[Peculiarities of the psychic state and quality of life in patients with duodenal ulcer in the context of chronomedicine].

Most clinicians consider duodenum ulcer as a psychosomatic disease. Objective: To show the interdependence of this condition and mental disorders and their relation to disturbances of melatonin production . Materials and Methods: 15 patients with seasonal DU and 15 healthy subjects of the control group were examined during 3 years using laboratory, endoscopic, and standard psychodiagnostic methods. Results. It was found that all patients with exacerbation of DU experienced enhanced anxiety, reduced background mood, and impaired quality of life based on general health and mental health scoring scales. The circadian rhythm of melatonin production was markedly distorted throughout the observation period but especially during exacerbations of the disease. Conclusions. The results indicate a high degree of correlation between DU and mental disorders caused by impaired production of melatonin. It suggests common etiological mechanisms of DU and psychosomatic symptom complex.

[Psychoemotional status and "adaptation diseases" at patients with the peptic ulcer in Ural Federal Territory].

RESEARCH OBJECTIVE: To study the psycho-emotional status and prevalence of the coronary heart disease (CHD) and the idiopathic hypertensia (IH) at patients with the peptic ulcer of a stomach (PUS) and at patients with a peptic ulcer of a duodenum is (YaB DPK). MATERIALS AND METHODS: Examination of 226 patients with an exacerbation of a peptic ulcer was conducted. Patients were distributed in 3 groups of observation depending on localization of ulcerative process. At all surveyed questioning was carried out, data on heriditary burdeness, smoking, alcohol intake, existence of somatopathies were specified, clinic-morphological implications of a peptic ulcer were studied. RESULTS: Feeling of alarm was present at 109 (48.2%) patients with a peptic ulcer, from them at 92 (40.7%) the subclinical level of alarm is noted, and at 17 (7.5%) clinically expressed form is taped. At 39.3% of the examined patients the depression is defined, from them two thirds of patients had the subclinical level of a depression, and 13 people suffered from clinically expressed depression form. Communication of recurrence with a stress was noted at 86.0% of patients, professionally caused stress--at 44.4%. In our research at the time of the beginning of a disease prevalence of an ischemic heart disease among patients with an ulcer of a duodenum (DPK) made 18.2%. In group of patients with the combined localization of ulcerative defect in a stomach and in DPK which already had an ischemic heart disease before emergence of the second ulcerative defect there were 26.6% that statistically significantly doesn't differ. However that by the time of emergence of the combined lesion this category of patients made already 73.4% is indicative. In case of DPK ulcer prevalence of an ischemic heart disease increased from the moment of the beginning of a disease until carrying out research twice (to 36.4%), but patients with the combined ultserozny lesion nevertheless distinguished both larger initial prevalence of an ischemic heart disease, and more expressed its gain. At the time of the beginning of a disease of GB met in a group of persons with the isolated ulcerative defect authentically more often (36.4% against 18.7% in group of patients with the combined localization of an ulcer). At the time of carrying out research prevalence of GB among patients with DPK ulcer (47.7%) whereas in group of the combined lesion of a stomach and DPK of GB without ischemic heart disease there was only every fourth patient remained significant by 2,7 times (DI 1.2-6.3). The combination of associated diseases of an ischemic heart disease and GB at patients with the advent of an ulcer at the same time in a stomach and DPK practically always met at the persons abusing alcohol and tobacco smoking that in general enlarges risk of development of an ulcer of the second localization by 7,6 times CONCLUSION: At the peptic ulcer (PU) of any localization the previous stress conducting quite often to formation of alarm and a depression conducts to also education a stress--the induced conditions, for example, of an arterial hypertonia, and later--to an ischemic heart disease. As specific to every second patient with the combined form of a peptic ulcer of a stomach and a duodenum it is possible to consider a polisintropiya from such the comorbidity diseases as coronary heart disease and an idiopathic hypertensia. The combination of these associated diseases to alcohol intake and tobacco smoking progressively enlarges risk of development of a peptic ulcer of the combined localization by 7,6 times in comparison with the isolated duodenum canker. RESEARCH OBJECTIVE: To define influence of the comorbidity diseases and risk.

[Association of structure-functional indices of the heart and psychoemotional factors in patients with duodenal ulcer].

Peptic ulcer is a disease of the upper part of the psychosomatic continuum, that allows to consider it as a result of mental maladjustment. The cross-sectional study examined 62 men with newly diagnosed duodenal ulcer, the average age of the surveyed was 21.5 ± 2.1 (M ± s). Men suffering from duodenal ulcer have a significant correlation of structure-functional indices of heart and psychoemotional factors examined. According to the step by step regression to coping-strategies "flight- avoidance" in a lot of left ventricular myocardium and the indexed rate ranged between 62-77%. Our data allow us to propose that the left ventricular hypertrophy in patients with duodenal ulcer with the normal level of blood pressure is morphological and functional expression of adaptation in response to various stressors and exposure on the force. The nature of stress changes their biochemical, hormonal, functional support, essential for uncovering the mechanisms of influence of stress on the development and course of systemic diseases, develop psychosomatic approach to prevention of functional and organic psychosomatic disease.

Usefulness of a fast track list for anxious patients in a upper GI endoscopy.

BACKGROUND: To determine whether patients with no alarm signs who ask the endoscopist to shorten their waiting time due to test result anxiety, represent a risk category for a major organic pathology. METHODS: At our open-access endoscopy service, we set up an expedite list for six months for outpatients who complained that the waiting time for gastroscopy was too long. Over this period we studied 373 gastroscopy patients. In addition to personal details, we collected information on the presence of Hp infection and compliance with dyspepsia guideline indications for gastroscopy. RESULTS: Average waiting time was 38.2 days (SD 12.7). The 66 patients who considered the waiting time too long underwent gastroscopy within 15 days. We made 5 diagnoses of esophageal and gastric tumour and gastric ulcer (7.6%) among the expedite list patients and 14 (4.6%) among those on the normal list (p=0.31). On including duodenal peptic disease in the analysis, the total prevalence rate rose to 19.7% in the short-wait group and to 10.4% (p=0.036) in the longer-wait group. DISCUSSION AND CONCLUSIONS: Our data suggests that asking to be fast-tracked does not have prognostic impact on the diagnosis of a major (gastric ulcer and cancer) pathology.

[Factors affecting psychological reserves in the patients presenting with chronic somatic diseases].

The present study included 105 patients suffering chronic somatic diseases (CSD). Their health status was estimated based on the brief multifactor questionnaire for personality (BMQP) analysis; Spielberg state trait anxiety inventory (STAI); the Beck depression scale with the use of the "patient's quality of life" method; the well-being, activity, and mood (WAM) self-assessment test, and the stress-tolerance self-assistance test. The impairment of psychological reserve was documented in 85.7% of the patients with CSD. The degree of CSD deterioration was shown to be related to the frequency of exacerbation of clinical conditions, the severity of pain syndrome, the level of anxiety, depression, and hypochondriac mood. The impairment of psychological reserve was accompanied by the deterioration of the quality of life due to constraints imposed by the necessity to undergo medical treatment, avoid situations of emotional stress, restrict the scope of physical and social activities.

[Quality of life before and after surgical treatment of duodenal ulcer].

The quality of life was studied in dependence of ulcer disease severity and type of surgery. Found out that it was in close correlation with the severity and duration of the disease and the presence of complications. Patients with sub- and decompensated ulcer stenosis showed the worst quality of life. Long-term results' study demonstrated that only organ-preserving operations, rather then gastric resection, allow adequate quality of life for the operated patients.

[Gastric and duodenal ulcer disease: morphofunctional, neuroendocrine and clinical parallels].

Morphofunctional state of gastric mucous tunic and neuroendocrine cells, and clinical indices at various stages of gastric and duodenal ulcer disease was studied. It was shown, that in clinico-endoscopic remission stage of disease intensity of pathogenetic mechanisms of some neuroimmune-endocrine and clinical indices remained.

Quality of life and emotional functioning in selected psychosomatic diseases.

BACKGROUND: Disease and its treatment may affect a patient not only in the physical, but also in the psychological and social spheres. Quality of life (QOL) is a global concept which should include mental and social actions, physical activities, and the beneficial aspects of a good physical and mental condition as well as negative ones caused by disease and infirmity. The aim of this study was to assess the relationships between emotional functioning and QOL among people diagnosed with coronary disease, hypertension, or gastric and/or duodenal ulcer. MATERIAL/METHODS: A group of 180 male patients hospitalized during 1999-2002 at the Military Medical Academy Hospital in Lódz was subjected to examinations. The Emotional Control Questionnaire by Brzezinski was applied together with the SF-36 Quality of Life Test. The psychometric techniques used in the examinations allowed determining statistically significant relationships between QOL level and emotional excitability, emotional expression control, and situation control. RESULTS: 1) The QOL level of the psychosomatic patients was essentially lower compared with that of healthy people. 2) QOL was strictly related to the emotional functioning of the subjects. 3) There was no essential diversity in the range of emotional functioning among the patients. 4) QOL of the patients suffering from gastric ulcer was on average a little higher than that of patients with coronary disease.

[Gastric and duodenal peptic ulcer in automobile drivers: prevalence, clinical features and prophylaxis].

The authors first studied epidemiology of gastric and duodenal peptic ulcer, risk factors of gastro-duodenal diseases among automobile drivers; defined their real frequency and clinical features--presence of intensive boundary psychic disorders, combination with arterial hypertension and coronary heart disease, lower quality of occupational efficiency.

[Quality of life in patients with duodenal ulcer].

AIM: To examine influence of duodenal ulcer (DU) on quality of life (QL) and changes in QL after different DU treatments. MATERIAL AND METHODS: QL in DU was assessed with Russian version of SF-36 questionnaire in 66 DUpatients with Helicobacter pylori (HP) aged 16-80 years (mean age 44.6 +/- 17.3 years). RESULTS: DU healing was achieved after 2 weeks of therapy with ranitidine (300 mg/day), amoxicilline (2000 mg/day), metronidasole (1000 mg/day), and famotidin (40 mg/day), amoxicilline (2000 mg/day, clarithromycin (1000 mg/day) in 69.2 and 94.9% cases (p = 0.04), after 4 weeks--88.2 and 96.8%, rrespectively (p = 0.52). Hospital stay was 16.1 +/- 2.1 and 22.2 +/- 3.4 (p < 0.05), respectively. Exacerbation of DU leads to deterioration of QL according to all the SF-36 scales. Four weeks of therapy produced a statistically significant (p < 0.05) improvement of QL by all the scales. In failure of HP eradication QL worsened. CONCLUSION: QL is low in exacerbation of DU associated with HP. Antihelicobacter therapy improves QL of DUpatients. QL investigations help to select most effective therapy.

The role of psychosocial factors in peptic ulcer disease: beyond Helicobacter pylori and NSAIDs.

A variety of organic etiologies are associated with peptic ulcer disease, and the most relevant of these are infection with Helicobacter pylori and use of nonsteroidal anti-inflammatory drugs. Between 5% and 20% of patients with gastric or duodenal ulcer, however, lack an identifiable organic etiology. In these patients particularly and in all ulcer patients in general, psychosocial factors may play a significant role. At present, there is no definitive study proving a causal relationship between psychological stress and the development of ulcer disease. Studies to date suffer from significant methodological limitations and have not effectively addressed the poor correlation between ulcer craters and ulcer symptoms. A conservative application of available data would suggest that psychosocial factors play a significant role in symptom perception and reporting in patients with dyspeptic symptoms and may play a role in ulcer formation.

[Treatment of patients with duodenal peptic ulcer not associated with Helicobacter infection].

The authors have shown in the artcile personality characteristics and neuropsychic disorders in patients with duodenal peptic ulcer. These characteristics are the following: increased level of anxiety, presence of frustration, agressiveness, apparent rigidity and astenic, depressive, affective derangements. It does have not positive influence on the course of the disease and requires adequate correction. Psychotherapy use in a complex treatment makes for ulcers healing, dicreasing treatment period and numbers of relapses. It eliminates disorders of psychoemotional status of patients, enhances quality of life of patients from the beginning of the treatment.

[Personal and psychological peculiarities of patients with complicated forms of duodenal ulcer, and their influence on the progress of the disease].

In spite of achievements of modern pharmacology, duodenal ulcer (DU) incidence and, what is more, the frequency of complications, are still high. The presented study was carried out in order to evaluate somatic, personal, and psychological peculiarities of patients receiving different types of treatment for duodenal ulcers complicated by hemorrhage or perforation. The patients whose treatment for perforation or hemorrhage was not radical, demonstrated high relapse rate within 4 to 7 years after hospitalization (76% and 50%, respectively). Study of coping revealed high rate of "optimization " mechanism in the emotional sphere of the patients in both groups (56% in the group with perforation, 48%--in the group with hemorrhage). The dominance of this coping mechanism was associated with frequent refusals to receive repeated courses of antiulcer therapy. The study found significant difference in the cognitive and behavioral spheres of coping between the groups. So, "active avoidance" and "retreat" mechanisms predominated in the behavior of hemorrhage patients, which was accompanied by significant reduction in a range of life quality parameters. The obtained data correspond to the results of study of "internal picture" of the disease. Anosognostic attitude to the disease was predominant in perforation group (43.5%), while ergopathic attitude was typical of hemorrhage patients (28.6%). The results suggest that in order to increase the life quality and compliance of patients with DU, medical and rehabilitation measures should be individualized and optimized in accordance with personal and psychological peculiarities of these patients.

Reduced relapse rate in duodenal ulcer disease leads to normalization of psychological distress: twelve-year follow-up.

BACKGROUND: The aim of this study was to elucidate the relationship between duodenal ulcer (DU) disease and psychological symptoms. METHODS: Sixty-four Helicobacter pylori-positive patients with frequently relapsing DUs (patient group 1) were compared with 78 control subjects without dyspepsia, starting 2 years before and ending 10 years after eradication of H. pylori. Seven non-relapsing and untreated patients (patient group 2) were also followed-up. RESULTS: The relapse rate was reduced from 100% per year in the two years before anti-H. pylori treatment to 0.3% per year after treatment in patient group 1. The reinfection rate was 0.7% per year. Anxiety and neuroticism were high at inclusion, but had normalized at the 10-year follow-up in relapse-free patients. There was no increase of gastro-oesophageal reflux symptoms during the 10 years after H. pylori eradication. CONCLUSIONS: Normalization of anxiety and neuroticism following cure of DU disease supports the view that the increased anxiety and neuroticism are consequences, and not causes, of the disease.

[Psychiatric features of patients with duodenal ulcer at various stages of the disease]. / Osobennosti psikhicheskoisfery bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki na raznykh stadiiakh zabolevaniia.

AIM: To examine patients with duodenal ulcer (DU) at different stages of the disease for psychic alterations. MATERIAL AND METHODS: Psychodiagnostic techniques were employed in examination of 192 patients with DU (81 new cases of the disease, 88 cases of recurrent exacerbations, 23 cases with persistent remission for 2 years and longer). Control group consisted of 73 patients without gastrointestinal complaints. RESULTS: Abnormal psychic adaptation was found in 73.3% patients with DU exacerbation, in 47.8% patients in remission and 41.1% controls. Hypochondriac condition and non-adaptation were diagnosed in new cases of DU and recurrent exacerbations with the same frequency. The former had more frequently mixed attitude to the disease and mixed psychopathological syndromes. Psychic compensation rests on information about DU and its prevention which patients receive from the doctor, so these patients benefit much from communication with the physician. Observation over the patient's behavior during such communication allows the doctor to reveal anxiety and depression. Such patients should be referred to consult psychotherapist or psychiatrist. CONCLUSION: Psychic non-adaptation accompanying development of DU manifests with different clinical symptoms at different DU stages. Diagnosis of mental condition of DU patients is important for the choice of individual treatment approach.

Coping with first-time endoscopy for a select sample of Chinese patients with functional dyspepsia and duodenal ulcer: an observational study.

OBJECTIVE: This study examined how patients with functional dyspepsia (FD) and duodenal ulcer (DU) coped with first-time endoscopy, a highly relevant real-life stressor. We adopted an observational method to enhance the ecological validity of the study on stress and coping. METHODS: A matched case-control design was adopted to compare differences between 30 Chinese FD patients from a select sample and 30 Chinese DU patients (13 females and 17 males in each group) in observed coping behaviors, mood states, and subjective appraisals of endoscopy. A new observation checklist was developed for recording subjects' coping behaviors, and our validation study showed that this newly developed measure had adequate reliability and criterion-related validity. RESULTS: Compared with their DU counterparts, FD subjects 1) used more problem-focused coping, 2) used less emotion-focused coping, and 3) sought more instrumental support. They also had higher levels of anxious mood both before and after the endoscopy than did DU subjects. Moreover, compared with DU subjects, FD subjects reported having more pains and discomfort during the endoscopy and more dissatisfaction with the endoscopy. CONCLUSIONS: Using an objective observational method in a select sample of FD patients, the present study provided tentative evidence that FD subjects tend to adopt an action-oriented coping pattern when encountering first-time endoscopy.

[Correlations between clinical features, personality disorders and the antioxidant system in patients with peptic ulcer]. / Vzaimosviaz' klinicheskikh osobennostei zabolevaniia, lichnostykh izmenenii i aktivnosti antioksidantnoi sistemy u bol'nykh iazvennoi bolezn'iu.

The examination of 68 patients with duodenal ulcer (DU) has found correlations between relations in married couples, the level of the subjective control, behavior stereotype, anxiety, neurotism, extra-introversion of the patients and antioxidant activity (AOA) of blood plasm (BP) in various clinical symptoms of the diseases. The relations between psychological factors in DU patients and BP AOA were seen in mild disease: regular terms of scarring, rare recurrences, weak mucosal inflammation, short disease duration, minimal psychological changes. A correlation analysis of interrelations between psychological factors and activity of the antioxidant system in patients with DU can be used for prognostication of the disease course.

[Course of duodenal ulcer disease depending on personality type and effectiveness of differential psychotropic therapy]. / Techenie iazvennoi bolezni dvenadtsatiperstnoi kishki v zavisimosti ot tipa lichnosti i éffektivnost' differentsirovannoi psikhotropnoi terapii.

AIM: To determine features of duodenal ulcer (DU) course as regards personality traits and to validate a differentiated approach to psychopharmacological correction of such patients. MATERIAL AND METHODS: The personality type was determined in 102 DU patients using an experimental psychological examination. RESULTS: Among the examinees, submissive and excitable personalities predominated (56.9 vs 43.1%, respectively). Submissive personalities were anxiously accentuated, moderately psychically rigid and moderately neurotic. Morphologically, they had diffuse fundal and antral gastritis with moderate H. pylori dissemination, intact acid production, ulcer size > 1 cm. Excitable personalities had antral gastritis with moderate H. pylori dissemination, high acid production, ulcer defect 0.6-0.9 cm. CONCLUSION: Anti-acid and eradication therapy in combination with individual psychotropic therapy (amitriptilin in submissive and nozepam in excitable personalities) reduced the time of DU healing and prevent recurrence for one year.

[Psychophysiological aspects of duodenal ulcer in young patients]. / Psikofiziologicheskie aspekty iazvennoi bolezni dvenadtsatiperstnoi kishki u lits molodogo vozrasta.

SMALL and Spilberg-Khanin questionnaires were used to examine psychological state while statistical and spectral analysis of heart rate at rest and orthostasis to evaluate vegetative status in 86 patients aged 15-24 years with duodenal ulcer (DU). Patients with mild DU had the least psychological and vegetative alterations primarily of the neurotic trend with a relative enhancement of the nervous sympathetic component. A severe disease was characterized by the greatest psychovegetative changes--high SMALL scales, anxiety, stress of the vegetative nervous systems at rest and orthostasis. Thus, alterations in psychic and vegetative status may serve criteria in prediction of DU course in young patients.