[Features of the upper gastrointestinal tract mucous membrane state in patients with atherosclerosis of the mesenteric arteries].

AIM: To evaluate the clinical and endoscopic features of diseases of the upper gastrointestinal tract (GIT) in patients with atherosclerosis of the mesenteric arteries (MA). MATERIALS AND METHODS: The study included 48 patients with atherosclerosis of MA and 43 patients without atherosclerosis of MA, who were hospitalized in the department of vascular surgery of the Chelyabinsk Regional Clinical Hospital in the period from 2019 to 2021. All patients underwent multispiral computed tomoangiography of the visceral and lower limb arteries, esophagogastroduodenoscopy. RESULTS: Assessment of lesions of the upper gastrointestinal tract revealed a higher incidence of erosive and ulcerative gastroduodenopathies among patients with atherosclerosis of MA (60.4%), compared with patients without atherosclerosis MA (39.5%); p=0.047. Signs of severe atrophy according to the data of histological examination were statistically significantly more frequent among patients with atherosclerosis of MA (29.2 and 11.6%; p=0.031). According to the results of logistic regression, the following predictors of erosions and ulcers of the upper gastrointestinal tract were revealed: the severity of stenosis of the superior mesenteric artery (SMA) is more than 35%, the body mass index (BMI) is less than 25.9 and the total score on the HADS scale is more than 6.5 points for depression (p=0.008). CONCLUSION: Erosive-ulcerative gastroduodenopathies and atrophy of the gastric mucosa are significantly more common in the group of patients with MA atherosclerosis. The main risk factors for erosions and ulcers of the upper gastrointestinal tract in patients with MA atherosclerosis are: the severity of SMA stenosis is more than 35%, a decrease in BMI is less than 25.9 and an increase in the HADS score is more than 6.5 points.

[Clinical implications of chronic mesenteric ischemia in elderly and senile patients].

AIM: To evaluate the sensitivity and specificity of the clinical criteria for the diagnosis of chronic mesenteric ischemia in elderly and senile patients with mesenteric atherosclerosis. MATERIALS AND METHODS: The study included 142 patients (82 men and 60 women). The median age of patients is 66.0 [62.0; 72.0] years. RESULTS: According to MDCT atherosclerotic lesions of the abdominal aorta and its unpaired visceral branches were diagnosed in 105 (73.9%) patients. A combination of atherosclerosis of the celiac trunk and the superior mesenteric artery with the presence of hemodynamically insignificant stenosis was revealed. Hemodynamically significant atherosclerotic narrowing of at least one mesenteric artery was present in 15% of cases. Among them, a single vascular lesion was found in 6 patients (4.2%), a combination of hemodynamically significant lesions of two arteries in 15 (11%) patients. Depending on the clinical manifestations, all patients are divided into two groups: the first group 30 (21.1%) patients with the presence of symptoms characteristic of chronic mesenteric ischemia (CMI). The second group consisted of 112 (78.8%) patients without a characteristic triad of symptoms. The clinical symptom complex of СMI, including postprandial abdominal pain, intestinal dysfunction and progressive weight loss, as a diagnostic criterion showed low sensitivity 13.3% and specificity 77.9%. At the same time, the sensitivity of such a clinical combination as a combination of atherosclerosis of the arteries of the lower extremities, weight loss and abdominal pain syndrome with a severity of more than 5.5 points, with respect to the detection of hemodynamically significant stenoses of two or more mesenteric arteries was sensitivity 86.7%, specificity 74.0%.

Prognosis factors of survival in patients with liver cirrhosis and portal hypertension.

AIM: To study prognostic factors for survival in patients of liver cirrhosis (LC) with portal hypertension (PG). MATERIALS AND METHODS: 155 patients (women - 49.4%, men - 50.6%, median age 56.4 years [51.3; 61.6]) were follow up for 36 months. Viral LC was diagnosed in 33.8%, alcohol LC - 22.1%, autoimmune LC - 15.6%, other causes and cryptogenic causes noted in - 28.5%. More than half of the patients had a class В of Child-Pugh (51.9%). RESULTS: During the study period 42 patients (28.3%) died. The analysis of survival by various factors for Kaplan-Mayer was carried out. Significant predictors: Child-Pugh class, LC etiology, comorbidity in Charlson scores, adherence to endoscopic treatment of esophageal varices were included in the model of proportional Cox risks. In a single-factor analysis, the risk of death is higher in patients who violate the timing of endoscopic treatment, but this factor has lost significance in the multifactor model. Patient with Child-Pugh C, alcoholic LC, comorbidity more 5 points by Charlson score have a higher mortality risk. CONCLUSION: Identification of risk factors that affect the survival of LC patients will allow to use of an individual plan for the LC treatment and prevention of PG complications.

[Abdominal pain in migraine patients]. / Abdominal'naia bol' u bol'nykh c migren'iu.

AIM: To study the frequency of comorbid abdominal pain in migraine patients and the influence of that symptom on the formation of disease phenotype. MATERIAL AND METHODS: Clinical features of migraine were studied in 66 patients with episodic migraine and 40 patients with chronic migraine. Presence of pain, intensity, duration of seizure-associated abdominal pain and interictal abdominal pain were assessed. RESULTS AND CONCLUSION: The frequency of abdominal pain in the painful phase of migraine was >11% and did not depend on the type of migraine. Pain in the abdomen were reported by 88% of patients, with the increase in the frequency in patients with chronic migraine. The intensity and frequency of abdominal pain did not depend on organic pathology of the digestive system. Correlations between the intensity and duration of abdominal pain during the migraine attack phase (k=0.59), between the intensity of associated pain and maladjustment severity (k=0.59), and also between the abdominal pain intensity during the painful phase and in the interictal period were identified. Allodynia developed more frequently in patients with abdominal pain between migraine attacks (РF=0.005). Also relationships between the level of intensity of interictal abdominal pain and the rates of alexithymia (k=0.24), anxiety (k=0.29) and depression (k=0.25) were revealed. The association of abdominal pain with disease severity and allodynia suggests similar development of these symptoms.

[Clinical significance of nausea in migraine]. / Klinicheskoe znachenie toshnoty pri migreni.

AIM: To study the prevalence and intensity of nausea in pain, prodromal and postdromal phases of migraine paroxysm, and in between the paroxysms in migraine patients, depending on the type of migraine paroxysm and frequency of pain days, and to evaluate an effect of nausea on the course of migraine. MATERIAL AND METHODS: One hundred and four patients with migraine, aged from 18 to 60 years, were examined. The intensity of nausea was evaluated by a 5-point verbal analogue scale, and its intensity in between the paroxysms by the Gastrointestinal Symptom Rating Scale. All of the patients underwent a complex examination of the gastrointestinal tract. RESULTS AND CONCLUSION: Paroxysms with accompanying nausea were found in 90% patients. Acute nausea was associated with older age, earlier onset and longer experience of migraine. In a group of patients with acute nausea, the frequency and intensity of migraine paroxysms, probability of reoccuring pain in the first day and the severity of social disability were higher. Development of nausea in between the paroxysms and its intensity was significantly higher in patients with high intensity of nausea in migraine paroxysms. Nausea in the prodrome was significantly associated with migraine without aura and chronicity of the disorder. Patients with nausea in the prodrome also had a longer painful phase and more severe social disability. No relationship between organic diseases of the digestive tract and nausea was found. Nausea can have its own pathological mechanisms not related to concomitant diseases of the digestive tract that should be taken into account in therapeutic interventions aimed at improving quality of life of the patients.

[ANALYSIS OF THE EFFECTIVENESS OF DIFFERENT METHODS OF HEMOSTASIS AND PREVENTION OF BLEEDING IN PORTAL HYPERTENSION].

The review presents the whole range of modern methods of hemostasis and prevention of bleeding in patients with portal hypertension, assessed the effectiveness of each.

[Clinical and immunological study of the relationship of the digestive system chronic diseases and atherosclerosis in the basin of the abdominal aorta in elderly patients].

Paper describes clinical and immunological study about the relationship between chronic diseases of the digestive system and atherosclerosis in the basin of the abdominal aorta in patients of elderly and senile age. There were revealed the structural and clinical features of the gastrointestinal tract diseases, depending on the extent of atherosclerosis in the basin of the abdominal aorta. Evaluation of the immune status included the determination of lymphocyte subpopulation composition, the functional state of neutrophils and cytokine levels. It is found that the progression of atherosclerosis in the basin of the abdominal aorta in patients of elderly and senile age with chronic diseases of the digestive system was accompanied by the activation of pro-inflammatory mechanisms of the immune system and the accompanying intensification of oxidative stress.

[Pathological features of coronary heart disease in patient of elderly and senile age depending on a blood flow condition in the abdominal aorta].

AIM: To perform the analysis of correlation of clinical symptoms and laboratory sings in patients of elderly and senile age with coronary heart disease depending on a blood flow condition in the pool of abdominal aorta. MATERIAL AND METHODS: Longitudinal clinical research was conducted. The register was made by 132 patients of elderly and senile age with coronary heart disease being on treatment during the period since 2013-2014. RESULTS: Results of the research of correlation of clinical symptoms and indexes of lipidemia in patients of elderly and senile age with coronary heart disease depending on a blood flow condition in the pool of abdominal aorta are performed. CONCLUSION: Specific features of the cardiovascular pathology and a course of coronary heart disease in combination with atherosclerosis of the abdominal aorta and its visceral branches are revealed.

[Efficacy of emoxipine and mexidol in patients with chronic disorders of the digestive system and atherosclerosis of the abdominal aorta].

The influence of emoxipine (2-ethyl-6-methyl-3-hydroxypyridine hydrochloride) and mexidol (2-ethyl-6-methyl-3-hydroxypyridine succinate) on the content of lipid peroxidation products in peripheral blood and the dynamics of clinical symptoms of gastrointestinal tract pathology has been studied in patients of middle and senile age with atherosclerosis in the abdominal aorta. It is established that a two-week 3-hydroxypyridine derivatives leads to a decrease in the level of lipid peroxidation products. The administration of emoxipine led to the most pronounced control of pain.

[Comparison of the state of the gastrointestinal tract with the values of lipids and their peroxidation in patients with atheromatosis of the celiac trunk].

The values of lipidemia were studied, by comparing with the levels of lipid peroxidation products and the state of antioxidant defense in patients with atheromatosis of the celiac trunk. A group of patients with ischemic enterocolonopathies showed a trend for the level of low-density lipoprotein cholesterol to increase as compared with abnormalities at other sites. In patients with ischemic gastropathies, the levels of heptane-soluble ketodienes and conjugated trienes were higher than those in patients with pancreatopathies and enterocolonopathies.

[Impact of Bestim on the immunological status and clinical course of ulcer]. / Vliianie bestima na immunologicheskii status i klinicheskoe techenie bolezni.

Ulcer disease is accompanied by all immune responses with the development of secondary immune deficiency. This makes it necessary to include immunomodulators into the complex antiulcer treatment. The application of a new drug Bestim in the combined antiulcer treatment affects the immune state of the patients favourably. It decreases the inflammatory effect in the stomach and duodenal mucosa, it precipitate regress of clinical symptoms and scarring of the ulcer.