Currently, there is an active development of spa treatment, which is an important part of the healthcare system, aimed primarily at medical rehabilitation and disease prevention, demonstrating high efficiency in the complex use of non-drug methods and natural resources (drinking mineral water and mineral baths) during the rehabilitation treatment of patients carried out in spa organizations of the country.

Due to the high prevalence of gallstone disease, methods of rehabilitation treatment after cholecystectomy (CE) are being developed. Spa treatment methods, such as drinking mineral water and mineral baths, can affect the pathogenesis of symptoms, improving the functionality of the digestive organs [1]. Some of the most common concomitant diseases after CE are gastritis (a stomach disease in which the mucous membrane is damaged and the organ stops fully digesting incoming food) and esophagitis (inflammation of the esophageal mucosa, often caused by the backflow of gastric contents).

It is necessary to maintain an adjusted hydration level adapted to the individual physiological norm of each person [2]. In addition, to ensure healthy hydration and proper homeostasis, it is important to take into account the mineralogical composition (MC) of water, where the main role is played by the MC of natural mineral waters, which can be beneficial for health depending on the needs of each person [3]. 

Mineral waters are unique natural formations that have therapeutic effects on humans and their bodies. The analysis of the mineral water and its division into groups is carried out according to many indicators, including: mineralization level, ionic and gas composition, temperature, acidity or alkalinity, and radioactivity. Natural waters with a total mineralization of 1 to 10 g/dm3 are classified as medicinal table mineral waters (GOST R 54316-2020).

An important area of the modern healthcare system in many countries is the study of health-related quality of life (HRQOL), which is the main indicator of the degree of a person's adaptation to illness and shows his subjective assessment of his own health. The scientific literature has published the results of direct national assessments of the value of health states according to the EQ-5D system (standard value sets) in many countries of the world [4-6]. In recent years, among Russian medical organizations, questionnaires for assessing HRQOL have also been used to determine the quality of life of the country's population [7, 8].

The study involved 63 people aged 54 to 69 years (62±2.7 years) undergoing treatment at the State Autonomous Healthcare Institution of the Yaroslavl Region “Sosnovy Bor” Sanatorium and Preventorium (Yaroslavl Region, Gavrilov-Yamsky District) with a history of laparoscopic cholecystectomy (gall bladder removal). Men accounted for 42.9% (n=27), women 57.1% (n=36). All participants were randomly divided into 2 groups at the 1st visit depending on the intervention tactics. 

The study participants met the following inclusion criteria: men and women >50 years old, laparoscopic cholecystectomy (6 months or more after surgery), and confirmed diagnosis of gastritis and/or esophagitis. Exclusion criteria: gastrointestinal tract (GIT) pathologies in the acute stage, cardiovascular disorders, pregnancy, and lack of voluntary consent to participate in the study.

The study consisted of two stages: a sanatorium-and-prophylactic stage (14 days) and an outpatient stage at the medical center of the Federal State Budgetary Educational Institution of Higher Education Yaroslavl State Medical University of the Ministry of Health of the Russian Federation (14 days). During the first stage, both groups were treated with: light therapy using the Bioptron device (once a day for 20 minutes, daily), the Abizea Fito-ZhK tea drink (120 ml daily), an oxygen cocktail (2 servings daily, 200 ml), and the Mustang-PHYSIO-MELT-2K electrotherapeutic device (SMT3 amplipulse therapy, 2 times a week). 

Therapeutic exercise classes (TEC) and dosed walking (30 min/day) were conducted at stages 1 and 2 in both groups, without changing the duration of training and the pace of exercise. Table 1 shows the gradation of patients depending on gender and concomitant pathology. 

Physical therapy in the study groups was conducted 3 times a day at a moderate pace, with a density of 80%. In group I (n=31), the duration of training was 40 min, in group II (n=32) – 50 min, with an emphasis on breathing exercises [9].

Patients of the second group additionally took 50 ml of medium-mineralized (M 6.3 - 7.7 g / dm3) sodium sulfate mineral water extracted in the Sosnovy Bor rural settlement from well 1/85 (depth 191 m), classified as drinking medicinal and table water (special medical opinion of the Federal State Budgetary Institution "NMIC RK" of the Ministry of Health of Russia No. 7-1475 dated June 30, 2023). It has been proven that sulfates have a beneficial effect on intestinal functioning, help reduce gastric acidity, stimulate bile synthesis, and help normalize water-salt metabolism [10].

Also, during their stay at the sanatorium, all representatives of group II were prescribed hydromassage procedures (3 times a day for 20 minutes). To determine the quality of life, the EQ-5D-3l questionnaire was used, which consists of five questions to assess the subjective sensations of a person's physical and mental health. The second section of the questionnaire is a visual analog scale (VAS / EQ-VAS) presented in the form of a 20-cm vertically graduated ruler from 0 to 100, where 100 is the best possible health condition in the respondent’s opinion [11]. For an adequate assessment of the possible manifestation of symptoms of functional dyspepsia and irritable bowel syndrome (IBS), the "7x7" questionnaire (7 symptoms in 7 days) was used, which is based on the description of the clinical symptoms of functional dyspepsia and IBS and includes questions about the presence and severity (minor, moderate or severe) [12]. Assessment using questionnaires was carried out on the 1st and 28th day of the study.

The patients’ diet consisted of 5 meals in accordance with the recommended diet.

The results of the study were processed using MS Excel and Statistica ver.12.0. Differences were considered statistically significant at p <0.05.

In accordance with the age classification adopted by the World Health Organization (WHO, 2016), 42.9% (n=27) of middle-aged people and 57.1% (n=36) of elderly people who underwent planned spa treatment at the Sosnovy Bor sanatorium and health resort (Yaroslavl region) participated in this study.

Representatives of group I assessed their health status according to the second section of the VAS questionnaire, where respondents noted their current health status on the scale on the first day of their visit to the doctor as 70.2%; in group II this figure was 70.8%. At the beginning of the study, no reliable difference was found between the groups for all 5 parameters of the EQ-5D-3l questionnaire (p >0.05). After 28 days of rehabilitation treatment, all study participants underwent a repeat survey (see Table 2).

First, the dynamics of improvement of the subjective assessment of the general condition of patients in both groups was analyzed. As a result, reliable differences were found between groups I and II for 4 of the 5 criteria of the EQ-5D-3l questionnaire (p <0.05). For example, the mobility indicator in group I, when the patient did not report any problems with this criterion, was 48.4% (an increase of 19.4%), while in group II it was 71.9% (an increase of 37.5%). A significant decrease in anxiety/depression was also noted among patients: 83.9% (n=25) reported their complete absence in group I, while in group II it was 90.6% (n=29). These indicators are an important criterion of a person’s general well-being. It has been proven that the most common reactions to stress are anxiety and depression. In 2019, every eighth person on the planet suffered from a mental disorder, with the most common being anxiety (301 million people) and depressive states (280 million people) [13, 14]. 

A repeat VAS survey (after 4 weeks) showed that in groups I and II, respondents assessed their current health status by 79.3% (+9.1%) and 83.2% (+12.4%), respectively (p >0.05). The VAS indicator, in addition to the value of the quantitative expression of health status, allows for additional consideration of health problems that do not fall under the 5 standardized questions of the EQ-5D [7].

Because patients with digestive symptoms are the largest group of visitors to a practicing physician, the 7x7 questionnaire was used to assess the severity of symptoms [12]. During visit 1, it was found that most patients rated the severity of their general condition according to the 7x7 questionnaire as mild (57.1%; n=36), moderate (14.3%; n=9), or no symptoms at all (28.6%; n=18). There were no significant gender or intergroup differences in the intensity of the disorders identified. As a result of visit 2, after completion of the treatment course, the total number of people with mild digestive disorders decreased by 25.7% (to 31.4%; n=20), the differences are significant (p <0.05); moderate decreased to 7.9% (n=4), the difference was 6.4%. No significant differences were found in the questionnaire between groups I and II, with the most pronounced reduction in symptoms in group II (p >0.05).

Drinking mineral water, hydromassage, and conducting therapeutic exercise classes with an emphasis on breathing exercises increase the positive dynamics during the complex spa treatment of middle-aged and elderly patients with concomitant gastrointestinal diseases after laparoscopic cholecystectomy. The use of the EQ-5D-3l and "7x7" questionnaires in clinical practice allows for an adequate assessment of the severity of possible adverse manifestations for the patient, as well as obtaining a subjective assessment by the patient of the effectiveness of treatment in the form of an improvement in the patient's condition in all areas of his activity, which is an important aspect of modern personalized medicine.