy. In addition to the quantitative composition of the diet, it is important to follow a diet. Food should be not only frequent, but also fractional, regular. Eating small amounts of food improves digestion and absorption. Patients with functional disorders of the stomach, as a rule, are treated on an outpatient basis. Follow a diet and diet should be a long time and only 2-3 months after the disappearance of all functional disorders of the stomach, you can gradually switch to diet No. 15. At first, the patient refuses mashed food, receives boiled meat with a piece, cereal is friable, vegetables are not mashed . Then 1 time per week include a weak meat or fish broth on the menu. Diet should be observed all life. Achilia functional is caused not by organic damage to the parietal cells producing hydrochloric acid, but by their deep inhibition, which is often based on nervous disorders. Among the causes of the development of functional achilia, there may be eating disorders, mainly unbalanced nutrition, for example, when consuming excess amounts of carbohydrates or fats and insufficient protein content; in case of non-compliance with the diet, violation of its rhythm, overeating, frequent use of alcoholic beverages. Dietary treatment for functional achilia is aimed at activating the secretory function of the stomach. Prescribe mechanical sparing diets containing stronger secretion pathogens. The diet is physiologically complete, with the exception of spicy dishes, smoked meats, fat mutton, pork, duck, goose, marinade, pastry, canned snacks, raw vegetables and fruits, legumes, brown bread, carbonated drinks, milk in kind when intolerant.

Violation of the motor function of the stomach. Functional hypotension of the stomach is one of the options for impaired motor function of the stomach. A typical symptom of decreased stomach tone is a constant splashing in the epigastric region during palpation. Before eating, patients feel good, after eating, they feel pressure, bursting and heaviness in the epigastric region and fast satiety. Diet therapy provides a high-calorie, nutritious, high-protein, vitamin-rich diet. Food should not contain large amounts of slag and water. It is recommended to eat food in small portions, immediately eat no more than two dishes and do not take solid and liquid foods at the same time.

General characteristics of the diet 15

A physiologically complete diet, with a high protein content and slightly higher than the physiological norm of fats and carbohydrates.
The chemical composition and calorie content. Protein 100 g (including animals 70 g), fat 100 (including vegetable 1/3), carbohydrates 500 g. Caloric value 3300 kcal. Salt -15 g. Culinary processing – the usual rational about the preservation of vitamins. Fractional diet (5-6 times a day). The temperature of a beggar is ordinary. A list of recommended foods and dishes. Bread and bakery products. White and rye bread , nechee , biscuit. Soups Different. Meat and fish dishes. Different in any cooking. Fatty varieties of pork, lamb, beef, geese, ducks are excluded. Dishes and side dishes from vegetables and mushrooms. Varied. Dishes from eggs. In any culinary processing. Fruits, berries, sweet foods and sweets. Various. Milk, dairy products and dishes from them. All kinds of. Spices. Pepper, mustard are allowed in moderation. Snacks Varied. Snack canned foods – in moderation. Beverages. Tea, coffee, cocoa, fruit and berry juices. Fats. Butter, ghee, olive, sunflower. A sample menu is given in table. Food is recommended to be taken in small portions, 5-6 times a day. Of great importance is the normalization of working conditions, adequate rest during the day, and sleep for at least 8 hours a day. Hydro-procedures (showers, rubbing with water at room temperature) have a tonic effect . Treatment at balneological resorts is contraindicated, taking a large amount of mineral water is impractical. Functional hypotension of the stomach is treated more often on an outpatient basis. Treatment should be lengthy until all clinical manifestations of the disease disappear , after 2-3 months the diet can be gradually expanded. The hypertonic state of the stomach is characterized by increased motor activity of the stomach, an increase in its tone, and convulsive contraction. Hypertension of the stomach can occur as an independent disease, often as a result of strong nervous overstrain. Secondary functional hypertension of the stomach develops in the initial stages of B1-vitamin deficiency, with some intoxications (zinc, lead), with gastritis, peptic ulcer of the stomach and duodenum, etc.

Movement of the stomach also includes spasm of the stomach, which is observed mainly in young people. The reason for almost all functional motor diseases of the stomach are stress reactions, strong nervous overstrain.
The treatment of patients with functional motor disorders is mainly dietary combined with drug therapy. The principles of constructing dietary treatment, recommended foods and dishes coincide with those for functional diseases of the secretory apparatus of the stomach. The diet is mechanically, chemically and thermally sparing prescribed until complete recovery, after 2-3 months the diet can be expanded. Dietary fractional (5-6 times a day), in small portions. Vitamin therapy is mandatory, especially B vitamins. Sometimes tranquilizers, antispasmodics, physiotherapy exercises, and hydrotherapy are prescribed .
Habitual vomiting develops as a result of a violation of the motor function of the stomach, increased peristalsis and its antiperistalsis. Not always familiar vomiting occurs due to organic lesions of the stomach. The causes of its appearance may be increased excitability of the vomiting center, mental stress, hysterical state, reflex effect on the stomach of nearby organs, etc. Vomiting may become habitual as a result of functional motor disorders of the stomach. The cause that initially caused vomiting may already work, but the established connection between eating and the act of vomiting often remains and becomes fixed. In diseases accompanied by vomiting, it begins a few hours after eating, at the height of pain; vomiting is preceded by nausea; Vomit contains a large amount of acidic liquid and food. Familiar vomiting associated with functional motor disorders of the stomach occurs immediately after or with food. Vomiting is easy. If s is the treatment, the patients lose weight, develop symptoms of vitamin deficiency, disorders of water-salt metabolism. In cases where the cause of habitual vomiting is an organic disease, treatment should begin with the underlying disease. If habitual vomiting is associated only with a violation of the motor function of the stomach, it is necessary to take into account the state of its secretory function. The principles of dietary treatment are aimed at relieving the symptoms of an “irritated stomach”. A diet is prescribed mechanically, chemically and thermally sparing, used for functional disorders of the secretory apparatus of the stomach. If habitual vomiting occurs in individuals with functional achilia, clinical nutrition should be mechanically sparing, but chemically irritating. In some cases, it is advisable to take solid and liquid foods separately. Vitamin therapy and measures aimed at normalizing water-salt metabolism are indicated. Dietary fractional (5-6 times a day), in small portions. It is recommended to expand the diet 2-3 months after clinical recovery. One of the frequent functional disorders of the stomach is aerophagia, i.e., ingestion of a large amount of air and associated belching. Aerophagy is often a symptom of organic damage to the stomach and is observed in chronic gastritis, gastric ulcer and duodenal ulcer. Dietary treatment is aimed at reducing the sensations of heaviness and raspirapiya associated with eating. Exclude nutrients that are long in the stomach (rich in connective tissue, fat), containing carbon dioxide. Clinical nutrition is similar to diet therapy prescribed for functional disorders of the secretory apparatus of the stomach. Dietary fractional (6 times a day), in small portions. In severe cases of aerophagy, a separate intake of solid and liquid food is prescribed. Vitamins are shown in large quantities, especially ascorbic acid and B vitamins. Psychotherapy is essential. Timely and adequate treatment of functional diseases of the stomach leads to a complete recovery and prevents the development of organic lesions of it.

Eosinophilic gastroenteritis

Eosinophilic gastroenteritis – a chronic disease of the stomach, small intestine and colon, accompanied by a high eosinophilia of blood and eosinophilic infiltration of the affected tissue without the development of vasculitis . In most cases, the etiological factor of eosinophilic gastroenteritis is not known, in 20% of patients it is a food allergy. There are various options for the course of the disease: prolonged diarrhea, steatorrhea , enteropathy exudative, hypoproteinemia , iron deficiency anemia (most typical for food allergies); thickening of the muscle layer of the stomach and intestines as a result of the infiltrative process with narrowing of the intestinal lumen, the development of pyloric stenosis; mainly damage to the serous membranes, followed by ascites and eosinophilia of serous fluid. If the cause of eosinophilic gastroenteritis is food allergy, then in patients, as a rule, the level of immunoglobulin E is increased and antibodies related to immunoglobulin E are determined. The function of T lymphocytes, the content of the remaining classes of immunoglobulins, and complement of the system are without special features. Eosinophilic gastroenteritis differentiates with regional ileitis. Treatment consists in an elimination diet, desensitizing non-specific therapy, and the use of glucocorticosteroid drugs.

Benign tumors of the stomach

Benign tumors include the most diverse tumors in histogenesis (epithelial – adenomas, polyps, non – epithelial – fibromas, leiomyomas , neuromas, hemangiomas , hamartomas , etc.). Epithelial tumors, according to most researchers, are the result of regenerative processes associated with chronic gastritis. With mass preventive examinations, the detection of gastric polyps is 0.3–2.6%. Polyps occur more often with reduced secretory activity of the gastric mucosa. There are hemispherical, rounded on a wide base, rounded on the leg and stalk (finger-shaped) forms of polyps.

By pathological signs distinguish: polypous gastritis; single and multiple polyps (benign, malignant ), according to the clinical course: asymptomatic form; gastritis form; anemic form; complicated form (bleeding polyps, prolapse of the polyp in the duodenum).

Indications for removal are single and multiple polyps with a diameter of more than 0.5 cm.

Foreign bodies of the stomach

Foreign bodies of the stomach are foreign bodies that invade the lumen of the stomach through the esophagus or through a wound, as well as parasites. The foreign body of the stomach may be a calculus formed in the body, phytobesoar .

Clinic of a foreign body of the stomach

A foreign body lingered in the stomach may not cause any pain for some time. A non-acute foreign body remains in the stomach for a very long time (years) and, gradually overgrowing with mucus and small food inclusions, having reached a considerable size, manifests itself as a violation of the evacuation from the stomach. Pointed foreign bodies damage the mucous membrane and underlying tissues, cause ulceration, hemorrhage, secondary infection with the development of phlegmon, perforation, peritonitis.

Diagnosis of a foreign body of the stomach

The diagnosis of a foreign body of the stomach is based on anamnesis and is confirmed radiologically and endoscopically . X -ray contrast foreign bodies (needles, nails, nuts, screws, etc.) are most easily recognized by X-ray . The question of the presence or absence of such a kind of foreign bodies in the stomach can be resolved by fluoroscopy. To clarify the position of foreign bodies, their amount, displacement , as well as to determine non-contrasting foreign bodies (various berries, phyto-, trichobesoars , roundworms, etc.), one has to resort to the study of the stomach using a contrast medium. When detecting foreign bodies of the stomach, the task of the radiologist is to track their future fate, since therapeutic tactics depend on this. If you suspect a foreign body of the stomach before radiological examination, it is strictly forbidden to take laxatives and emetics to avoid possible damage to the gastric wall by the foreign body at the time of vomiting or active peristaltic contractions. Endoscopic examination allows you to determine the localization of a foreign body, the size and its effect on the mucous membrane.

Erosive gastritis

Erosive gastritis is one of the most common causes of gastrointestinal bleeding, which is usually minor. Clinical symptoms are often absent. The disease can be combined with other forms of gastritis. At the same time, erosion may develop without previous damage to the gastric mucosa in stressful situations, when taking acetylsalicylic acid, glucocorticoids or as a result of a disturbance in the blood supply to the stomach. Erosion, as a rule, are multiple. The diagnosis is made by gastroscopy. Usually, with this disease, gastric secretion is increased, therefore, patients are prescribed antacids , and sometimes H2-histamine receptor blockers. It should be borne in mind that erosive gastritis in some cases is prone to recurrent course.

Traditional methods of treatment of peripheral vessels and venous insufficiency

In diseases of peripheral vessels, the effectiveness of using drugs based on garlic, ginkgo biloba, omega-3 PUFA, Padma 28 (a mixture of herbs from 22 different ingredients) and vitamin E has been studied. Results of randomized controlled studies, systematic reviews and meta-analyzes indicate the effectiveness of ginkgo biloba compared with placebo in patients with intermittent claudication.

There is also evidence of the effectiveness of Padma 28, but they are few. It has been shown that in case of venous insufficiency, an extract of horse chestnut seed is effective.

a) Ginkgo biloba leaf extract. Ginkgo biloba (Ginkgo biloba) is used to treat intermittent claudication in patients with PAD. A review of research findings suggests that ginkgo biloba extract more effectively placebo reduces the symptoms of intermittent claudication (Peripheral Arterial Disease Fontaine study, stage II).

In clinical studies, doses of 120-160 mg / day were used and the walking distance without pain and the maximum walking distance were analyzed. Ginkgo biloba leaves and their extract contain several biologically active substances, including flavonoids, terpenoids and organic acids. The main active substances are bilobalide and ginkgolides.

As in the case of any herbal remedies, several components of the extract of ginkgo biloba can cause positive effects. Ginkgo biloba does not interact with cardiac glycosides while using these drugs. Thus, against the background of the use of ginkgo biloba, a small positive effect on BAP is found, possibly due to the destruction of free radicals, anti-platelet action, anti-inflammatory effects, vasodilation and a decrease in blood viscosity.

The usual dose is 40 mg of the standardized extract of ginkgo biloba 3 times a day. Ginkgo biloba is considered a relatively safe drug, rare adverse events include mild gastrointestinal dysfunction, nausea, dyspepsia and headache. Ginkgo biloba is noted to increase the risk of bleeding. One hundred concomitant use with aspirin, NSAIDs and anticoagulants such as warfarin and heparin is not recommended.

b) Horse chestnut. Horse chestnut extract (Aesculus hippocastanum) contains saponins, coumarins, flavonoids and tannins. The biological activity of the extract is associated with saponins (escin). A systematic review of 17 randomized placebo-controlled trials of this drug has recently been carried out.

In 6 studies (n = 543). in which the pain in the legs when walking was assessed, the decrease in the severity of this symptom was reliably established compared with placebo. In 4 of 5 studies (n = 420) in patients taking horse chestnut extract, there was a significant decrease in edema compared with placebo. Also, while taking horse chestnut extract, the circumference of the lower leg and ankle decreases.

One study noted the effectiveness of horse chestnut extract in combination with wearing elastic stockings. The effective dose of horse chestnut extract is standardized so that the patient receives 100-150 mg of escin per day. While taking a horse chestnut extract, symptoms such as itching, fatigue and apathy are reduced. Adverse events are rare, but gastrointestinal irritation, dizziness, nausea, headache and itching are possible. There are 2 cases of toxic nephropathy.

Contraindications include hypersensitivity to escin, as well as abnormal liver function or kidney function. Escine – the main horse chestnut extract saponin – binds to plasma proteins and can affect the binding of other drugs. There is an assumption about the possible hypoglycemic effects of horse chestnut extract. German Commission E approved the use of horse chestnut extract for venous insufficiency; horse chestnut products are also available on the US market.

Traditional methods of reducing cholesterol. Guggulipid Chewing Gum

Traditional dietary supplements (BAA) and nutritional supplements used in hyperlipidemia (HLP) include foods that should reduce the production of lipids in the liver, such as artichoke extract (Cynara scolumus), garlic, polycosanol, and red yeast rice (Monascus purpureus).

The products that should reduce lipid absorption include stanols and sterols, chitosan, barley, psyllium, and oat bran. In addition, the effects of fish oil, DHA, EPA, and soy are studied in clinical studies. The following describes the effects of Guggulipid (Commiphora guggul) chewing gum containing myrrh tree resin extract and policosanol.

Chewing gum Guggulipid. This chewing gum has been used in ayurvedic medicine for a long time.

In the first randomized controlled study of Guggulipid chewing gum in the United States, in which 103 volunteers with HCS used 1000-2000 mg of Guggulipid chewing gum containing 2.5% guggulsterones, no improvement in the lipid profile was observed. A small number of study participants recorded a rash associated with hypersensitivity to the drug.

The effects of Guggulipid chewing gum on HDL were mixed. The standard dose of guggulsteron 75-150 mg is given in the form of a chewing gum Guggulipid 1000-2000 mg 2-3 times a day. Guggulipid chewing gum can cause abnormalities in the digestive tract, headache, nausea, vomiting, hiccups and rash.

Simultaneous intake per os of this chewing gum and preparations of propranolol and diltiazem may help to reduce their bioavailability and effectiveness. Guggulipid chewing gum can also have anti-platelet and anticoagulant effects. Data on the safety and efficacy of its use against the background of the western type of nutrition is not enough.

Policosanol Policosanol is extracted from cane sugar extract or wheat germ oil. It is a mixture of aliphatic alcohols. Hypolyidemic effects may include inhibition of cholesterol synthesis in the liver and an increase in LDL cleavage.

In 15 randomized, placebo-controlled studies of the efficacy of policosanol at a dose of 5–20 mg / day for a period of 6 weeks to 1 year,> 1,000 patients took part.

When using policosanol at a dose of 10–20 mg / day, a significant decrease in cholesterol levels (17–21%) and LDL (21–29%) with an increase in cholesterol level (8–15%) is observed. There is no data on the effect on endpoints.

Although, in general, policosanol is well tolerated, caution is needed when it is combined with antiplatelet and anticoagulant drugs, including preparations of garlic, ginkgo biloba and high doses of vitamin E, since it has been proven that policosanol inhibits platelet aggregation in both healthy individuals and patients with various diseases.

Independent verification of its effectiveness is necessary for the widespread introduction of policosanol into clinical practice.

Folk methods of reducing pressure. Arterial hypertension garlic

Randomized clinical studies of the effectiveness of garlic (Allium sativum), ginkgo biloba (Ginkgo biloba), hawthorn (Crataegus), pycnogenol, or Pinto martima bark extract, Oea leaf extract (Oea) have been used in arterial hypertension (AH), garlic (Allium sativum). , Asian ginseng root (ginseng wounds), coenzyme Q10, calcium and magnesium.

The results vary, and the effect is usually small. In a meta-analysis, it was shown that, compared with placebo, the use of garlic leads to a decrease in CAD, an average of 8 mm Hg. Art., and dad – 5 mm Hg. However, in a systematic review of 27 small, randomized, placebo-controlled studies of short duration, in 26 of which only adult patients participated, mixed, but always small effects of different garlic-based drugs in relation to blood pressure were obtained.

Most studies did not reveal significant differences in blood pressure levels in patients randomly assigned to the garlic group compared with the placebo group. The undesirable effects of oral intake of garlic included bad breath and body odor.

Other possible, but unproven, adverse events included flatulence, pain in the esophagus and abdomen, small bowel obstruction, contact dermatitis, rhinitis, asthma, bleeding, and MI.

In a systematic review of the use of coenzyme Q10 in arterial hypertension (AH) in 8 studies showed an average decrease in the GARDEN by 16 mm Hg. Art. and DBP – at 10 mm Hg. however, only 50% of the studies were placebo-controlled. The latest Cochrane review confirmed the ineffectiveness of the combined dietary supplement containing calcium, magnesium and potassium in terms of treating primary hypertension in adults.

Traditional treatments for stress in cardiovascular diseases

Stress is one of the significant risk factors (RF) for the development of cardiovascular diseases (CVD), therefore stress correction methods are very important.

Effect of stress on cardiovascular disease (CVD) factors. Stress can cause the development of hypertension as a result of repeated rises in blood pressure and an increase in the concentrations of vasoconstrictor hormones. The stress factors that increase the risk of developing hypertension include increased workload, social environment, emotional stress, a visit to the doctor (“white coat hypertension”), and the ethnic identity of influenivaum plays a certain role.

The Framingham Study showed that hypertension accounts for 80% of all tornadoes for her from cardiovascular diseases (CVD). In addition, the risk of death associated with hypertension is 2 times higher than the risk of death associated with smoking or increasing the level of cholesterol. Currently, an increase in blood pressure was recorded in 50 million Americans.

Stress correction methods:
1. Pets. Caring for pets reduces psycho-emotional stress by creating a goal in life and reducing the feeling of loneliness. The study showed that in patients with CVD, pet care can lead to increased heart rate variability.
2. Correction of stress through internal concentration. Correction of stress based on methods of internal concentration includes methods of internal meditation, yoga and coordinated deep breathing, aimed at reducing pain and reducing anxiety. In a meta-analysis, it was shown that the methods of inner concentration contribute to the reduction of stress and suffering associated with various diseases.
3. The method of controlled imagination. This therapeutic method allows the patient to use their own imagination to connect the body and mind in order to achieve the desired results, for example, to reduce the perception of pain or reduce anxiety. The method of controlled imagination in studies involving patients before and after surgery. In a study involving patients who underwent surgery on the heart, it was found that the method of controlled imagination can reliably reduce both pain and anxiety. In a continuing study at Scripps Clinic, it is noted that the use of guided imagination and healing touch before surgery on the heart and after the intervention is accompanied by a 50% reduction in pain and anxiety.
4. Transcendental meditation. Transcendental meditation is a unique method of meditation and relaxation, which is the most studied method of DAM. Studies of transcendental meditation began in the 1970s. Studies have shown that transcendental meditation lowers blood pressure and such a component of MS, as IL, and also improves the tone of the autonomic nervous system (VIS).
5. Biofeedback method. The biofeedback method is a way to change a person’s habitual reactions to stress. In patients with CHD, using this method increases heart rate variability.

6. Food additives and natural products. Eating certain components of the diet leads to a reduction in the risk of cardiovascular diseases (CVD). These components include plant sterols and stanols, soluble fibers, omega-3 PUFAs, garlic, soy, tea, and small amounts of alcohol. The 1994 Dietary Supplement Health and Education Act (DSHEA) amended the pre-existing dietary supplement definition given by the Federal Food, Drug and Cosmetic Act.

According to the new definition, dietary supplements are any product (with the exception of tobacco) that contains vitamins, minerals, herbs, or other plant components or amino acids and is taken as a supplement to the diet. Currently, food supplements in the USA can be labeled as dietary supplements. Accordingly, these products are not intended to diagnose, treat, cure or prevent diseases (the requirement for traditional drugs), nor are they traditional foods. According to U.S. Food and Drug Administration (FDA), in 2000 there were> 29 thousand dietary supplements in the US market, and every year there are 1,000 new ones.

In some countries (for example, in Germany, France, Sweden, Canada and Australia), licensing strategies for herbal preparations, including testing before entering the market, have been introduced. In the US, licensing of these drugs is not required.

Currently, a number of herbal substances with proven effect are widely used, for example, digoxin, atropine, reserpine and amiodarone. However, only with respect to a small number of commercial herbal remedies sold in the United States, studies of their effectiveness in cardiovascular diseases (CVD) have been conducted. Hawthorn (heart and coronary insufficiency), garlic (atherosclerosis), ginkgo biloba (artery occlusion) and horse chestnut (chronic venous insufficiency) were studied.

Rigid formalization and standardization necessary for conducting clinical trials are possible only for a few supplements. Herbal supplements, unlike most traditional drugs, are a complex mixture of biologically active substances, each of which may or may not have a therapeutic effect. Very often, the active ingredient is unknown, a complete description of the chemical composition is missing. Like many traditional medicines, herbal remedies can have a therapeutic effect in one dose and toxic in another.

Concomitant use of herbs can mask, enhance, or level the effects of other drugs. In cardiology, the problem of unrecognized interactions of herbs and traditional cardiovascular drugs, many of which have a narrow therapeutic dosing range, is very important. The table below lists the sources of detailed information on nutritional supplements and herbal preparations.

The herb-drug interaction can be described as pharmacodynamic or pharmacokinetic. Pharmacodynamic interaction develops when the components of the herbal preparation have a synergistic or antagonistic effect on the traditional drug, thereby affecting the effects of the drug at the receptor level. Pharmacokinetic interaction is a violation of the absorption, distribution, metabolism or elimination of a traditional drug under the influence of herbal remedies or food supplements.

Herbal remedies contain several components that are metabolized in phases 1 and 2 of drug metabolism, especially with the participation of cytochrome P450 (CYP3A4), and also are substrates of certain transporter proteins and P-glycoprotein. In vivo and in vitro studies have shown that P-glycoprotein-mediated elimination and / or CYP metabolism is the most likely interaction of a drug with a herbal remedy, which can reduce the effectiveness of the drug and increase its toxicity.

The clinical significance of this interaction depends on a variety of factors: the dose, frequency and time of administration of the herbal remedies, the dosage regimen and the route of intake of the drug and its therapeutic range. In addition, the use of herbal remedies can lead to a significant change in the results of laboratory tests. Deviations of laboratory tests from the norm may indicate the need for careful collection of anamnesis about the patient’s intake of herbal remedies and nutritional supplements.

Herbal remedies can affect the results of laboratory tests due to the direct impact on the studied parameters, most often immunological, due to physiological effects due to toxicity and induction of enzymes, or due to the presence of pollutants.

Objectives of supplementary and alternative medicine (DAM) in cardiology

Complementary and Alternative Medicine (DAM) is a term used by the National Institute of Health (NIH) to describe this section of medicine. Additional, alternative and complex methods of treatment include treatment with herbs, vitamins, special foods, as well as treatment, including effects on the spiritual world, bioenergy (for example, acupuncture or energy fields), and psychosomatic therapy.

According to the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics (NCHS), 36% of adult Americans use some form of DAM, and if you include in the definition of DAM prayers for improving health, this figure will increase to 62 % It is important to note that the methods of complementary and alternative medicine (DAM) are used in 25 US medical centers.

The great doctors interacted with the patient on the physical, mental and spiritual levels, using the principles of the ability to listen, cause trust and express sympathy. The introduction of DAM in practical medicine should be based on the principles of compassion for the patient, but on a scientific basis; The main goal of the implementation should be to strengthen the doctor’s interaction with the patient, since human relationships are central to the process of providing medical care.

The physician must establish a trusting relationship with the patient so that, understanding his problems, goals and preferences, he can offer the patient accurate and adequate information about a rational and mutually acceptable treatment plan. Most patients use DAM methods, so it is very important to respect the patient’s perceptions about this and preserve his love, not trying to persuade, even if the doctor does not completely trust these methods.

In addition, since patients believe that many doctors are not interested in DAM methods, i.e. the patient takes what medicinal herbs and biologically active additives (BAA), then the patients do not give this information to the doctor. Ego can lead to the development of heavy allopathic drug interactions with herbs and dietary supplements. In order to avoid such problems, it is extremely important to obtain information from the patient about everything that he uses for treatment.

Effective prevention and treatment of chronic diseases require multi-component therapy combined with lifestyle changes. Since there is currently very little evidence of evidence of melicins regarding the efficacy and safety of nutritional supplements and herbal remedies, the physician must study and record the use of dietary supplements in order to provide the patient with relevant information and follow his preferences.

Uncontrolled physical training.

Many patients cannot attend controlled physical training (PT), because the cardio-rehabilitation program is unavailable to them or it is inconvenient for them to attend controlled physical training (PT). Despite this, all patients with coronary artery disease should be recommended training to improve cardiovascular prognosis.

Patients without orthopedic problems of the lower limb should be recommended to walk fast as a method of FT. Patients in unsupervised programs should train before they develop mild dyspnea. This approach eliminates the need to control the pulse. Many patients either cannot control their heart rate accurately, or become overly concerned with pulse interruptions caused by atrial or ventricular extrasystoles. Patients who train independently can be recommended to use the “conversational test” (that is, to train with a load that allows comfortable conversation) to assess the intensity of the FN. This level of load corresponds to the training recommended for cardiac patients.

Other components of comprehensive cardiac rehabilitation. In 1994, the American Heart Association recommended the expansion of cardiac rehabilitation programs with the inclusion of other strategies aimed at reducing cardiovascular risk. Among them are nutritional, psychological and social-labor counseling, as well as correction of such RFs as DLP, increased blood pressure and smoking. These components of secondary prevention of KBS, of course, are very important. It has repeatedly been shown that a decrease in lipid levels during treatment with statins leads to a decrease in the frequency of repeated cardiac events in patients with coronary heart disease (CHD). A review of 20 prospective cohort studies showed that in patients with CHD who give up smoking, the overall mortality rate decreases by 36%.

The inclusion of these aspects in cardiac rehabilitation programs requires a balance between the role of the staff of the cardiac rehabilitation program and the role of the polyclinic doctor. Cardiac rehabilitation program personnel usually provide advice on managing the FR, and also provide information on the interpretation of laboratory results and doctor’s instructions. In relation to the correction of lipid levels, the program staff can evaluate the results of laboratory tests and invite the patient to ask the attending physician for more stringent tactics to achieve the target cholesterol level.

Cardiac rehabilitation programs vary in counseling and patient education. Assessing the ability of patients to learn can increase the potential of educational programs. In many programs, the aerobic part of FT, when the patient is on the simulator, is used for training. In some programs, patients simply provide printed materials. Other programs use televisions and special video programs that provide information on risk factors and risk reduction. But in some programs, FT has been replaced by educational programs. We oppose this approach, given the positive physiological effects of physical training (FT).

Training programs can be creatively modified depending on the needs of patients, but should be complementary to the FT. Ideally, the components of the educational program on nutrition, lipid correction, smoking cessation and psychological problems should be provided by specialists from relevant fields of medicine, but usually all the components of the educational program are provided by the rehabilitation program staff.