Efficacy of Extremely High Frequency Electromagnetic Waves in the Combined Treatment of Children with Gastroduodenal Pathology

The dissertation is devoted to the evaluation of the efficacy of extremely high frequency electromagnetic radiation (EHF therapy, or microwave resonance therapy) in the combined treatment of children with erosive and ulcerative lesions of the gastroduodenal zone. The work lies at the intersection of pediatrics, pediatric gastroenterology, and physiotherapy and is aimed at finding non-pharmacological methods that can complement antacid and anti-Helicobacter pharmacotherapy in duodenal ulcer and chronic erosive gastroduodenitis.

The study employed clinical, endoscopic, histological, morphometric, and immunohistochemical methods to comparatively assess the dynamics of the mucosa of the stomach and duodenum under standard therapy and with the inclusion of EHF therapy in the complex of therapeutic measures. The author analyzes the influence of microwave resonance therapy on the timing of repair of ulcerative defects, the severity of inflammatory and dystrophic changes in the mucosa, the eradication of H. pylori, and the frequency of relapses in short-term and long-term follow-up.

Relevance of the problem. Gastroenterological pathology occupies a leading place in the structure of chronic morbidity of childhood, and the medical care of patients with these diseases is an important area of activity for a pediatrician in broad clinical practice.

Despite certain advances in the elucidation of pathogenetic mechanisms, in diagnostics (primarily endoscopic), and in treatment, the number of patients with gastroduodenal pathology is not declining (7, 15). While effectively relieving the acute manifestations, modern methods of treatment do not sufficiently reduce the probability of repeated relapses, creating a threat of prolongation of this group of diseases into adulthood and leading to substantial economic losses (78, 95).

Modern pharmacotherapy of erosive and ulcerative lesions of the gastroduodenal zone includes the use of two groups of drugs: those with antacid and anti-Helicobacter action (87, 147). Although the number of agents used in pediatric patients is limited, such treatment can still produce side effects. In addition, anti-Helicobacter and antacid agents act predominantly on isolated factors of induction and aggression in gastroduodenal pathology and do not possess a broad spectrum of action. This predetermined the necessity of developing new non-traditional methods of treatment, including physical ones, in order to optimize the cost/efficacy ratio and reduce side effects (3, 35).

Microwave resonance therapy (MRT), or electromagnetic radiation in the millimeter range of extremely high frequencies (EHF therapy), exerts an influence on the pathogenetic shifts accompanying the formation, course, and recurrence of erosive and ulcerative lesions of the gastroduodenal zone (12, 27). MRT has practically no contraindications in pediatric practice, is devoid of side effects, and can be applied repeatedly.

The first clinical trials of MRT in ulcerative processes of the gastroduodenal area were conducted in 1977, and since then considerable experience in its application in adult gastroenterology has been accumulated. In pediatrics, there are no full-scale studies on the results of MRT application either in short-term or long-term follow-up. Furthermore, the influence of this method on the structural changes in the mucosa of the gastroduodenal zone has not been evaluated at all. At the same time, studies in this direction will broaden the understanding of the mechanisms of action of MRT.

Aim of the study: based on clinical and morphological studies, to evaluate the effect of microwave resonance therapy on erosive and ulcerative diseases of the gastroduodenal zone.

Objectives of the study:

1. To study the clinical efficacy of microwave resonance therapy in the acute period of duodenal ulcer and erosive gastroduodenitis, as well as in long-term follow-up.

2. To provide a comparative assessment of the dynamics of histological, morphometric, and immunohistochemical changes in the mucosa of the duodenum in children with duodenal ulcer under conventional treatment and in the group of patients with microwave resonance therapy.

3. To identify differences in the dynamics of structural changes in the mucosa of the stomach and duodenum in children with erosive gastroduodenitis under standard treatment and with the inclusion of microwave resonance therapy.

4. To establish the effect of microwave resonance therapy on the eradication of H. pylori.

Scientific novelty. For the first time, on the basis of a comprehensive examination using clinical, endoscopic, histological, morphometric, and immunohistochemical methods of investigation, the expediency of including microwave resonance therapy in the complex of therapeutic measures for erosive and ulcerative diseases of the gastroduodenal zone has been proven. The positive influence of microwave resonance therapy in gastroduodenal pathology on the rate of repair of ulcerative defects, the elimination of accompanying inflammatory changes in the mucosa, and the process of elimination of Helicobacter flora has been demonstrated. An important indicator of the clinical efficacy of microwave resonance therapy is a significant reduction in the probability of recurrence of erosive and ulcerative processes with an increase in the duration of remission and acceleration of the elimination of acute manifestations with repeated application of microwave therapy.

For the first time, studies of a complex of morphological indices have established structural and functional changes in the mucosa of the gastroduodenal zone that determine the delayed clinical effect of this method of treatment. Under the influence of microwave resonance therapy, acceleration of the elimination of signs of dystrophy and an increase in the processes of repair of the mucosa of the stomach and duodenum occur. The positive influence of microwave resonance therapy on the elimination of H. pylori has been demonstrated.

Practical significance. The applied method of microwave resonance therapy is convenient for the physician and the patient both in hospital and outpatient settings, is non-invasive, and has no side effects in short-term and long-term follow-up.

The inclusion of microwave resonance therapy in the combined therapy of erosive and ulcerative diseases of the gastroduodenal zone in children exerts a positive influence on the acute manifestations of the pathology and reduces the frequency of exacerbations. Microwave resonance therapy makes it possible to shorten the duration of the active manifestations of the disease and the probability of relapses, which allows reducing the volume of pharmacological load and yields a significant economic effect. By eliminating the need for repeated administration of medications, microwave resonance therapy exerts a protective effect on the frequency of complications of pharmacotherapy. This method can be applied repeatedly for the treatment of relapses of erosive and ulcerative diseases of the gastroduodenal zone in hospital and outpatient settings.

Main propositions defended:

1) The inclusion of MRT in the complex of therapeutic measures for patients with erosive and ulcerative lesions of the gastroduodenal zone brings about a more rapid elimination of inflammatory changes and ulcerative defects of the mucosa in comparison with the control group.

2) The use of MRT reduces the probability of relapses of erosive and ulcerative diseases with an increase in the duration of remission. Repeated use of MRT contributes to the acceleration of mucosal repair processes.

3) The therapeutic effect of MRT is due to the acceleration of regeneration, reduction of the inflammatory process, and enhancement of local immune defense of the mucosa with the elimination of H. pylori.

Approval of the work. The main propositions of the work were discussed at the First Russian Congress of the Society of Gastroenterologists of Russia (1996), at the Third Russian Gastroenterological Week (1997), at the Conference of Young Scientists of the Moscow State University of Medicine and Dentistry (1997), and at the plenary meeting of the Moscow City Society of Pediatric Physicians (2001).

Structure and scope of the dissertation. The dissertation is set forth on pages of typewritten text, consists of an introduction, a literature review, 3 chapters of the author's own observations, a conclusion, conclusions, and practical recommendations. The dissertation contains 27 tables and 6 figures. The bibliographic index includes 219 literary sources, of which 160 are domestic and 59 are foreign authors.