[Clinic pathogenetic features of gastroduodenal erosions and ulcers in patients with unstable stenocardia].

OBJECTIVE: To reveal the clinical, morphological and pathogenic features of gastroduodenal erosions and ulcers in unstable angina. METHODS: 135 patients with unstable angina were examined and divided into 2 groups, depending on the presence of a pathological process in the gastroduodenal zone. The state of microcirculation in the tissues of the gastroduodenal zone, secretory and motor function of the stomach were estimated by complex of techniques, adapted to the severity of the patients. RESULTS: It is found that the pathological process in the gastroduodenal zone in patients with unstable angina was presented primarily by acute erosions, less - acute ulcers or recurrent peptic ulcer disease. In this case, the leading symptom of acute erosions was dyspepsia, that as a rule prevailed over the indistinct abdominal pain, and often disappeared in the first few days of treatment. Clinical picture of acute ulcers was determined by gastric dyspepsia and was often combined with abdominal pain and symptoms of gastrointestinal bleeding. The recurrence of peptic ulcer disease was characterized by the combination of moderate abdominal pain, often with migration in retrosternal and cardiac area and loss of circadian rhythm inherent in anthro-duodenal ulcer localization, and dyspeptic disorders. The severity of symptoms of ulcerous process was gradually decreased with time, but in most patients, they had remained by the end of the 2nd week of treatment. The basis of development of erosions and ulcers in unstable angina were the focal mainly thrombohaemorrhagic disorders of the terminal blood flow in the gastroduodenal mucosa. Its were combined with changes in the functional state of the stomach, manifested with an increase activity of acid-peptic factor, reduced production of gastromucoproteins, hypomotor dyskinesia and discoordination of anthro-duodenal propulsion on the hypotonic type. CONCLUSION: Erosive and ulcerative lesions of gastroduodenal zone in unstable angina have a number of clinical and pathogenetic features that should be considered in the process of diagnosis and treatment.

[The condition of sympathoadrenal and histaminoreactive systems and the influence of their changes on the peculiarities of a peptic ulcer relapse in patients with myocardial infarction].

The author presents the results of an examination of 106 patients with myocardial infarction (MI) of various severity, who also had a peptic ulcer relapse. Patients with moderate and severe MI in the majority of cases had solitary duodenal ulcers whereas those with extremely severe MI often had multiple ulcers in the body and the cardial part of the stomach, which were bleeding in 43.5% of cases. The pathogenetic basis of the ulcerogenesis was focal microcirculation disorders in the mucosa of the gastroduodenal zone of thrombohemorragic or thromboischemic type. In patients with moderate or severe MI they appeared against the background of hemostatic disturbances typical of the first stage of thrombohemorragic syndrome (hypercoagulation). In extremely severe MI they corresponded to the second stage i.e. partial consumption coagulopathy. In patients with moderate coronary pathology these changes were promoted by the activation of acid-peptic factor, the depression of mucopolysaccharide production, hypo- and hyperkinetic dyskinesis, and in those with extremely severe coronary pathology --the depression of all gastric function except normal acid production. One of the trigger mechanisms of ulcerogenesis could be changes in the activity of sympathoadrenal and histaminereactive systems, which increased in cases of moderate and severe MI and decreases to a certain extent in cases of extremely severe MI.

[Choline- and histaminergic shifts as a trigger of gastroduodenal erosive-ulcer lesions in myocardial infarction].

AIM: To clarify the role of cholin- and histaminergic shifts in the onset of circulatory and functional gastric disturbances associated with erosive-ulcer gastroduodenal lesions in myocardial infarction (MI). MATERIAL AND METHODS: Cholin- and histamine-reactive systems, end gastroduodenal mucosal circulation were studied in 80 Ml patients with gastroduodenal erosions and ulcers divided into three groups by the disease severity. RESULTS: MI features influence characteristics and severity of gastroduodenal erosions and ulcers. The latter develop due to focal microcirculatory disorders in gastric and duodenal mucosa by thrombohemorrhagic or thromboischemic type. Moderate and severe coronary pathology is associated with higher production of hydrochloric acid and pepsinogen, with depressed production of gastromucoproteins, hypo- or hypermotor dyskinesia, extremely severe coronary pathology--with decline of all gastric functions except normal acid production. Erosive-ulcer lesions may be triggered by alterations in cholin-histamine systems the activity of which in moderately severe and severe MI rises but in extremely severe--lowers. CONCLUSION: Pathogenesis of erosive-ulcer lesions of the gastroduodenal zone in MI has some specific features dependent on severity of MI. This should be taken in consideration in choice of drug therapy.

[Particular features of the treatment of ulcer recurrence in patients with myocardial infarction]. / Osobennosti lecheniia retsidiva iazvennoi bolezni u bol'nykh infarktom miokarda

107 patients with myocardial infarction and ulcer recurrence were examined. It was revealed that the ulcerous process proceeded with focal trombohemorragic disorders of local microcirculation in the gastroduodenal mucous coat in severe cases of myocardial infarction and with tromboischemic disorders of terminal blood flow in extremely severe cases. It was accompanied by the activation of acid and pepsin production, depression of mucopolysaccharides production and hypermotor gastric dyskinesis in patients with severe coronary pathology, in patients with the extremely severe pathology--by the depression of all functions of the stomach, except for normal acid production. The administration of an antiulcerous therapy helped to reduce the period of elimination of ulcer recurrence symptoms, liquidated microcirculatory and gastric functional disorders, and promoted the healing of ulcers. The therapy included omeprazole, sucralfate, long-term form of nifedipine for patients with severe myocardial infarction, and ranitidine, sucralfate and doxazosin in common doses for 20-25 days for patients with extremely severe cases.

[Clinical symptoms of erosive and ulcerous lesions of gastroduodenal zone in patients with unstable ischemic heart disease and the significance of endoscopy in diagnosis]. / Klinicheskie proiavleniia érozivno-iazvennykh porazhenii gastroduodenal'noi zony pri nestabil'nom techenii ishemicheskoi bolezni serdtsa i znachenie éndoskopicheskogo issledovaniia v ikh diagnostike.

We studied 103 patients with unstable ischemic heart disease and clinical signs of gastroduodenal injury. Among them 62 (60.2%) patients had moderate gastric dyspepsia and abdominal pain during first 1-5 days of hospitalization. In 17 (16.5%) cases these clinical symptoms were accompanied with symptoms of gastroduodenal hemorrhage. Twenty four patients (23.3%) with history of ulcer disease or chronic gastritis, were asymptomatic. In 96 (93.2%) patients endoscopy performed mainly on days 20-24 of hospital stay detected gastroduodenal erosions and ulcers: acute ulcers were found in 19.4, acute erosions - in 40.8, exacerbations of peptic ulcer - in 33.0% of patients. Clinical symptoms of gastroduodenal ulcers and erosions often did not reflect character, severity and dynamics of pathological process. Therefore gastro- duodenoscopy had decisive importance for diagnosis and assessment of effect of treatment. Endoscopy should be carried out with due consideration of concomitant coronary pathology.

[Clinical and pathogenetic features of recurrent and acute peptic ulcer in acute coronary syndrome]. / Kliniko-patogeneticheskie osobennosti retsidiva iazvennoi bolezni i ostrykh iazv pri ostrom koronarnom sindrome.

Clinico-pathogenetic characteristics of recurrent ulcer disease and acute ulcers were studied in 84 patients with unstable coronary heart disease (CHD). It was found that a relapse of ulcer disease (UD) in CHD presents with moderate abdominal pain without a typical circadian rhythm and with dyspepsia registered, as a rule, for 2 weeks. Acute ulcers often manifested with weak epigastric pain and symptoms of gastric dyspepsia observed usually for several days of hospital treatment. Gastroduodenal bleeding had obscure clinical picture but complicated recurrent UD and acute ulcers in 29.4 and 50% cases, respectively. The recurrence of UD in CHD developed in the presence of focal thrombohemorrhagic disorders of microcirculation in the tissues of gastroduodenal zone, high activity of the acid-peptic factor, low mucus production, hypomotor gastric dyskinesia, detection of Helicobacter pylori (HP). Acute ulcers are most frequently associated with focal thromboischemic disorders of end blood flow, minor changes in pepsin and mucoprotein production, prominent hypomotor gastric dyskinesia and, in 10% cases, HP.

[Clinico-morphological features of acute gastroduodenal erosion and ulcers in an unstable course of myocardial ischemia and role in disturbances of microcirculation, stomach function and their development]. / Kliniko-morfologicheskie osobennosti ostrykh gastroduodenal'nykh érozii i iazv pri nestabil'nom techenii ishemicheskoi bolezni serdtsa i rol' narushenii mikrotsirkuliatsii, gemostaza, funktsii zheludka v ikh razvitii.

AIM: Determination of clinicomorphological characteristics of acute gastroduodenal erosions and ulcers in unstable course of IHD and the role of disorders in microcirculation, hemostasis, gastric function in development of these erosions. MATERIAL AND METHODS: Clinically and endoscopically were examined 124 patients with unstable IHD. By detected gastroduodenal changes the patients were divided into three groups. The study was also made of local and systemic microcirculation, hemostasis, gastric functions. RESULTS: Acute gastroduodenal erosions and ulcers in unstable course of ischemic heart disease manifest with mild abdominal pains and gastric dyspepsia for several days. Disorders in the gastroduodenal zone arise because of focal disturbances of terminal circulation in the mucose according to thromboischemic or thrombohemorrhagic types related to generalized changes of microcirculation and hematasis. High activity of acid-peptic factor, low production of gastromucoproteins and hypomotor dyskinesia of the stomach contribute to development of erosive-ulcerous lesions. CONCLUSION: The above information is useful for early diagnosis of acute gastroduodenal erosions and ulcers in unstable course of IHD and upgrading of therapeutic measures.

[Status of vegetative tone and significance of changes in it in formation of erosive-ulcer damage to the gastroduodenal zone in patients with an unstable course of ischemic heart disease]. / Sostoianie vegetativnogo tonusa i znachenie ego izmenenii v formirovanii érozivno-iazvennykh porazhenii gastroduodenal'noi zony pri nestabil'nom techenii ishemicheskoi bolezni serdtsa.

It was shown in 60 examined patients, that the development of erosive-ulcer disorders of stomach and duodenum under unstable course of ischemic heart disease (IHD) takes place on a background of activation of the central contour of autonomic regulation, expressed sympathicotonia and reduced of vagus influences. The revealed changes of autonomic tonus can promote to arising of disorders of hemostasis, microcirculation and stomach functions what are the leading factors in pathogenesis of gastroduodenal pathology. In spite of stereotype character of autonomic disorders, the serious disorders of the terminal blood flow in gastoduodenal tissues, increase of acid-peptic activity and the reduce of mucopolysaccharides are found out only in the persons with erosions and ulcers. It testifies to the necessity of further specification of the mechanisms of its development in the patients with unstable course of IHD.

[Features of mucosal flora associated with relapse of ulcers and acute erosive-ulcer damage to the gastroduodenal zone during an unstable course of ischemic heart disease]. / Osobennosti mukoznoi flory, assotsiirovannoi s retsidivom iazvennoi bolezni i ostrymi érozivno-iazvennymi porazheniiami gastroduodenal'noi zony pri nestabil'nom techenii ishemicheskoi bolezni serdtsa.

There was a study of 34 patients both with an unstable course of ischemic heart disease and a recurrence of ulcer or acute gastroduodenal ulcers and erosions. Irrespective of the nature of the pathologic process 14-15 different genera and species of microorganisms with features of potential pathogenecity were revealed in the tissue samplings from the periulcerous and perierosive zones of the mucosa. The greatest frequency, quantity and fermentative activity were marked in staphylococci, streptococci, enterococci and candidas. H. pylori yielded to a number of specimens of the gastroduodenal zone microbiocenosis in this regard. A less marked activation of the microflora pathogenic potential was observed in the intact mucosa remote from the lesions as in its tissue samplings 10-12 genera and species of microorganisms were revealed. The pathomicrobiocenosis being formed there might inhibit the healing of gastroduodenal erosions and ulcers in patients with an unstable course of ischemic heart disease, which must be taken into consideration in the development of methods for their treatment and prophylaxis.

[Features of mucosal flora associated with relapsed ulcer and acute erosive-ulcer damage of the gastroduodenal zone in an unstable course of myocardial ischemia]. / Osobennosti mukoznoi flory, assotsiirovannoi s retsiadivom iazvennoi bolezni i ostrymi érozivno-iazvennymi porazheniiami gastroduodenal'noi zony prei nestabil'nom techneii ishemicheskoi bolezni serdtsa.

The findings indicate that erosive and ulcerous lesions of the gastroduodenal zone in case of an unstable course of ischemic heart disease are accompanied by an increase in the microbial semination of its mucous coat and induction of enzymatic activity of bacteria and fungi. The pathomicrobiocenosis being formed there can reinforce inflammatory and necrotic changes and inhibit their elimination. This should be taken into consideration when studying the pathogenesis mechanisms of erosive and ulcerous stomach and duodenal lesions in case of an unstable course of ischemic disease and developing methods for their prevention and treatment.