VALUE OF pH-METRIC IN DIAGNOSTICS AND FORMATION OF INDIVIDUAL COMPLEX TREATMENT OF PATIENT AFTER PILOUR SAFE PANCREATODUOODENAL RESECTION
DOI:
https://doi.org/10.11603/1811-2471.2019.v0.i2.10370Keywords:
insuloma, acid-dependent states, stomach, treatmentAbstract
Acid-dependent diseases constitute a significant part of gastrointestinal diseases. The exact diagnosis and effectively chosen therapy ultimately determine the course of the disease and the patient's prognosis. Currently, evaluation of the secretory function of the stomach using pH-metry is the most informative and perfect.
The aim – to demonstrate the diagnostic value of the use of pH-meter in an acid-dependent polymorbid state of a patient for a clinical specimen in order to determine medical tactics.
Results. Patient S., 45 years old. diagnosis: pancreatic insulinoma T2N0M0, stage II, clinical group IIa, 10.04.2017 – atypical resection of the head of the pancreas with insulinoma.
At the primary intra-gastric pH-express diagnosis, a pronounced hypoacidity was established: an existing duodenogastroiesophagel reflux on the background of a weekly withdrawal of pantoprazole, which was previously taken by the patient at a dose of 20 mg 1 time per day. Repeated intra-gastric pH-metry on the background of cancellation of pantoprazole for 1 month also showed the result at the level of severe hypoacidity. However, when comparing the pH-metrics in dynamics, a gradual decrease in the depth of the gipopic acidity, improvement of the general condition of the patient, and a decrease in the intensity of clinical symptoms were established.
Conclusions. 1. Appointment of protocol therapy in patients with acid-dependent diseases, even with a positive test for H. pylori, requires additional determination of acidity by performing intra-gastric pH-express diagnosis.
- Analysis of this clinical case with the performance of pH-metry confirmed the higher diagnostic value of the respiratory test on H. compared with the detection of a positive antigen in feces.
3. The result of performing pH-metry in this clinical case became the basis for the cancellation of an antisecretory drug pantoprazole.
References
Baranov, S.A., & Nechayev, V.M. (2017). Podzheludochnaya zheleza kak yedinyy funktsionalno vzayemodeystvuyushchiy organ [The pancreas as a single functionally interacting body]. Meditsinskiy sovet – Medical Council, 11, 148-151 [in Russian].
Kochatkov, A.V., Kriher, A.H., Horin, D.S., & Lebedieva, A.N. (2010). Endokrynni pukhlyny pidshlunkovoi zalozy [Endocrine pancreatic tumors]. Khirurhiia – Surgery, 9, 19-22 [in Ukrainian].
Perederii, V.H., & Tkach, S.M. (2012). Praktychna hastroenterolohiia. Suchasna taktyka i alhorytmy vedennia khvorykh z osnovnymy hastroenterolohichnymy zakhvoriuvanniamy i syndromamy: posibnyk dlia likariv [Practical gastroenterology. Modern tactics and algorithms for the management of patients with major gastroenterological diseases and syndromes: a manual for doctors]. Vinnytsia: Nova Knyha [in Ukrainian].
Belovol, A.N., Fadeyenko, G.D., & Babak, O.Ya. (2015). Ratsionalnaya diagnostika i farmakoterapiya zabolevaniy vnutrennikh organov [Rational diagnosis and pharmacotherapy of diseases of internal organs]. Kyiv: “Zdorovia Ukrainy” [in Russian].
Mostovyi, Yu.M. (Ed.). (2018). Suchasni klasyfikatsii ta standarty likuvannia zakhvoriuvan vnutrishnikh orhaniv. Nevidkladni stany v terapii [Modern classifications and standards of treatment of diseases of internal organs. Urgent conditions in therapy]. Kyiv: Tsentr DZK [in Ukrainian].
Kryvko, A.A., Melnychenko, H.A., Kuznetsov, N.S., Troshyn, E.A., & Didiv, I.I. (2013). Suchasni tekhnolohii v diahnostytsi ta likuvanni insulinomy [Modern technologies in the diagnosis and treatment of insulin]. Problemy endokrynolohii – Problems of Endocrinology, 5, 17-19 [in Ukrainian].
