CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF H. PYLORI-ASSOCIATED GASTRODUODENAL ZONE DISEASES: AGE-RELATED ASPECTS

The aim of the paper is to study the clinical and morphological characteristics of H. pylori-associated gastroduodenal zone diseases, depending on patients’ age. Materials and Methods. Three groups of patients of various ages with H. pylori-associated gastroduodenal zone diseases were formed in the course of a prospective clinical study. We studied the clinical picture, and morphological characteristics of the gastroduodenal zone before and after eradication therapy. Average length of the observation period was 172 days. All patients underwent esophagogastroduodenoscopy with biopsy. Results. Severe dyspeptic disorders were diagnosed in all young patients belonging to group 1 (100 %). The dyspeptic index corresponded to a high degree of severity. Morphological changes in the gastric mucosa were more significant in patients with a less pronounced clinical picture (Groups 2 and 3). In group 3, atrophic transformations of the gastric corpus were found in 30.5 %, atrophic transformations of the pylorus – in 11 %, and intestinal metaplasia – in 2.8 % of patients. Unlike young and middle-aged patients with pronounced dyspeptic syndrome, elderly patients were characterized by a low-symptom clinical picture, which was accompanied by morphological gastroduodenal zone transformations with the possible progression. Conclusions. Effective eradication therapy contributes to clinical, endoscopic and morphological remission of the gastroduodenal zone and prevents the progression of the inflammatory cascade. Key words: Helicobacter pylori, gastroduodenal diseases, eradication therapy, age characteristics. Цель исследования – изучить клинико-морфологические особенности H. рylori-ассоциированных заболеваний гастродуоденальной зоны в зависимости от возраста пациентов. Материалы и методы. В процессе проспективного клинического исследования были сформированы три группы пациентов разного возраста, имеющих H. pylori-ассоциированные заболевания гастродуоденальной зоны. Изучали клиническую картину, морфологические особенности гастродуоденальной зоны до и после эрадикационной терапии. Период наблюдения больных составил в среднем 172 дня. Всем пациентам выполнялась ззофагогастродуоденоскопия с биопсией. Результаты. У 100 % пациентов молодого возраста (I группа) установлены выраженные диспепсические расстройства. Диспепсический индекс соответствовал высокой степени тяжести. Для пациентов II и Ш групп при менее выраженной клинической картине морфологические изменения слизистой оболочки желудка оказались более существенны. В старшей группе (Ш группа) атрофические преобразования тела желудка выявлены у 30,5 % пациентов, привратника желудка – у 11 %, кишечная метаплазия – у 2,8 %. В отличие от пациентов молодого и среднего возраста, имеющих выраженный диспепсический синдром, для пациентов пожилого возраста характерна малосимптомная клиническая картина, которая сопровождалась морфологическими преобразованиями гастродуоденальной зоны с возможностью прогрессирования. Выводы. Эффективная эрадикационная терапия способствует достижению клинико-эндоскопической и морфологической ремиссии состояния гастродуоденальной зоны и создает условия для предотвращения прогрессирования воспалительного каскада. Ключевые слова: Helicobacter pylori, заболевания гастродуоденальной зоны, эрадикационная терапия, возрастные особенности.

Calcium imbalance in comorbid gastroduodenal ulcers

Purpose of the study. To study the level of blood calcium, reflecting the functional state of the calcium-regulating system (CRS), in the comorbid course of gastroduodenal ulcers (GDU) with chronic erosive gastritis / chronic erosive duodenitis (CEG/CED), arterial hypertension (AH), their symptomatic nature when taking non-steroidal drugs (NSAIDs) and find out its effect on the activity of the ulcerous process, the state of regional microcirculation and the secretory function of the stomach.Materials and methods. 132 patients with GDU were examined. All patients were divided into groups: the first (39 people) – patients with recurrent peptic ulcer (PU) and CEG/CED, the second – 23 people with recurrent peptic ulcer and hypertension, the third – 20 patients with symptomatic gastroduodenal ulcers (SGDU) when taking NSAIDs. The fourth (control) group included 56 patients with PU without associated pathology.Results and discussion. Recurrence of PUr, comorbid to its course with CEG/CED, AH, SGDU, when taking NSAIDs, occurs with an increase in the level of calcium in the blood, which contributes to the activation of the acid-peptic factor, impaired microcirculation and repair processes in the mucous of the gastroduodenal zone, the development and maintaining the ulcerous process.Conclusion. Gastroduodenal ulcers are accompanied by dysfunction of the calcium regulatory system, which is characterized by an increase in blood calcium, which supports the formation of the main ulcerous mechanisms. In the treatment of comorbid and symptomatic gastroduodenal ulcers, it is necessary to include drugs for correcting the calcium-regulating system, which will increase the activity of sanogenic mechanisms.

ON THE PATHOGENESIS OF GASTRODUODENAL ZONE LESIONS IN VARIOUS VARIANTS OF DRUG THERAPY FOR OCCUPATIONAL RESPIRATORY DISEASES

A survey of workers of large industrial enterprises with occupational diseases of the respiratory system was conducted to assess the dependence of the risk of damage to the upper gastrointestinal tract on the features of pharmacological therapy of respiratory pathology. The specificity of the pathogenesis of gastric and duodenal lesions associated with the properties of drug treatment of occupational respiratory diseases was revealed.

BIOMICROSCOPY OF THE CAPILLARY FLOW - INTERDISCIPLINARY APPROACH AND EFFECTIVENESS OF PATHOLOGICAL CONDITIONS DIAGNOSTICS

The goal – to evaluate the features and diagnostic value of the capillary bedbiomicroscopy results in various pathological conditions.Material and methods. The paper presents data on microcirculation study in patientsof various ages (adults and children) with different somatic pathologies (with diabetesmellitus, arterial hypertension, chronic gastroduodenitis, acute bronchitis) comparedwith healthy persons. The state of microcirculation was recorded using a digital USBmicroscope and evaluated by qualitative and semi quantitative assessment.Results. In patients with diabetes, the most changes in the form of capillariesand venules microaneurism, reduction of the functioning vessels number, slowingblood flow, decrease of arteriolo-venular coefficient were registered. In arterialhypertension, the signs of an increase in peripheral resistance were dominated, andin inflammatory diseases of the gastroduodenal zone and during bronchitis there wasa slowing of blood flow in arterioles and capillaries, an increase in the vascularity ofarterioles and the erythrocytes adhesion inside vessels.Conclusions. Biomicroscopy is simple and informative method for studyingmicrocirculation both chronic and acute diseases, the volume and nature of violationspredominantly depends on the type of pathology, its severity and duration.

Guality eradication anti-helicobacter therapy increases the effectiveness of treatment of patients with stable angina pectoris

Aim. On the basis of the complex analysis, to evaluate the efficiency of eradication therapy at patients with stable stenocardia with a combination of chronic gastritis. Material and methods. 46 patients with stable stenocardia with a combination of chronic H. pylori-associated gastritis were included in the open prospective clinical study. Two groups of patients were formed during the study. Patients of group I (n = 25) received eradication therapy in accordance with antibiotic sensitivity of H. pylori strains, patients of group II (n = 21) - without antibiotic sensitivity. In all patients before and after treatment were performed: evaluation of clinical status, laboratory indicators, EGDS with biopsy sampling, diagnosis of H. pylori. Results. The effectiveness of eradication therapy was 86.9%, at the same time, 96% -in group I and 76.2% - in group II. It is established: stabilization of clinical status of patients, improvement of morphological and endoscopic picture of gastroduodenal zone, improvement of laboratory indices. Conclusions. The inclusion of antibiotic-sensitive erication therapy in the algorithm of treatment of patients with stable stenocardia in combination with chronic gastritis allows to achieve high effectiveness of killing the infection Helicobacter pylori. At the same time stabilizes clinical status of patients, laboratory indices, has a positive effect on morphological and endoscopic picture of gastroduodenal zone, preventing progression of metaplastic changes.

A case of long-term staged treatment of a patient suffering from a peptic ulcer of the gastroduodenal zone. Case report

Currently, a unified approach to the treatment of peptic ulcer of the upper gastrointestinal tract has been developed, based on knowledge of the pathogenesis of the disease. However, standard methods of conservative and surgical treatment do not bring positive results to a number of patients. The reason may lie in the impossibility of establishing the true etiological factor of this pathology. It must be remembered that patients with of the gastroduodenal zone are not a homogeneous group and require a differentiated approach to diagnosis and treatment. The article describes a clinical case of successful of complicated ulcerative lesions of the gastric and duodenal mucosa, resistant to various methods of conservative and surgical treatment.

Efficacy of antiinflammatory and metabolic bioregulation in complex therapy of chronic pancreatitis with the inflammatory changes of gastroduodenal zone organs

Background. The clinical course of chronic pancreatitis (CP) is characterized by symptomatic polymorphism, which is often associated with comorbidity of CP with other lesions of the gastrointestinal tract. Destructive-inflammatory processes of the upper gastrointestinal tract are very common. Such comorbidity is especially typical for young patients with CP (up to 45 years). The aim is to study the effectiveness of bioregulatory anti-inflammatory and metabolic therapy based on the dynamics of clinical indices and parameters of exocrine pancreatic function and the condition of the mucous membrane of the gastroduodenal zone of patients with CP. Materials and methods. We examined 50 patients with CP with exocrine insufficiency in the phase of unstable remission in combination with inflammatory diseases of the mucous membranes of the gastroduodenal zone. Group 1 (28 patients, age 40.25±1.34 years) received conventional treatment (CT) — pure pancreatin enzymes, proton pump inhibitors, antispasmodics or prokinetics (if necessary), enhanced by a step-by-step course of bioregulatory therapy, including parenteral course of anti-inflammatory drug Traumel C 2.2 ml intramuscularly twice a week (e.g., Monday and Thursday) and metabolic Ubiquinone Compositum 2.2 ml intramuscularly twice a week (e.g., Tuesday and Friday) № 5 each drug with the transition for oral administration of Traumel C per 1 tablet 1 hour after meals three times a day for 30 days. 22 patients with CP and concomitant exacerbation in gastroduodenal zone group 2 (age 41.34±1.21 years) received only complex CT. Results and discussion. A comparative analysis of the dynamics of treatment outcomes in the two study groups showed that almost all clinical signs of the disease, endoscopy and exocrine pancreatic function after treatment in the group using anti-inflammatory and metabolic bioregulatory therapy results were significantly better than in CT group. The mean time to normalization of mucous membranes of gastroduodenal zone in the group with an additional course of bioregulation was 14.4±0.86 days, while in the group of CT — 18.1±0.46 days. Conclusion. It was proved that the additional inclusion of step-by-step bioregulatory antiinflammatory (Traumel C) and metabolic (Ubiquinone Compositum) therapy according to the proposed scheme to the CT significantly more effectively (p˂0.05–0.001) improved the clinical course of the disease, contributed to the normalization of exocrine pancreatic function, as well as more quickly normalized the condition of the mucous membrane of the gastroduodenal zone — during 14.4±0.86 days, while in the group of CT — during 18.1±0.46 days.

Management of postprandial distress syndrome in a young patient with the course application of still mineral water “Uvinskaya”

Aim. The purpose of the article is to study the possibilities of MRI diagnosis of postprandial distress syndrome using the drinking test and its correction with mineral water.Materials and methods. Clinical observation is described. Patient A., 24 years old, came to the clinic with symptoms of functional dyspepsia. After a comprehensive examination, the diagnosis of Postprandial Distress Syndrome was established. The capabilities of MRI diagnostics of functional dyspepsia were assessed by drinking test. The study lasted 50 minutes. Scans were performed 5, 13, 20, 35 and 50 minutes after water intake. For the next 4 weeks, the patient ingested the non-carbonated mineral water “Uvinskaya” room temperature 30 minutes before taking a meal of 100 ml in the first 6-7 days, followed by an increase in volume to 200 ml 3 times a day.Results. An MRI study with a drinking test in dynamics showed an increase in the volume of water drunk. When assessing the morphofunctional state of the stomach, differences were revealed at the level of the fundus: before treatment - the wall is tense, after course therapy - relaxed, relaxation accommodation is more pronounced. An acceleration of evacuation of the received water into the duodenum after treatment was also found. The positive dynamics of the state of motor-evacuation function of the stomach is due to the chemical composition of mineral water and the regimen of balneotherapy.Conclusions. Gastric MRI is an informative and safe diagnostic method for Postprandial Distress Syndrome, which allows to evaluate the structural and functional features of the gastroduodenal zone. Drinking test can help in the MRI diagnosis of functional dyspepsia, increasing the information content of the study. The use of drinking mineral waters in postprandial distress syndrome is pathogenetically justified, but requires further research to develop rational balneotherapy regimens.