=Paper=
{{Paper
|id=Vol-2753/paper13
|storemode=property
|title=The Use of The Results of Intellectual Monitoring in The Practice of Treatment of Inflammatory Bowel Diseases
|pdfUrl=https://ceur-ws.org/Vol-2753/paper9.pdf
|volume=Vol-2753
|authors=Serhii Holub,Andriy Dorofeyev,Gulustan Babayeva,Svitlana Kunitskaya,Oleg Ananiin
|dblpUrl=https://dblp.org/rec/conf/iddm/HolubDBKA20
}}
==The Use of The Results of Intellectual Monitoring in The Practice of Treatment of Inflammatory Bowel Diseases==
https://ceur-ws.org/Vol-2753/paper9.pdf
The Use of the Results of Intellectual Monitoring in the Practice
of Treatment of Inflammatory Bowel Diseases
Serhii Holuba, Andriy Dorofeyevb, Gulustan Babayevac, Svitlana Kunitskayaa and Oleg Ananiina
a
Cherkassy State Technological University, 460 Shevchenko Boulevard, Cherkasy 18006, Ukraine
b
National Medical Academy of Postgraduate Education named after P.L.Shupik, 9, Dorogozhytska
Street, Kyiv, 04112, Ukraine
c
Azerbaijan State Advanced Training Institute for Doctors named after A.Aliyev, Department of
Therapy, Tbilisi ave, 3165, Baku, AZ1012, Republic of Azerbaijan
d
University 1, Address, City, Index, Country
Abstract
The processes of diagnosis and treatment of inflammatory bowel diseases are characterized
by a high level of uncertainty in information about the causes of the disease, its etiology, the
influence of external and internal factors on the patient's condition, the patient's individual
response, and the standard treatment regimen. The paper presents the results of studies of the
process of using intelligent agents of the monitoring information system to adapt the control
influences of treatment regimens for Crohn's disease and ulcerative colitis to the mechanisms
of individual interaction of processes occurring in the patient's body. As a result of joint
research of scientists in the field of medicine and information technologies of Ukraine and
Azerbaijan, a methodology for developing treatment regimens for inflammatory bowel
diseases using the results of intellectual monitoring of the patient's condition was presented
and experimentally tested. The paper formulates a number of hypotheses, for testing which
experiments were carried out: an approach to the process of forming indicators to describe
the patient's condition is described; available laboratory research methods are used; the
problem of classification of patients' conditions is being solved; a method for non-invasive
diagnostics of the influence of indicators on the patient's condition and interpretation of
monitoring results has been developed. As a result of this work, experimental confirmation of
the effectiveness of the process of using the results of intelligent monitoring in the practice of
treating inflammatory bowel diseases was obtained.
Keywords 1
Inflammatory bowel diseases, intellectual monitoring, assessment of the influence of factors,
treatment regimen
1. Introduction
Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease
(CD), are an urgent problem in modern medicine. According to the WHO, the incidence of IBD is
growing worldwide. Despite the high level of health care, only in the United States - 1.5, and in the
European Union - 2 million patients [1]. The situation is aggravated by the fact that the etiology of
IBD remains unknown, and the pathogenesis is not fully understood. At the same time, it is known
that UC develops as an immune reaction of the colon mucosa, and CD - as an autoimmune lesion of
the entire digestive tract.
IDDM’2020: 3rd International Conference on Informatics & Data-Driven Medicine (IDDM 2020), November 19 - 21, 2020, Växjö, Sweden
EMAIL: s.holub@chdtu.edu.ua (S. Holub); dorofeyevand@mail.com (A. Dorofeyev); ghbabayeva@gmail.com (G. Babayeva);
kunitskaya33@gmail.com (S. Kunitskaya); olegudacha@ukr.net (O. Ananiin)
ORCID: 0000-0002-5523-6120 (S. Holub); 0000-0002-2631-8733 (A. Dorofeyev); 0000-0002-5805-3741 (G. Babayeva); 0000-0001-6343-
9780 (S. Kunitskaya); 0000-0001-9203-597X (O. Ananiin)
©️ 2020 Copyright for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
CEUR Workshop Proceedings (CEUR-WS.org)
The diagnosis of diseases is established on the basis of generally accepted criteria in
accordance with the recommendations of the European Crohn's and Colitis Organization (ECCO) [1,
2]. The severity of the clinical course of the disease is assessed in accordance with the Truelove-Witts
Index (TW) and Mayo in the case of U2C and Crohn's Disease Activity Index (CDAI) and the
Harvey-Bradshaw activity index in Crohn's disease.
At the same time, laboratory diagnostics, based mainly on taking into account only two parameters
(C-reactive protein and calprotectin), in our opinion, needs to be expanded and modernized.
Insufficient information content of the patient's test results does not allow using existing methods of
processing observation results and using them when choosing or constructing treatment regimens. In
such conditions, the effectiveness of treatment is largely determined by the doctor's intuition. Taking
this into account, we made an attempt to create a system for assessing the patient's condition on the
basis of other laboratory tests and indicators, building an information system for intelligent
monitoring [3] and using monitoring results to support the attending physician's decision to choose an
individual patient treatment regimen.
2. Existing methods and means of monitoring the condition of patients
Information technology of intelligent monitoring [3] is implemented in the form of a
monitoring information system (MIS) [3] in various subject areas. In medicine, a type of MIS is used,
which is implemented based on an agent-based approach. The virtual robot solves the global
monitoring tasks for the formation of a dictionary of signs, the organization of continuous monitoring
of the patient's condition, the development of their results, and the formation of conclusions following
the doctor's instructions and using the interactions of intelligent agents.
Each intelligent agent forms and adapts its structure following the local tasks that are assigned
to it. The main element of the agent structure is the model knowledge base [3].
A significant process for intelligent monitoring is the formation of a list of indicators that are used to
assess the patient's condition. For the formation of signs of the condition of patients with IBD, the
results of invasive studies are used, by processing images after endoscopy [4], by analyzing blood and
feces [5].
Today, for the diagnosis of IBD, protocols are used that take into account the results of a
complete clinical, instrumental, laboratory, and pathomorphological examination of patients. At the
same time, the main emphasis in instrumental studies is placed on radiation (CT, MRI, ultrasound)
imaging methods and a thorough endoscopic examination with mandatory multiple biopsies of at least
5 sections of the intestine, and in laboratory diagnostics, in addition to routine studies and the
exclusion of opportunistic infections, on the determination of calprotectin (a marker of damage to the
intestinal mucosa) in feces and a marker of the acute phase of inflammation - "C" reactive protein
(CRP) in the blood.
This approach, with undoubted advantages, has two significant drawbacks: the high cost of the
study and the remoteness of the timing of the diagnosis (waiting for the results of the
pathomorphological study). An important factor is also the patient's adherence to research (MRI, CT,
endoscopy). At the same time, laboratory diagnostics is based mainly on only two indicators: the
content of calprotectin in feces and CRP in the blood. In the literature, the possibility of using
additional methods of laboratory diagnostics is widely discussed [7, 8, 9]..
3. Unsolved problems
The published materials contain the results of studies to describe the condition of patients at
different stages of monitoring - expert determination of the list of signs, procedures for determining
the characteristics of these signs, processing, and expert interpretation of the results. These results
were used to diagnose the patient's condition. It was not possible to find a description of the use of the
results of intelligent monitoring in the practice of treating IBD.
4. Aim
Investigation of the processes of using the results of intelligent monitoring to support decision-
making in the practice of treating inflammatory bowel diseases using the example of the treatment of
Crohn's disease and ulcerative colitis.
5. Research results and discussion
In the course of the research, several hypotheses were put forward.
Hypothesis 1. There are distinctive features that characterize patients with IBD, and MIS can be
used in the process of constructing an individual treatment regimen for each of these patients.
Hypothesis 2. The body of each patient individually reacts to the onset of the disease and its
course under the influence of drugs. The choice of a treatment regimen should depend on the priority
factors that determine the patient's condition.
Hypothesis 3. Using the results of intelligent monitoring can improve the effectiveness of
treatment.
A series of experiments were carried out to experimentally test the hypotheses put forward.
Based on the research results, the monitoring information system was tasked with determining which
processes and in which subsystems of the individual patient's body determine the condition of the
patient with IBD.
The aim of the study is formalized as the task of supporting decision-making in the process of
adapting treatment regimens by classifying the condition of patients based on the results of medical
testing and determining the individual influence of factors. The list of classes of patient conditions,
factors, and properties of patients was obtained by expert advice with the involvement of practicing
doctors with scientific research experience, who are co-authors of this work.
The assessment of the condition of each patient was carried out especially for him by the
intelligent agent MIS. The results of the analyzes were submitted to the agent's input in the form of a
table of the input data array. The model knowledge base generated a conclusion about the patient's
condition at a given time and the influence of the factors presented in Table 1 on the patient's
condition. The assessments of the influence of factors were used by an expert physician as
information about the individual characteristics of the patient in the process of adapting the treatment
regimen. The effectiveness of using the results of intelligent monitoring was assessed according to the
list of typical indicators before the application of the treatment regimen, built using assessments of the
influence of factors, and after its application.
The input data array was formed based on the results of clinical studies. The list of indicators of
the patient's condition was formulated expertly. When choosing the list of indicators, we proceeded
from the fact that the basis of IBD is immunological, aseptic inflammation.
The term "endothelium" was proposed in 1865 to designate the lining of blood and lymphatic
vessels, heart, serous, synovial and meninges, posterior chamber of the eye, respiratory tract.
Currently, this term is used only to refer to the inner cell lining of the vascular bed. The endothelium,
according to modern concepts, is the largest active endocrine organ in the human body, diffusely
located in all organs and tissues.
The endothelium - the inner lining of blood vessels - consists of approximately 1-6 × 1013
cells. The endothelium of the vascular intima performs barrier, secretory, hemostatic, vasotonic
functions, plays an important role in the processes of inflammation and remodeling of the vascular
wall. Endothelial cells create a barrier between blood and tissues and, with the help of the factors they
synthesize, perform many important regulatory functions, contributing to the maintenance of
homeostasis. It is generally accepted that endothelial dysfunction (ED), as a typical pathological
process, is a key link in the pathogenesis of many diseases and their complications, incl. with IBD.
The inflammatory process in the intestinal mucosa, in particular leukocyte infiltration, contributes to
damage to the vascular endothelium of the intestinal mucosa, causing a violation of microcirculation
in it with the appearance of microthrombi and further trophic changes.
It is known that systemic endothelial dysfunction is reflected in damage to the wall of the
glomerular apparatus of the kidneys, which in turn leads to increased excretion of albumin in the
urine. It is believed that microalbuminuria (MAU) is an early marker for the development of
endothelial dysfunction [5], which can also be used when examining patients with inflammatory
bowel diseases to assess their state of vascular endothelium.
To assess endothelial dysfunction, various parameters are currently being studied, such as
homocysteine, thrombocytosis, von Willebrand factor, endothelin, high-sensitivity CRP, changes in
the lipid spectrum and interleukin series, PAI-1, PAI-2, ICAM-1, NO, P- and E-selectins and many
others [10, 11, 12]. At the same time, recently, vitamin D deficiency has been identified as a risk
factor for the development of autoimmune pathology [13].
Our results allow us to conclude that the severity of endothelial dysfunction indicators directly
correlates with the severity of the patient's condition.
Taking into account the fact that there is no significant difference between the groups of
patients with UC and CD, we understand that these changes have a low level of specificity, and,
therefore, can be applied only in cases of a previously established diagnosis.
We have selected the most accessible, both in practical terms (availability and availability in the
laboratory network) and economically, to study indicators of endothelial dysfunction. The list of these
indicators is presented in table 1.
Table 1
Patient indicators used as modeling variables
№ Index Variable
1 Highly sensitive C-reactive x1
protein, mg / L
2 Vitamin D, ng / mL x2
3 Homocysteine, μmol / L x3
4 Platelets, t / mm3 x4
5 Fecal calprotectin, μg / g x5
6 Albumin in urine, mg/L x6
The advantages of using this list of indicators include: 1) economic feasibility, 2) speed of
calculation, 3) ease of implementation for the patient, 4) wide availability in outpatient practice.
To obtain the values of the indicators presented in Table 1, in the period from August 2015 to
December 2018, 246 patients with IBD were examined at the clinical base of the Department of
Therapy of AzSATI, the Department of Invasive Diagnostics and Treatment of the National Center of
Oncology, the Medical Center "Memorial Klinika". Of this contingent, 44 people refused to
participate in the study, and 19 people were excluded due to comorbid conditions (6 with arterial
hypertension, 2 with chronic renal failure, 11 due to previous surgical interventions).
For the study, 183 patients were selected who had no complaints and anamnestic indications of
cerebro-, cardio- and nephrovascular pathology. The diagnosis of the disease was established based
on generally accepted criteria following the ECCO recommendations. The severity of the disease was
assessed using the CDAI, HBI, and TW criteria.
The age of the patients was from 17 to 60 years (42.3 ± 2.7). By sex: 81 women and 102 men.
The duration of the disease before going to a specialist doctor is 1.2-9.4 years (3.4 ± 1.1). 167 patients
were examined on an outpatient basis, and 16 were on inpatient treatment. Of the patients, 104
(56.8%) suffered from CD, and 79 (43.1%) had UC. The patients were under dynamic observation
from 9 to 36 months (14.2 ± 3.8). Patients, if necessary, underwent repeated examinations (426 in
total). The results obtained in the study of the main group of patients are presented in table 2.
As can be seen from Table 2, in the total group of IBD patients, out of 426 studies conducted,
369 (86.6%) cases had an increased blood level of homocysteine, 405 (95.0%) - the level of h/s CRP,
322 (75,5%) - thrombocytosis, in 411 (96.4%) - a decrease in vitamin D content, in 308 (72.3%)
albumin was found in urine, and in 411 (96.4%) - and increased content of calprotectin in feces. A
separate analysis of the detection of each of these indicators in the UC and CD groups did not reveal
any difference (p ˃ 0.05). Also, no difference was found when analyzing the results by gender (p ˃
0.05).
In the control group K1 (patients diagnosed with irritable bowel syndrome, N = 20), an increase
in homocysteine was detected in 3 cases, a decrease in the content of vitamin D, in 3 cases an increase
in the level of h/s CRP and in 1 case a slight increase in calprotectin. In the control group K2 (healthy
individuals, N = 20), in 3 cases, a decrease in the content of vitamin D was revealed and in 1 - a
moderate increase in homocysteine. There was no statistically significant difference between groups
K1 and K2. At the same time, the results of studies in both control groups significantly differed from
those in the main (p ˂0.01). The same tendency persisted when the control groups were separately
compared with the groups of UC and CD patients (p ˂0.01).
We carried out statistical processing of the data obtained to search for a possible relationship
between the indicators of endothelial dysfunction and the severity of the patient's condition,
determined following the ECCO recommendations. The severity of changes in the studied indicators
of endothelial dysfunction was assessed as a percentage of the permissible value of the norm (with an
increase in the indicator - it's excess of the upper limit of the norm and a decrease in comparison with
the lower limit - with a lower content).
Table 2
Distribution of endothelial dysfunction parameters in patients with ulcerative colitis and Crohn's
disease
Number of patients
Index With Crohn's With ulcerative colitis, % Total, %
disease, %
Highly sensitive CRP (x1)
before 10 mg/L 69,1 59,8 64,4
10-20 mg/L 17,9 21,0 19,5
more 20 mg/L 12,9 19,1 16,0
Vitamin D (x2)
30 - 20 ng/mL 14,6 22,0 18,2
20 - 10 ng/mL 69,6 51,5 60,8
less 10 ng/mL 15,8 26,5 20,9
Homocysteine (x3)
before 15 µmol/L 51,8 56,7 54,2
15-20 µmol/L 32,4 30,3 31,4
more 20 µmol/L 15,7 12,9 14,3
Platelets (x4)
up to 440t / mm3 43,8 58,0 51,2
from 440 to 480t / mm3 35,4 32,9 34,1
more than 480t / mm3 20,6 8,9 14,5
Calprotectin (x5)
before 100 µg/g 11,9 17,3 14,5
from 100 to 150 µg / g 17,2 25,2 21,1
more 150 µg/g 72,1 57,4 64,2
Albuminuria (x6)
microalbuminuria
80,1 89,1 84,4
(up to 30 mg / L)
macroalbuminuria
19,8 10,8 15,5
(more than 30 mg / L)
For simplicity of calculation, a point-based system for assessing the significance of these
parameters was developed. The results are shown in Table 3.
Table 3
Correlation of some indicators of endothelial dysfunction and the severity of the clinical course in
patients with inflammatory bowel disease
The severity of the disease
Index Norm
I II III
h/s CRP N 1,3 N 1,5 N >1,5 N
Homocysteine N 1,3 N 1,5 N >1,5 N
Platelets N 1,1 N 1,2 N >1,2 N
Vitamin D N 0,7 N 0,4 N <0,4 N
Calprotectin N 2N 3N >3 N
Albumin in urine N – Micro- Macro-
Points 0 1 2 3
As a result, it was found that in the presence of the severity of endothelial dysfunction,
estimated from 4 to 6 points, patients with IBD have mild, from 6 to 9 points - medium, and if there
are more than 9 points, a high degree of severity of the clinical course of the disease. Clinical and
endoscopic remission corresponded to 3 points or less. The degree of correlation was 0.863.
Thus, hypothesis 1 received experimental confirmation. It has been proven that the list of
indicators proposed as modeling variables in Table 1 are significant in determining IBD.
The individual condition of the patient was determined based on the results of solving the MIS
classification problem. The results of the expert classification of the patient's condition were used as a
modeled indicator. It was proposed [15] to distinguish four states (classes) of the patient. Table 4
shows the characteristics of the classes.
Table 4
Characteristics of classes
Condition characteristics Class value in
Class Name the input data
array
0 Clinical endoscopic Absence of clinical manifestations and 0
remission macroscopic changes during endoscopy
1 Mild course of the In accordance with the indicators of tables 5, 6, 7 50
disease
2 Moderate condition In accordance with the indicators of tables 5, 6, 7 500
3 Severe condition of In accordance with the indicators of tables 5, 6, 7 1000
the patient
The severity of the disease as a whole was determined by expert judgment, taking into account the
severity of the current condition, the presence of extraintestinal manifestations and complications,
refractoriness to treatment, in particular, the development of hormonal dependence and resistance
[14,15] in accordance with the data in Tables 5-7.
Table 5
UC attack severity according to Truelove-Witts criteria [15]
Patient condition class
The indicator Easy course of the Medium severity Severe condition of the
disease condition patient
The frequency of bowel <4 ≥ 4 if: ≥ 6, if:
movements
Pulse Normal values ≤ 90 heart rate / min > 90 heart rate / min or
Temperature Normal values ≤ 37,5°С > 37,5°С or
Hemoglobin Normal values ≥ 105 g / l < 105 g / l or
ESR Normal values ≤ 30 mm / h > 30 mm / h
Contact vulnerability of No There is There is
the mucous membrane
of the colon
Table 6
The severity of the attack according to the UC Activity Index (Mayo Index) [13]
Patient condition class
Clinical and
Index value Easy course of the Medium severity Severe condition
endoscopic
disease condition of the patient
remission
Stool Plain 1-2/day more than 3-4/day more than 5 / day more than
frequency usual usual usual
Blood in No Blood veins Visible blood Mostly blood
stool
The Norm Easy vulnerability Moderate Severe
condition of (1 point on the vulnerability vulnerability
the mucous Schroeder scale) (2 points on the (3 points on the
membrane Schroeder scale) Schroeder scale)
General Norm Satisfactory condition Moderate condition Grave condition
assessment
by a doctor
State of moderate severity and serious condition are detected when the index value (the sum of
the ratings for 4 parameters) is from 6 and above.
Table 7
Harvey Bradshaw CD Activity Index [15]
Symptom Severity Rating
Overall well- Good 0
being A bit below average 2
Bad 3
Very bad 4
Terrible 5
Abdominal Not 0
pain Weak 1
Moderate 2
Strong 3
Diarrhea 1 point for each bowel
movement per day
Abdominal Not 0
infiltrate Availability is doubtful 1
Availability 2
The presence of muscle tension in the 3
abdominal wall
Complications Arthralgia, uveitis, erythema nodosum, 1 point for each complication
gangrenous pyoderma, aphthous stomatitis,
anal fissure, new fistula or abscess
The sum of the ratings determines the class of condition of the patient.: ≤4 remission; 5-6 - light
attack; 7-8- medium-heavy; ≥ 9 – heavy
Table 8 shows a fragment of the input data array, built according to the results of observations
and testing described above.
Table 8
Elements of the input data array
Vitamin Albumin
Homocysteine, Platelets, Calprotectin,
A patient Class h/s CRP D, in urine,
μmol / L t / mm3 μg / g
ng / mL mg/L
245 50 2,6 13,2 11 251 166 15
244 500 1,3 26,2 13,4 351 304 3
241 0 0,6 40,2 11,1 361 266 13
240 50 1,9 52,1 8,8 224 171 14
233 1000 16,3 8,2 23,4 301 744 10
232 500 11,8 16 9,4 249 93 13
230 500 3,2 7,4 8,5 241 612 12
… … … … … … … …
Factors were assessed according to standard MIS procedures. The structure of the agent of the
monitoring information system includes a model knowledge base and a model synthesizer [3].
Agent model synthesizers build of model knowledge base to classify the conditions of each
patient adaptively. The influence of the indicators presented in Table 1 was determined after
calculating the values of partial derivatives. Table 9 presents the influence of factors found in agent
models that were synthesized using the multi-line GMDH algorithm [6].
Table 9
Elements of the input data array
Influence, %
A patient Vitamin Albumin
h/s CRP Homocysteine Platelets Calprotectin
D in urine
245 35,00 0,00 7,00 12,00 46,00 0,00
244 0,00 0,00 30,00 8,00 62,00 0,00
241 59,00 33,00 7,00 1,00 0,00 0,00
240 0,00 23,00 4,00 2,00 34,00 38,00
233 34,00 15,00 17,00 0,00 34,00 0,00
232 53,00 13,00 8,00 1,00 0,00 25,00
230 43,00 0,00 0,00 0,00 57,00 0,00
… … … … … … …
The results presented in Table 9 make it possible to determine the prevalence of processes that
determine the course of the disease in a patient whose name is encrypted in Tables 8 and 9. As a result
of a detailed study of the data in Table 9, decisions were made on the individual correction of
treatment regimens based on indicators that affect the course of the pathological process. For
example, when correcting the treatment regimen for patient 245, it was taken into account that the
prevailing factor at the time of diagnosis is an increase in the level of fecal calprotectin (influence
46%) with a concomitant increase in the level of h/s CRP (influence 35%) and an increase in the level
of platelets (influence 12%). This means that in this patient, the course of the disease is determined by
inflammatory processes in the intestinal mucosa, directly related to disturbances in microvascular
hemodynamics, and as a consequence, correction is necessary not only in terms of escalating the dose
of the basic drugs used, but also the correction of microvascular processes.
In patient 244, the prevailing factor at the time of diagnosis is also an increase in the level of
fecal calprotectin (influence 62%), but with a concomitant increase in the level of homocysteine
(influence 30%), which means that one of the triggers is deep intracellular hypoxia with a deficiency
of folic acid and vitamin B12 and the correction of therapy in this patient must take these aspects into
account. In the majority of patients, one of the highly prevalent factors at the time of diagnosis, along
with calprotectin, was h/s CRP, the drug correction of which significantly improved the treatment
results in patients.
At 12 weeks of treatment, patients were asked to undergo re-examinations. Some of the patients
refused to take a complete list of tests. Therefore, 59 patients remained in the control group. The
results of assessing the condition of patients by intelligent agents, expertly confirmed by a doctor,
after 12 weeks of treatment using adapted regimens are presented in Table 10.
Table 20
Patient indicators used as modeling variables
The patient's condition at 12
The patient's condition before the
№ A patient weeks of treatment for the
correction of treatment regimens
adjusted regimen
1 245 The average Easy
2 244 The average Average improved
3 241 Remission Remission
4 240 The average Remission
5 233 Heavy Remission
6 232 The average Easy
7 230 The average Easy
8 226 Remission Remission
9 224 The average Average improved
10 223 Easy Remission
11 222 The average Easy improved
12 218 Easy Remission
13 217 Easy Easy
14 215 The average Average improved
15 210 The average Remission
16 209 The average Easy
17 208 The average Remission
18 207 Heavy Average improved
19 204 The average Remission
20 203 The average Average improved
21 202 Average improved Average improved
22 201 The average Remission
23 200 Remission Remission
24 194 Remission Remission
25 192 Average improved Remission
26 191 Remission Remission
27 190 Easy Remission
28 189 The average Remission
29 188 The average Average improved
30 187 Average improved Remission
31 186 The average Average improved
32 185 Average improved Remission
33 184 The average Average improved
34 181 Easy Remission
35 180 Easy Easy
36 178 Easy Easy improved
37 176 The average Remission
38 170 Easy Remission
39 166 The average Easy
40 165 The average Remission
41 163 The average Average improved
42 162 Easy Average improved
43 161 The average Average improved
44 160 Average improved Without changes
45 159 Remission Remission
46 156 Remission Remission
47 151 Heavy Average improved
48 148 Remission Remission
49 146 Remission Remission
50 145 Heavy Easy
51 144 Remission Remission
52 141 Heavy Average improved
53 139 The average Easy
54 138 Easy Easy improved
55 136 The average Easy improved
56 135 Easy Remission
57 133 Remission Remission
58 132 Easy Easy improved
59 131 Easy Easy
The results of Table 10 suggest that the use of the results of intelligent monitoring of MIS
agents increases the efficiency of treatment of patients with IBD.
At 12 weeks of treatment according to the adjusted scheme, 52 patients (88.0%) showed a
significant improvement in well-being; at the same time, 10 (16.9%) patients showed remission, 34
(57.6%) patients showed a decrease in the severity of the disease course, and 8 (13.5%) patients
showed subjective improvement in well-being was not accompanied by a noticeable improvement in
the process activity indicators (false positive result). Another 4 (6.7%) patients did not notice an
improvement in their condition, and 3 (5.1%) patients showed a deterioration. These patients were re-
examined and it turned out that the patient under code 162 did not comply with the treatment period
(he completely stopped taking one and reduced the dosage of other drugs). In patients under codes
131 and 160, opportunistic infections were detected (in 1- tuberculosis according to the quantiferon
test, in 1 - herpes viruses HSV6 and EBV, detected by PCR of biopsies of the gastrointestinal
mucosa). That is, 74.7% of patients achieved a positive treatment result.
Thus, we obtained experimental confirmation of hypothesis 2 and 3. It has been proved that taking
into account the individual reactions of the patient's body when constructing a treatment regimen and
using the results of intellectual monitoring increases the effectiveness of treatment.
6. Conclusions
The process of supporting decision-making by a doctor in the process of treating inflammatory
bowel diseases consists in providing an intelligent agent with information about the patient's
condition, the influence of well-known factors, and the prognosis of the results of the use of adapted
treatment regimens.
The hypothesis of the existence of signs that characterize patients with IBD has been
experimentally confirmed, and MIS can be used in the process of constructing an individual treatment
regimen for each of these patients.
The source of increasing the effectiveness of the treatment of inflammatory bowel diseases in a
patient is the correction of his treatment regimen, taking into account the priority factors that
determine the patient's condition. As a result of combining methods for solving intellectual problems
by agents of the monitoring intellectual system and correcting the methods of treating inflammatory
bowel diseases used by a doctor, a systemic effect was obtained in the form of improving the health of
patients.
7. References
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disease in the 21st century: a systematic review of population-based studies.
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[2] 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease
2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis (2017) 11 (1): 3-25.
doi:https://doi.org/10.1093/ecco-jcc/jjw168
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