Internal use of mineral waters for chronic diseases of intestines

Among diseases of the intestines, which shows resort therapy, the most important functional disorders of it (the so-called neurosis intestines), and inflammatory lesions - colitis and enterocolitis. Neuroses intestine is divided into motor (dyskinesia), secretory ("the mucous colic", "membranous colitis) and intestinal dyspepsia - fermentation, putrefaction and mixed (I. C. savoshenko, A. M. Noveller in. A. Ivanov, 1954). In resort practice often have to observe patients with a dyskinesia of intestines, at least - with intestinal dyspepsia. Other forms of functional pathology of the intestine at the resort are less important. Dyskinesia of intestines in most cases is an expression of neurosis, i.e. has kortiko-visceral Genesis, but often it is a reflex - viscero-visceral nature (diseases of stomach, liver, biliary tract) or has nutritional origin.
Intestinal dyspepsia can be not only functional - often it is associated with inflammatory intestinal damage. For fermentative dyspepsia typical diarrhea - discharge of liquid light yellow stool frothy nature, acidic, high content of organic acids, iodophyllic bacteria, undigested starch.
Putrid neuralgia develops as a result of intensive rotting protein in the intestine. For this form of dyspepsia are characterized by irregular discharge dark stool alkaline reaction with strong odor of hydrogen sulfide and increased amount of ammonia; often there are phenomena of intoxication - lack of appetite, fatigue, headaches, sleep disturbance.
Inflammatory bowel disease - colitis and enterocolitis is very diverse both in origin and in clinical course.
In resort practice of the greatest importance colitis and enterocolitis infectious, nutritional, toxic and parasitic etiology and dyskinetic, secondary and mixed (I. C. savoshenko and others, 1954, and others).
Alimentary colitis occurs on the background of the quantity and quality of malnutrition develops gradually, without the effects of intoxication, fever, bleeding from faeces and so on, flowing steadily, sometimes giving a mild exacerbation due to errors in the diet; as a rule, is accompanied by chronic gastritis (often with secretory insufficiency).
Toxic colitis develop as a result of acute or chronic toxicity of mercury, lead, arsenic and other poisons out of the body through the large intestine, causing him inflammatory and degenerative changes.
Parasitic colitis caused by Giardia, trichomonads, amoeba and other protozoa. Beginning of the disease can be acute, with a very loose stools and peremptory craving, but without increased temperature and without allocation of blood. The disease long, hard. Therapy without the use of specific antiparasitic funds usually presentation. Characteristic periodic aggravation and associated lesions of the biliary tract is also parasitic.
Dyskinetic colitis develops on the ground prior dyskinesia of intestines and is characterized by the change of constipation diarrhea, which usually takes place without increasing the temperature and without allocation of blood.
Secondary colitis occur at various diseases of the stomach (stomach ulcer, chronic gastritis), a liver and bilious ways, and according to its Genesis close to dyskinetic colitis.
Among colitis mixed etiology of the greatest importance infectious and nutritional, infectious-parasitic and parasitic-alimentary. The clinical picture of these colitis combines the features of two or more forms of diseases of intestines.
Special attention should be paid to chronic inflammation in the small intestine - enteritis. Isolated defeat of the small intestine currently is relatively rare in practice resorts usually have to deal with enterocolitis infectious, nutritional, toxic or parasitic etiology. For enterocolitis unlike colitis characteristic signs of violation of absorption function of the small intestine (SEATO-, create and amylacea, pathological indicators of iodine and calcium samples and others) and related General disorders in the body: underweight, phenomena polyvitamins, iron deficiency anemia, osteoporosis, etc., Among the existing methods of treatment of patients with chronic diseases of intestines of great practical importance resort factors, including mineral water.
When using natural medicinal waters for patients with diseases of the intestine should first of all take into account their total mineralization. Observations show how A. S. Vishnevsky (1954), in patients with intestinal fistulas water of low mineralization when they are drinking the application is rapidly absorbed in the digestive tract and do not reach the distal and especially of the large intestine. Water of medium mineralization are absorbed more slowly, but they reach only to the cecum, and in the quantity not exceeding 25% of the dose. So when bowel disease more than for all other forms of digestive tract pathology, an important role along with drinking treatment play a rectal administration methods of mineral waters.
Effect of mineral water on the state of the intestine is defined their gas and ion composition. The most important are such components of mineral water, free carbonic acid, bicarbonate ions, sulfate, chloride, calcium and magnesium (N. N. Papkov, 1955; A. S. Vishnevsky, 1959). Carbon dioxide stimulate peristaltic function of the stomach and thereby accelerating the transition of mineral water in the intestines. Mineral water promotes segregation of mucus and its removal from the surface of the mucous membrane of the intestines. Anti-inflammatory effect hydrocarbonate ion increases with the presence in the waters of calcium ions, which reduces the permeability of cell membranes and promotes weakening of secretory and peristaltic function of the intestine. Sulphate ions slow the absorption of a liquid in the intestines and accelerate its peristalsis, so they cause the dilution of stool and contribute to a more complete emptying of the bowel. This effect increases with the predominance of cations of sodium and magnesium sulphate-sodium (Glauber's) and sulphate-magnesium (bitter) water act like a salt laxatives, especially if enough of total mineralization of them. Similar influence and chloride-sodium water of medium and high salinity.
In addition to the General mineralization and chemical composition, the impact of the natural medicinal waters on the state of the intestine is the role of the thermal factor (A. A. Lozinsky, 1956). Hot and warm water relaxes smooth muscles bowel and thereby contribute to the elimination of spastic phenomena in it. Cold water, on the contrary, increase the tone and strengthen the peristaltic activity of the intestinal muscles.
According to A. G. Sahakyan and I. C. Nanazashvili (1962, 1963), the effect of Essentuki mineral water on the motility of the small intestine depends on temperature, salinity and the initial state of bowel function. Less mineralized water Essentuki # 4 entered into the small intestine at a temperature of 36°, at rest and weak motor activity of the bowel increases irritative, and in marked reductions gives inhibitory effect. Cold water (20 degrees) basically has a stimulating effect, and hot (45 degrees and above) gives the most pronounced effect as stimulating and inhibiting. More mineralized water Yessentuki number 17 has on the motility of the small intestine mainly stimulating effect.
Similar data were obtained by the authors on the effect of mineral mikroklizm on the tone and peristalsis of the colon. It is established, that in comparison with the effect of mineral water is relatively indifferent temperature (36-37 degrees) cold water (20-22C) gives the most beneficial effect.

The principles differentiated use of mineral waters for chronic infectious colitis largely retain their value and other forms of chronic colitis. But you must make some adjustments in the method of construction of medical facilities depending on the etiology of the disease. For example, chronic nutritional colitis, almost as a rule, combined with gastritis. Therefore, often there are indications for a longer application of rigorous diet (diet 1 restriction of milk, diet 2A and 2), the purpose of washing stomach mineral waters, and with the escalation to the use of factors of substitution therapy: hydrochloric acid, pepsin, Pancreatin, abomina etc.
In chronic parasitic colitis leading importance specific medication. It must precede the direction of the patient to the resort, but often is held in the resort. Drinking treatment in such cases is carried out in accordance with the above recommendations. Rectal administration of mineral waters, especially subaqueous baths, should be prescribed only after holding at least one cycle of specific anti-parasitic treatment, because without this, the introduction of a large number of mineral water in the intestines under pressure can contribute to the promotion of parasites from the lower intestine in higher divisions. Mud treatment with parasitic colitis prescribed mainly in the presence of concomitant pathology of the liver and biliary tract. In the diet it is recommended to increase the protein content of up to 150-160 g (M. I. Pevzner, 1958).
When toxic colitis shown curative water, which promote the excretion of heavy metals and metalloids. These include, in particular, sulfide water used successfully for internal use in Pyatigorsk, resorts Hot Key, Sernovodsk-Caucasian etc. Are also prerequisites for use with toxic colitis mineral waters, containing radon. These assumptions are derived from experimental studies A. G. Sahakyan (1959), which showed that Pyatigorsk radon mineral water release previously blocked sulfhydryl groups in isolated tissues of the colon rabbit. The most effective in toxic colitis should be considered internal use of mineral water, contributing to the release of the body of those substances (mainly heavy metals), excretion which actively involved the large intestine. In the absence of contraindications preference should be given subaqueous baths. (If necessary, be limited to a more sparing methods shown siphon of enema, intestinal soul, gastric lavage. It is also useful in the treatment of drinking water to increase the dose of mineral water up to 300 - 400 ml per reception in order to increase diureza and strengthening of renal excretory function.
If you select the internal use of mineral waters and build the whole medical complex along with etiology and phase of the disease it is necessary to consider and localization of pathological process. Particularly noteworthy are the patients, who reveals the defeat of the small intestine (enteritis, enterocolitis), and distal colon (symplectic). Chronic enteritis and colitis, accompanied by diarrhea, apply heated to 40-45° water of low mineralization (the priority is hydrocarbonate-calcium) at a reduced dose of 100-150 ml per reception 1-2 times a day. In respect of absorption function of the small intestine, according to the observations of A. G. Sahakyan and A. JT. Ivanilova (1962), effective introduction 200 ml of mineral water directly into the small intestine through a tube. During periods of increased motility of the small intestine A. G. Sahakyan and I. C. Nanazashvili (1963) found a positive effect of this method is mainly when the water temperature 45 C; with a weak motor activity of the small intestine, the authors observed a more pronounced positive effect from the introduction of the 200 ml of mineral water temperature of 36 degrees and even (if less saline water) 20 degrees.
Along with the previously described methods, internal use of mineral waters enteritis and colitis recommended transduodenal of enema with the introduction of the medicinal waters of low salinity temperature 37-40 degrees and in the amount from 1 to 2 litres within 15-30 minutes 2-3 times a week, only 6-8 procedures for the course. Rectal administration methods of mineral waters are used depending on the nature and the extent of involvement of the colon. The diet of patients enteritis and enterocolitis should be gentle, diet, you should increase the amount of protein (140-150 g), vitamins, salts of calcium; when fermentative dyspepsia, very often complicates the defeat of the small intestine, it is necessary restriction of carbohydrates to 250-300 g / day.
When enzymatic deficiency of digestive glands shows the use of hydrochloric acid, pepsin, Pancreatin, abomina. Recommended preparations of calcium carbonate, tannin and parenteral vitamin V PP, WB, B12, S.
One of the most difficult parts of gastroenterology is a resort treatment of patients with chronic cosmopolitan. In recent years this question more fully studied in the works of A. S. Vishnevsky and B. S. Lensky (1957, 1959, 1962). The authors recommend differentiated methods of treatment of patients with chronic cosmopolitan depending on the nature of the defeat mucous membrane of intestine and offer in the resort to differentiate according to rectoromanoscopy catarrhal, ulcer, atrophic and hypertrophic and combined forms of the disease. Of particular importance in cosmopolitan get microclysters of mineral waters and medicinal, irrigation of bowels according to the method of Lensky and mud rectal tampons. Microclysters appropriate to assign from the beginning of the course in order to prepare the patient for other rectal treatment methods that have a more intense (often irritating) effect on colon,various washings mineral waters and mud tampons.
With significant local changes in the mucous membrane of the sigmoid and rectum microclysters used throughout the course in combination with other rectal treatment methods. Of drugs used to mikroklizm, recommended antimicrobial, antibacterial and astringent - 5-10% syntomycin and streptocida emulsions, solutions furacillin 1:5000, colloid (0,5%), protargol (0,25%), rivanol 1:3000, potassium permanganate 1 :6000, Vishnevsky ointment and others With long-term care is useful combination and succession of mikroklizm with various drugs.
Irrigation of intestines is with constructed B. C. Lensky special device "Essentuki B. L.". In the intestines enter mineral water of the temperature of 39 degrees and in quantity from 8-10 l in the beginning of the course, with a gradual increase up to 18-20 l at subsequent procedures. Irrigation appointed a day, just 8-10-12 procedures per course. Colon irrigation is most effective when catarrhal symplectite; ulcerative process they contraindicated. Along with the irrigation of intestines can be used intestinal shower (or rather rectal), which is introduced into the intestine from 2-4 to 6-8 liters of water per procedure. So this method may be recommended for a more gentle effect on the intestine (with a significant degree of the inflammatory process, inclinations to exacerbations, light sensitive mucous membranes, and others). Subaqueous baths in chronic symplectite shall be permitted only in the phase of remission in the absence of evidence of active inflammatory and destructive process in the mucous membrane of the distal colon and anus.
Mud rectal tampons - effective method of treatment of chronic Cosmopolita, especially its catarrhal and atrophic forms. Mud rectal tampons appoint patients with severe inflammatory intestinal damage at a temperature of no higher than 38-40°, at a moderate degree of destruction is at a temperature 42-44-46 degrees. The procedure is prescribed in a day, just from 6 to 12 per course. It is advisable to combine mud rectal tampons and application on the abdomen and lower back.
Mud rectal tampons is contraindicated in symplectite in the phase of deterioration, ulcerative process with a tendency to bleed.
In recent years, on the Caucasian Mineral Water resorts in chronic colitis successfully used siphon of enema, the so-called mud mash - solution curative mud mineral water (1 :7).