[SPA treatments of diseases pertaining to internal medicine]. / I mezzi di cura termale nella terapia di malattie di competenza internistica.

Authors resume the therapeutic employment of mineral waters, muds and baths in internistic syndromes or diseases. Mineral waters are used in the therapy of functional dyspepsia, gastro-oesophageal reflux, chronic primary stipsis, irritable bowel, biliary dyskinesias, mainly hypokinetic gallbladder and Oddi's sphincter, spasm, postcolecystectomy syndrome. The therapeutic effects of mineral waters are determined by their anion and cation content, the presence of undissociated salts and also by the presence of oligoelements. Additionally, the effects of a mineral waters are connected with physical constants: osmotic pressure and temperature. Many researches showed activity of the mineral waters on intestinal autonomic nerves and plexus (CIA), motility, exocrine, endocrine and paracrine digestive secretions and therapeutic properties belonging to evidence based medicine. Mud and bath therapy are effective in treatment of osteoarthritis. During and after mud-therapy effects on diencephalic-pituitary-adrenal axis were displayed, producing increase of endogenous opioids and cortisol. Clinical controlled trials showed significant improvement of symptoms as pain and stiffness. Inhalant therapy by sulphureous and salsojodic mineral waters improve symptoms as cough and escreate and functional indices as FEV1 in chronic obstructive pulmonary disease. The oligomineral waters are very useful in the treatment and secondary prevention of urolithiasis and of relapses of urinary stones after spontaneous expulsion, surgical treatment, stones removal by percutaneous or uretheroendoscopic treatment and lithotrypsia. Patients must drink at least 2L every day, substantially for ever. Chloruratesodic and bicarbonate mineral waters show improvement in disorders of lipidic and urate metabolism.