[ENDOSCOPIC ANATOMY AND MORPHOLOGICAL CHANGES OF THE GASTRODUODENAL JUNCTION IN ULCER OF THE DUODENUM].

OBJECTIVE: To Improve the diagnosis of duodenal ulcer and preneoplastic changes of gastroduodenal transition. MATERIALS AND METHODS: 112 patients with duodenal ulcer, 208 healthy pearsons of three age periods: second period of mature age, elderly and senile age were examined. Video endoscopy equipment company "OLYMPUS" (Japan), morphological methods and the determination of Helicobacter pylori (Hp) were used. RESULTS: The connecting line of gastric and duodenal mucous membrane can be located on the gastric side of the pylorus (13% in normal cases and 22.3% in cases of ulcer disease), on pylorus and go into the bulbus of duodenum (87% and 77.7 %, respectively), in cases of duodenal ulcer the connecting line more often has jagged and tongue-shaped form. Mucous membrane forms folds in prepyloric part of the stomach most often on the front wall in healthy pearsons in 14.4% of cases, in patients with duodenal ulcer--in 75.9%. The number of folds decreases with age. HP, atrophy, intestinal metaplasia of the mucous membrane is more often found in duodenal ulcer disease--76.8%, 69.7% and 62.5% comparing with healthy persons: 51.4%, 5.3% and 47.7% respectively. Frequency of preneoplastic changes increases with age. The individual differences of the mucous membrane of the gastroduodenal transition are identified. They are expressed in the particular location and shape of the connecting line of gastric and duodenal mucous membranes in normal cases and in cases of ulcer disease in different age groups. Some endoscopic changes requiring biopsy and morphological studies are revealed.

[CLINICAL, ENDOSCOPIC AND MORPHOLOGICAL FEATURES OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH CERTAIN SURGICAL DISEASES OF THE UPPER GASTROINTESTINAL TRACT].

OBJECTIVE: To reveal the peculiarities of manifestations and treatment of gastroesophageal reflux disease (GERD) in patients with peptic ulcer disease of the stomach and duodenum, hiatal hernia (HH) and after stomach resection. MATERIALS AND METHODS: 387 patients with GERD, peptic ulcer disease of the stomach and duodenum (200 patients), after resection of the stomach Billroth II (150 patients), 37 patients with HH. Videoendoscopic equipment company OLYMPUS (Japan) was used. Biopsies of the mucous membranes of the pylorus, body, angle of the stomach and esophagus were studied to identify preneoplastic changes. HP was determined histologically, cytologically, urease tests. RESULTS: The patients with GERD and peptic ulcer disease of the stomach and duodenum were complained on the heartburn, the patients after resection of the stomach--on feeling bitterness in the mouth, with HH--on the pain behind the breastbone. More severe degree of GERD (C and D) was endoscopic feature in patients with HH and A degree or endoscopic negative form--after resection of the stomach. Preneoplastic changes of the esophageal mucosa with columnar epithelium were found in cases of less severe degrees of inflammation. The degree of esophagitis, presence of preneoplastic changes were determined depending on the presence of Helicobacter pylori. Antireflux surgery was performed under strict indications. CONCLUSION: Clinical features, endoscopic, morphological manifestations of GERD in patients with pectic ulcer disease of the stomach and duodenum, with resection of the stomach and patients with HH were determined. This is dictated the individual differentiated approach to the choice of the treatment.