The Conception Of The Main
Sanative Mechanisms Of Fasting Dietetic Therapy
In Curing The Patients Suffering From The Pathology Of Digestion Organs With Allergic Complications
E. Arkhiy
Professor, Doctor of
Medicine, Head of Propaedeutic Therapy Chair of Uzhhorod
National University,
Uzhhorod, Ukraine
The problem connected with the application of fasting
dietetic therapy ( FDT ) in many complicated diseases and, most of all, in case
of the pathology of digestion organs has
become of great importance recently. This is caused by the fact that nutrition
as the process of satisfaction of human being’s
energy and ductile needs conceals the danger of antigenic and toxic aggression and it is natural that
the main reasons for population allergization are considered to be ones caused
by the irregularity of food assimilation processes. In this aspect a combined
pathology of digestion organs ( CPDO ) takes a leading place.
Considering the illness of digestion system as the
irregularity of assimilation processes , including the adaptation to food
composition ( R. Kushak, 1983 ) one may admit that the readaptation to food of
patients with CPDO is one of the main conditions of their medical treatment.
The irregularities of digestion - transport functions,
mucosal-cellular and liver barriers in patients with CPDO in their turn tend to
the development of different variants of immune - pathological states which
become a favorable background for the formation of allergic reactions and
allergic diseases. In this aspect the local immune system reactions of the
mucosa of small intestines ( GALT ) being the main component of local immune
system of mucosae, or MALT present a peculiar interest.
In spite of a large number of works that demonstrate a
positive medicinal action and advantages
of FDT in case of the pathology of
digestion organs, especially at combined variants of this pathology ( O. Ganich
et all, 1988, 1993, E. Tkachenko et all, 1993, A. Andreychin, P. Kuziv 1993, V.
Maksimov 1993, A. Dmitriyev et all. 1995, E. Arkhiy 1995 ) a lot of mechanisms
of sanative, adaptation - genic influence of this therapy aimed at the
preservation of a physiologic state of an organism remain undisclosed.
Proceeding from these statements the study of separate
sanative- and pathogenetic mechanisms of a medicinal action of FDT at CPDO with
allergic complications ( AC ) was set as an object of this work.
To realize this aim some tasks were set forth, in
particular - to study the main chains of immune status of an organism: a
non-specific resistance or congenital immunity, T and B – chains of congenital
immunity and the state of MALT in patients with
CPDO before the medical treatment and in all periods of the treatment by
the FDT method;
to study the digestion processes in small intestines (
by hydrolysis of oligopeptides and carbons in patients with CPDO + AC ) and
their dynamics under the influence of FDT;
to
determine pathogenetic mechanisms of irregularities of the immune status,
proceeding from the state of all its chains, as well as the digestion processes
in small intestines as the components of pathogenesis of AC at
CPDO;
to reveal sanative mechanisms of medicinal action of
FDT on a gastroenterologic patient’s organism as well as the role and
interrelation of MALT and processes of digestion while curing AC.
Materials of examination and methods of investigation
During 14 years 1057 patients treated by the FDT
method were examined, in 757 of them a combined affection of digestion organs
with two or more diseases available was diagnosed. 607 patients with CPDO that
had attendant allergic complications were set apart. Under the conditions of a
gastroenterologic cell the fibrogastroduodenoscopy was conducted in 108 of
these patients before and after FDT with the aim of a parietal intake of digestive juices by a special
stomach pump of Ivashkin, Denisova, Tkachenko’s design ( 1991 ) and for the
intake of a bioptic material ( 10-15 cm) behind the Treitz chorda with
subsequent morphological and morphometric examination of a mucosa of small
intestines.
The immunological status was estimated over 26 indices
of I - II level according to the methods used in the immunologic laboratory of Military Medical Academy
in Saint- Petersburg. Among 168 patients with CPDO 42 ones are practically healthy
people. The state of MALT was estimated with respect to Ig content in digestive
juices, saliva and urine in the dynamics of FDT, namely 3IgA, 4SIgA,
2IgG, 1IgM determined according to Mancini et all, 1965.
The functional state of a mucosa of small intestines
was studied with the help of analyzing peptide hydrolase activity according to
N. Timofeyeva ( 1969 ), sucrose and maltose activity according to O. Ugolev, N. Iezuitova ( 1969 ) and simultaneous application of
Dalqust method ( 1964 ).
The main results and conclusions of the study
The results of the study and their discussion
All 26 indices of the immunologic status of patients
were studied in the dynamics over periods of FDT, particularly in the acidosis
period ( AP ) - 7-9th day of
complete hunger without limitation of water use, the acidosis
compensation period ( ACP ) - 10-12th day of the whole fasting
period or medicinal action with full food deprivation ( FP )and recovery
period ( RP ) - 5-7th day of invalid food that gave the possibility to estimate the
influence of each of these periods of medical treatment on the immunity and to
recommend optimal terms of FP or food deprivation for FDT at CPDO.
While studying indices of a non-specific resistance in
the dynamics of FDT we observed that such indices as C3 – complement
component, α1 - antitrypsin, NK - cells in each of FDT periods
gradually increased and in RP they were reliably higher than before medical
treatment. However, each of these indices though reached the norm but failed to
achieve the level of practically healthy people; thus in RP the C3-complement
component was equal to : 0.66 ± 0.088 g/l in patients with AC; it was 0.72 ± 0.12 g/l in patients without allergy against 0.85 ± 0.07 g/l in practically healthy people; α1
- antitrypsin in patients with AC was 1.72±0.23 g/l, in patients without AC it was 1.63±0.20 g/l against 3.00±0.12 g/l in practically healthy people and the number
of NK-cells was 5.40±1.08% in patients with AC; in patients without AC it
was 5.00±1.70% against 10.00±0.60% in practically healthy people.
At the same time oxygen - dependent systems of
phagocytosis that were the same as in practically healthy people decreased in
patients with CPDO under the influence of FDT, though during FP or food
deprivation they were within the norm according to the data of tests on restoration
of nitroblue tetrasolium ( VBT and NST -tests according to Vickeman and
Mayamsky ( 1979 ) ), but in RP their considerable reliable decrease was
observed, however oxygen - dependent phagocytosis systems of neutrophiles
according to the data of lysosomalic - cationic test or LKT-test during FP at
FDT rather had a tendency to be increased and didn’t differ reliably from the
indices of LKT-test of practically healthy people. Thus, the decompensation of
oxygen - dependent phagocytosis system very likely connected with the peculiarities of metabolism at FDT is
probably compensated to some extent by a normal functioning of oxygen -
dependent phagocytosis system. However, it should be mentioned that under the
influence of FDT a non- specific resistance somehow improves, but prolonged
terms of FP in patients with AC at CPDO may threaten with its decompensation
taking into consideration the dynamics of its indices. One may definitely
observe an excess exertion of adaptive - compensatory processes at FDT while stimulating
an oxygen -dependent phagocytosis by zymozan. That is why optimal terms of food
deprivation that resulted in positive dynamics of all indices of congenial
immunity only are the cures of FDT within a 12 - 14- day food deprivation.
Besides it is important to emphasize that the recovery
period demands a constant doctor’s control due to some decompensation of
antiinfectious protection of patients with CPDO and inexpediency of medical
supplies after FDT.
While studying the dynamics of 9 indices of T -
cellular immunity we observed that the majority of them under the influence of
FDT approached the norm. Thus, erythrocyte – rosette-forming cells ( E- RFC
) ( T-general lymphocytes that form
rosettes with sheep’ erythrocytes ) and ОКТЗ ( series of monoclonalic antibodies which react with T - lymphocytes
or conditional T- general lymphocytes ) reached the level of practically
healthy people without AC and did not have essential divergences with them ( P > 0.05 and P > 0.5 ) , however in patients with AC they only tended to increase at FDT but they did not reach the
level of practically healthy people ( for example, ОКТЗ in RP was
0.69 ± 0.20, the norm being 1.09 ±0.08 of cells ). T-helpers - inductors also revealed
the tendency to be increased in the number of cells: they reached the level of
norm OKT4 in ACP ( in patients with AC it was 0.59±0.05, the norm being 0.65 ±0.05 ) but in RP the index somehow decreased up to
0.46±0.04 though it did not have a reliable divergence with
the norm ( P<0.05 ). The index of T-suppressors - killers revealed
a similar dynamics ( OKT8 ), but the changes in immune regulation
index, or immune regulation factor were
the most informative ones / OKT4 / OKT8 / which fully
reached the level of norm, i.e. 1.69±0.12 , in patients it was 1.65 ±0.20. Besides, in patients with AC the indices of “
active “ T- lymphocytes ( EA - RFC ) and “ active “ tymalin -
sensitive T - lymphocytes ( EAT - RFC ) strongly depressed to
medical treatment, under the influence
of FDT revealed the tendency to the normalization only up to AP and then they
strongly decreased again and remained reliably lower than the norm. From the
dynamics of changes in EAT - RFC and tymalin - sensitivity index we
can make an interesting conclusion that while curing by FDT the prescription of
immune modulators is counter - indicative after AP in RP. Thus, at AC a short
immune suppression is indicative which is characteristic for FDT at food
deprivation. That is why at this time an excess production of lymphokines was
observed which are able to hamper the migration of leucocytes, macrophages and
decrease the tempo of division of cells, synthesis of DNA, etc., proceeding
from the data with concanavaline that reliably exceeded the level of norm in
all periods of FDT. From the dynamics of changes in indices of T-cellular
immunity we can also make a conclusion about the inexpediency of very long
terms of FP because the indices of T-chain of immunity have already been
reduced before treatment, and a long inhibitory influence on the immune system,
which is necessary at AC for a short period, at large terms of FP can cause the
failure of adaptive - regulatory processes aimed at the compensation and
preservation of a physiologic state of T-chain of the immunity, as an immuno-
modulating effect has a positive dynamics
only before the period of acidosis according to the determination of
sensitivity index to tymalin. While studying different indices of B - system of
the immunity in the dynamics of FDT we observed that FDT did not influence
essentially a clonalic expansion of B
/Ig+/. However, B/IgA+/ and B/IgG+ / after FDT also reliably exceeded the
number of cells in practically healthy people. When investigating
immunoglobulins of blood serum we observed that FDT via adaptive - compensatory
changes in a humoral chain fully increased a protective - barrier function of
the immune system. In particular, in patients with AC the level of IgM and IgE
became normal, SIgA remained considerably increased in comparison with the norm
- 3.10 ±0.42 g/l ( P < 0.001 ) and IgG was a little bit higher, i.e. 14.10 ±0.90 g/l ( P<0.05 ).
The dynamics of IgE was peculiar and very interesting.
FDT promoted the liberation of immune complexes and IgE- antibodies from “a
shock organ”, normalizing the index IgE and circulating immune complexes ( CIC
) in blood serum because of their maximal increase in ACP and full
normalization in RP. However, a high index of IgE during the whole period of FP
testified to peculiar for this contingent of ill people susceptibility to
atopies and alerted in respect to relatively larger terms of food deprivation,
because during 14 days the index gradually increased though it reached the norm
for restoration, but larger terms could cause the irregularity in regulation
and adaptation to an excess increase of the production of IgE, its insufficient
alimination with all possible consequences of such a situation.
The changes in MALT were important, rather leading
ones at FDT. By studying the dynamics of changes in immunoglobulins / Ig /
of digestive juices, saliva and urine at
FDT we observed some adaptive - compensatory changes of Ig in MALT among which
the most essential changes were those in Ig of MALT and especially the dynamics of
changes in SIgA.
Thus, while investigating Ig of digestive juices in
patients with AC that were taken parietally behind the Treitz chorda we revealed an excess secretion of SigA /
3.86±0.96 against 0.87±0.02 g/l as the norm/ as well as 9-fold increased
level of IgG /0.240±0.090 against 0.026±0.011 g/l as the norm/ and IgM /0.150±0.070 against 0.009±0.001 g/l as the norm/ due to the pathology in MALT.
Only the level of IgA- monomer remained normal.
In saliva of patients with CDOP and AC before the
beginning of treatment SIgA ( P<0.05 ) and IgG ( P<0.05 ) were also reliably higher than the norm, at the
same time IgM was not revealed at all and IgA-monomer was within the norm. In
urine due to the pathology an increased number of SIgA and IgG was observed.
So, according to the data of examination of the immune system at CDOP before
medical treatment by FDT we observed the deviation from the norm in all chains
of the immunity, but the most essential changes in the immunity were in local
immune system, where even a very high secretion of SIgA, whose protective
properties are well-known could not protect a mucosa of intestines from the
antigenic aggression that resulted in the increased level of IgG and IgM, and
in connection with this the possibility of activating the complement with the
release of proteolytic ferments appeared.
However, under the influence of FDT in digestive
juices IgG and IgM reliably normalized at a constant normal level of IgA,
though the secretion of SIgA whose protective properties are well-known,
decreased but remained reliably higher than the norm.
The dynamics of Ig of saliva and urine also reflects a
positive character of adaptive - compensatory changes in MALT under the
influence of FDT which result in the increase in protective - barrier function
of MALT and elimination of conditions for the antigenic aggression within a
mucosa of intestines or GALT. So, in medicinal action of FDT that is realized
by the complex of sanative adaptogenic mechanisms of the influence on all
chains of the immunity a normalizing influence on protective-barrier functions
of MALT is a leading one.
It is clear that adaptive - compensatory processes in
MALT brought out the protective activity of MALT under the influence of FDT to
a new increased level of the protection expressed in preparing MALT to the
meeting with exoantigenes as well as in the elimination of autoaggression and
autoimmunic reactions due to the normalization of IgG and IgM levels within the
limits of MALT that we had to observe in respect to Ig of digestive juices,
saliva and urine. Besides, it should be mentioned that the study of saliva may
be recommended as the screening - test of the estimate of MALT state.
Frequent allergic complications in patients with CDPO
allow one to admit that in the pathogenesis of allergic reactions in these
patients the irregularities of digestion processes take an important, or even
leading place, in particular, an insufficient hydrolysis of oligomers of
protein and carbonic nature.
Proceeding from these statements and the data of MALT
investigation it is expedient to put the
study of digestion processes as the further task of our work which first of all are fraught with the
possibility of antigenic aggression.
Studying the digestion processes of protein food in
1080 patients with CDPO and AC as the main source of antigens taking as an
example the hydrolysis of five oligopeptides: glycyl- 4- glycine, glycyl-
L-leucine, diglycylglycine, glycyl-4 - analine and glycyl -4-valine in a
bioptic material of small intestines we observed a reliable decrease in the
hydrolysis of all oligopeptides. Thus, as it was admitted, an insufficient
hydrolysis of oligopeptides was the main source of antigens in patients with
CDPO.
We also studied the digestion processes of carbons as
the possible source of heptenes. According to the data of the study of
amylolytic activity the cavernous, parietal or brush border splitting of
carbons was estimated, whereas while analyzing sucrose and maltose activity we
considered the hydrolysis of oligosaccarides within the limits of brush border
of enterocytes. The cavernous fraction of amylase ( C ) in patients with CDPO
and AC was considerably lower, the same can be told about the fraction of
desorbed amylase ( ΣD ) and homogenate (
H ) , i.e. in patients with CDPO a cavernous ( P< 0.05 ) and especially parietal hydrolysis of carbons
( ΣD + H ) ( P<0.001 ) considerably decreased as the results of
investigating the amylolytic activity of a mucosa of small intestines testify.
Besides, the decrease in normal brush border hydrolysis of disaccharides
resulted from the data of studying sucrose ( P<0.05 ) and maltose activity ( P<0.05 ).
So, except abnormal digestion processes of proteins,
in particular, oligopeptides themselves, we also diagnosed in patients with
CDOP and AC the irregularities in final stages of digestion of carbons, and so,
the possibility of the formation of heptenes.Thus, this is one more source of
antigenic aggression.
While studying peptide hydrolase activity taking into
consideration the hydrolysis of 4 dipeptides and 1 tripeptide after FDT we
diagnosed that peptide hydrolase activity being considerably reduced before
medical treatment varied in two directions : it rose under the influence of FDT
under the hydrolysis of such substrata as diglycyl - glycine ( P <0.05 ) reaching the norm, and glycyl - L - leucine ( P<0.001 ) but it did not reach the norm in respect to
the latter ( P<0.001 ) and only revealed some tendency to increase
the activity of peptide hydrolases under the hydrolysis of glycyl - L - glycine
( P<0.05 ); and it did not change at all under the
influence of FDT in respect to substrata : glycyl- L valine ( P<0.5 ) and glycyl- L - alanine ( P<0.5 ).
So, these data allow us to state that even without
special methods of solubilization of ferments we observed the reactions of
brush border and cytosolic peptide
hydrolases , which react to the FDT treatment differently. The brush border
membraneous hydrolysis of protein subtrata reliably increased and peptide
hydrolase activity considerably increased whereas cytosolic hydrolysis of
dipeptides or more exact cytosolic peptide hydrolases within a 12-14 - day FP
did not react to FDT by varying its activity towards one or other direction.
Such a distribution of peptide hydrolase activity
against FDT gave the possibility to improve digestion processes of protein food
without lysosomalic hydrolases which could result in unwanted ulcerogenic
effects in a mucosa of a
gastrointestinal tract.
In its turn, the improvement of digestion processes of
protein food within brush border of enterocytes gave the possibility to
eliminate or at least considerably decrease the antigenic aggression, i. e. FDT
caused important adaptive - compensatory reorganizations of the digestion
process of proteins.
Simultaneously with the study of peptide hydrolase
activity after FDT in a bioptic material of small intestines the amylolytic ,
sucrose and maltose activities were studied.
Thus, all the stages of hydrolysis of carbons were
estimated. Under the influence of FDT the hydrolysis of carbons was normalized
at all stages.
So, sucrose (P<0.05) and maltose ( P <).05 ) activities increased and the level of
amylolytic activity both within membrane digestion (ΣD + H) and, especially,
cavernous fraction - amylase C (P<0.05) even slightly exceeded the norm, so, FDT
resulted in the complete normalization of cavernous and membrane hydrolysis of
carbons.
Thus, FDT is able to provide complex adaptive -
compensatory reorganizations of digestion processes, in particular of the
hydrolysis of oligomers of protein and carbon nature, that created the conditions
of readaptation to food, its composition and preservation of a physiologic
state of digestion processes and in such a way to eliminate the sources of
antigenic aggression to a great extent.
So, from the results of our work it is seen that at
CDOP with allergic complications FDT has some advantages over medicamental
treatment because it influences all the complex of differently aimed
pathogenetic mechanisms and ensures the whole series of adaptive - compensatory
sanative processes and reorganizations if immune modulation and immune
suppression processes in different parts of the immunity are available aimed at
the increase in protective - barrier functions of the immune system. Such
sanative influence brought out functioning of the immune system as well as
digestion processes and digestion - transport functions of a mucosa of the
intestines to a qualitatively new level.
Conclusions of conducted investigations
1. In patients with CDOP we revealed:
the decrease in a non -
specific resistance of an organism;
secondary T- cellular
insufficiency;
activation of B-chain of the
immunity with further development of different
types of hypersensitivity;
irregularity of barrier
functions of MALT, particularly GALT against the
irregularities of digestion and
food assimilation processes
2. In patients with CDOP and AC pathological changes
in MALT took place which were characterized by a considerable increase in
levels of limmunoglobulins: of digestive juices, where IgG, IgM and SIgA rose;
of saliva where IgG and SIgA content increased: of urine where a level of IgG
and SIgA rose.
3. It is shown that FDT enhances protective - barrier
functions of MALT at the expense of the normalization of IgG, IgM and SIgA in
digestive juices, saliva and urine against the increased content of secretory
IgA.
4. Along with immune modulating influence on the
indices of MALT the FDT method results in the normalization of some indices of
T - and B - chains of the immunity in patients with CDOP and AC and ensures the
improvement of a non-specific resistance of an organism both through the
processes of immune stimulation and immune suppression depending on the period
of treatment by the FDT method and the state of indices before the medical
treatment.
5. In the majority of patients with CDOP and AC we
revealed a raised level of IgE and the decrease in circulating immune complexes
in blood serum that was considered as an inherent susceptibility to atopy.
Under the influence of FDT IgE - antibodies and
immune complexes were freed from a “ shock organ ” and eliminated as CIC
from the organism that resulted in the normalization of their levels in the
blood serum.
6. At CDOP with AC the processes of cavernous and
membrane hydrolysis of food substrata in small intestines became abnormal and,
first of all, the speed of membrane hydrolysis of protein and carbon nature -
oligomers considerably decreased and the latter are certain to become the
source of antigenic aggression.
7. Under the influence of the FDT method the
normalization of digestive processes of food substrata is effected. Especially
the speed of membrane hydrolysis of protein and carbon nature - oligomers
increases but that of intercellular hydrolysis of oligopeptides does not change
which causes a maximal elimination of exoantigen aggression and preservation of
a physiologic state of a mucous membrane of small intestines.
Practical recommendations
1. The method FDT in contrast to medicamental treatment at CDOP with AC is the most optimal
one because it stimulates sanitative immune modulating mechanisms of
readaptation in all chains of the immune system, especially in MALT and other
important processes, in particular, hydrolysis and assimilation of protein and
carbonic components of food.
2. It is shown that an optimal term at FDT which does
not threaten by the break-down of sanitative, adaptive-genic mechanisms of its
influence like stress-reactions on the immune system is a 12-14 day course of
full food deprivation without limitation of a drinking regime.
3. At the FDT method both the period of food
deprivation and that of RP of nutrition as the main period of readaptation to
food which demands a strict gradualness, adequacy and responsibility of food
loading of a functional state of digestive organs as well as correction of
vitamin status of patients and control of general clinic and immunologic
indices are equally responsible and demand a strict control of a physician.
List of literature used
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Kuziv P.P. et all. Clinical and pathological
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2.
Arkhiy E.I.
Adaptive - compensatory processes in a mucous membrane of small intestines
while curing the combined pathology of digestion organs complicated with
allergy by fasting dietetic therapy //
Proceedings of Uzhhorod State University
on the occasion of 50 anniversary of its foundation. Uzhhorod, 1995. -
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3.
Ganich O.N., Arkhiy E.I., Veresh N.N. et all. Ultimate results of curing the pathology of
gastrointestinal tract by FDT// Proceedings of scientific - methodological
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4.
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Arkhiy., Zheltvay V.V., Turyanitsa I.M. et all. On the problem of scientific
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Maksimov V.A.
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