["High" and "low" gastric ulcers in posthelicobacterial era--is this division vital?].

AIM OF INVESTIGATION: To specify etiopathogenetical characteristics of the disease in case of "high" and "low" gastric ulcers. MATERIALS AND METHODS: 96 patients with relapse of gastric ulcer disease (GUD) were examined, median age 41 +/- 3.1 years, 71.9% of male patients, 28.1% of female patients. The first group included 58 patients with "high" ulcer, the second included 38 patients with pyloroantral ulcer. All patients underwent esophagogastroduodenoscopy and 24-hour intragastric pH-metry prior to the prescription of antisecretory therapy. The results of the examination were compared with data of 100 healthy subjects. RESULTS: Intragastric acidity in case of "high" ulcers, by value of fundal and antral pH and its circadian dynamics, was comparable to that of the healthy people. By the frequency of duodenogastral reflux (DGR) close to normal the total duration was significantly higher because of considerable increase of portion of long and high refluxes. High acidity in corpus and antral region, absence of the normal daily variations, significant increase of night acidity, decrease of DGR frequency and duration were noted by "low" gastric ulcers. CONCLUSIONS: In case of "high" localization of gastric ulcer normal acidity production and unusual high and enduring duodenogastral refluxes are revealed more often; combination of high hyperacidity and pronounced depression of duodenogastral reflux are seen in case of pyloroantral ulcer.

[Clinical and endoscopic features and treatment problems in patients with perforated duodenal ulcer].

AIM: To compare clinical and endoscopic findings and standard therapy results in duodenal ulcer disease (DUD) patients with and without a history of perforated ulcer. SUBJECTS AND METHODS: One hundred and thirteen patients with recurrent DUD, including 61 patients with uncomplicated DUD (Group 1) and 52 patients with a history of perforated ulcer (Group 2) were examined. Esophagogastroduodenoscopy (EGDS) and 24-hour pH-metry were performed in addition to physical examination. Ulcer scarring was evaluated during control EGDS. RESULTS: 75% of the patients with uncomplicated DUD were observed to have classical pain syndrome and the pain was milder, more extensive, and food-unrelated in the patients who had sustained perforation. Decreased appetite was more common in uncomplicated DUD (35%). EGDS showed that complicated DUD was accompanied by a significantly higher detection rate of erosive esophagitis (20%), gastritis (52%), duodenitis (25%), multiple ulcers (28%), and larger ulcer sizes. 35% of the patients who had experienced duodenal ulcer perforation exhibited an inadequate antisecretory effect of standard omeprazole doses, which was followed by the increase in ulcer scarring time by an average of 1.2 days. CONCLUSION: In the patients with perforated DUD, the history was typified by less pronounced, more extended, and food-unrelated pain, esophageal and gastroduodenal erosive damages, multiple ulcerative defects, large ulcer sizes than in those with uncomplicated DUD, as well as resistance to standard omeprazole dose in one third of the cases, and delayed ulcer scarring.

[Characteristics of duodenogastric reflux in duodenal ulcer patients and its dynamics after Helicobacter pylori eradication].

UNLABELLED: Studying role of duodenogastric reflux (DGR) in pathogenesis and sanogenesis of duodenal ulcer (DU). MATERIAL AND METHODS: 233 DU patients (92 patients with a mild, 45--with modern and 96--with the complicated current of disease) are surveyed. Control group were 100 healthy volunteers. Clinical research, endoscopy and 24-hours pH-metria was carried out. In a year after eradication Helicobacter pylori (Hp) 30 patients are repeatedly surveyed. RESULTS: at healthy acidity more low, and DGR above and more for a long time, than at DU patients. DU was especially supressed at complicated current DU. Eradication Hp was accompanied by acidity normalization only at mild DU, and at complicated DU--is not present. CONCLUSION: at healthy people DGR arises in reply to antrum's acidification and has compensative value, and at DU there is the considerable suppression leading to insufficiency of antrum's alkalization. After eradication Hp normalization DGR is marked only at mild current DU.

[What contributes to the transformation of Helicobacter pylori from symbiont into the etiopathogenetical factor of duodenal ulcer?].

UNLABELLED: The aim was to study the relationship duodenogastral reflux (DGR) and Helicobacterpylori infection (Hp) at duodenal ulcer (DU). MATERIAL AND METHODS: Group 1-50 patients with uncomplicated course of DU, Group 2-75 patients with destructive complications of DU; Group 3-40 "healthy" volunteers. It was performed daily EGDS, pH meter, semi-quantitative assessment of contamination of the Hp. RESULTS: The acidity in the body of the stomach was highest in group 2, and lowest--in group 3, patients diagnosed DU night rush giperatsidnosti. In the night period patients from the 1st and 3rd groups were recorded an increase of antral pH, including the expense of growth duration of DGR, while in group 2 reflux was extremely short. The maximum Hp dissemination was in a bulb at fetomaternal of DU. CONCLUSIONS: in healthy individuals DGR intragastral involved in the regulation of pH, in patients with uncomplicated DU while reducing the duration of this resonance persists compensation of antral alkalization, and complications throughout the DGR sharply depressed, which is accompanied by severe decompensation alkalization of antrum. Bulbs semination with Hp inversely proportional to the intensity of this resonance.

[Clinical value of time course changes in postprandial intragastric acidity].

AIM: to study the level and duration of postprandial pH abnormalities in the body of the stomach in healthy individuals and in patients with duodenal peptic ulcer (DPU). SUBJECTS AND METHODS: 24-hour pH-metry was used to study the degree and duration of postprandial pH abnormalities in the body of the stomach in 50 healthy individuals and 188 patients with DPU. RESULTS: Interdigestive gastric pH in healthy individuals was significantly higher than that in patients with DPU; food intake was followed by an 86 +/- 3.4% increase in pH, the latter returned to the baseline pH values within 64.7-70.3 minutes. In the uncomplicated course of DPU, the mean postprandial pH increase was comparable in the level and duration with the similar indices in healthy individuals. Complicated DPU was characterized by a short-term and insignificant increase in postprandial pH. CONCLUSION: The mean postprandial pH increase and the time of its return to the baseline level in uncomplicated DPU were comparable with those in healthy individuals; there was a significant reduction in these indices in complicated DPU.

[Circadian rhythms of acid production and alkalization in the stomach of healthy subjects and duodenal ulcer patients].

We studied 24-h rhythms of acid production and alkalization in 30 patients with duodenal ulcer (DU) and 30 healthy subjects using upper endoscopic examination and computer intragastric pH-metry. Gastric acid production was higher in DU patients and was more intensive in the daytime than at night. Healthy subjects had low and monotonous acid production. In DU decompensation of alkalization in the antral stomach and suppression of duodenogastric reflux is total. In healthy subjects antrum alkalization is more evident and intensive at night due to, among other causes, duodenogastric reflux.

[Painful syndrome in patients with ulcer disease in relation to intragastric pH].

Painful abdominal syndrome and diurnal fluctuations of pH values were investigated in 125 patients with different clinical variants of duodenal ulcer disease (DUD) in the phase of exacerbation. Fifty patients had uncomplicated DUD; it was complicated in the remaining 75 patients. The clinical course of the uncomplicated disease was characterized by moderate to severe painful hyperacidity syndrome coincident with the period of exacerbation, marked daily variations of pH, and manifest duodenogastric reflux (DGR). These made the patients opportunely apply for medical aid while acidification and alkalinization processes in the stomach prevented the development of complications. The complicated disease was associated with short-term pain or its absence, monotonic diurnal variations of acid production and alkalinization, weak DGR. Taken together, these clinical features explain why such patients less frequently apply for medical aid and eventually develop destructive complications.

[Clinical significance of "night acid burst" phenomenon in patients with duodenal ulcer].

The article discloses the results of the examination and treatment of duodenal ulcer patients with or without "nocturnal gastric acid breakthrough". This phenomenon was recorded in 19% patients. They have night heartburn, complicated duodenal ulcer in anamnesis, on the one hand, and more long duration of ulcer healing, decreasing efficiency of eradication Helicobacter pylori, on the other hand.

[Characteristics of the psychological status of patients with peptic ulcer].

The article discusses changes in the psychological status and the forming of various types of attitude towards the disease in patients with a favorable and unfavorable course of peptic ulcer (PU). The subjects of the study were 82 patients with exacerbation of PU; among them there were 30 patients with a favorable and 52 patient with a complicated course. Patients with a favorable course of PU did not displayed prominent peaks in SMOL profile, which reflected a relatively benign state of their psychological status. Favorable type of response to the disease--harmonic and anosognostic--with lesser social disadaptation prevailed in these patients. On the contrary, patients with a complicated course of PU displayed a relative increase in the profile on the scales, reflecting a higher tension in combination with diadaptive response to the disesase, which should be taking into account when correcting treatment.

[Quantitative-qualitative assessment of duodenogastric reflux at 24-h pH-metry].

AIM: To study characteristics (other than duration) of duodenogastric reflux (DGR), correlations of secretory function and DGR characteristics with gastroduodenal disorders (ulcer, chronic hyperacid gastritis). MATERIAL AND METHODS: A total of 110 patients were examined with 24-h pH-metry: 68 patients with duodenal ulcer (DU), 15 patients with gastric ulcer (GU), 27 patients with chronic hyperacid gastritis (CHG). Mean levels of pH and duration of hyperacidity in the body and an antral part of the stomach, duration of DGR, pH in the body and antral part of the stomach depending on DGR severity were studied. RESULTS: DGR was registered almost in all the patients with DU, GU and CHG. Groups of the patients differed by duration and height" of the DGR. CONCLUSION: Patients with DU are characterized by low refluxes which do not reach gastric body.

[On correlations between the clinical course of peptic ulcer and the patients, compliance and quality of life].

The article is dedicated to changes in life quality (LQ) and mental status, and to forming of various types of response to the disease in patients with benign and unfavorable course of peptic ulcer (PU). The subjects were 140 patients in acute phase of PU, in 66 of whom the course of the disease was benign, and in 74--unfavorable. In both groups there were patients with low and satisfactory LQ. High level of nervousness was typical of patients with low LQ and benign course of the disease. Patients with satisfactory LQ and unfavorable course of the disease were characterized by minor personality changes, but developed an agnostic response to the disease much more frequently. Reduction of compliance was found mainly in patients with low LQ and an agnostic response; this should be taken into consideration while correcting the therapy.

[Role of duodenogastric reflus in pathogenesis of duodenal ulcer]. / O roli duodenogastral'nogo refliuksa v patogeneze iazvennoi bolezni dvenadtsatiperstnoi kishki.

Duodenal ulcer is characterized by certain recurrence and occurs more often in men than in women. One can assume that functional changes, which are characterized by the seasonal nature and sex differences, play some role in its pathogenesis. There was a study of the duodenogastric reflux role in the pathogenesis of duodenal ulcer. It was revealed that duodenal reflux is provoked in about one half of patients sent for an endoscopic examination, less frequently--in spring and autumn, and least of all--in male patients with duodenal ulcer during seasons of the maximum frequency of duodenal ulcer exacerbations. The frequency of duodenogastric reflux provocation went down on days of geomagnetic storms. One could observe certain dependence between the extent and duration of reflux, on the one hand, and clinical registration of the disease, on the other hand.

[Gastroduodenal reflex in duodenal ulcer and chronic hyperacidic gastritis]. / Duodenogasteral'nyi refliuks pri iazvennoi bolezni dvenadtsiatiperstvoi kishki i khronicheskom giperatsidnom gastritom.

AIM: To study motor and secretory function of the stomach and duodenum in duodenal ulcer (DU) and chronic hyperacidic gastritis (CHG). MATERIAL AND METHODS: Autonomic nervous system was studied and esophagogastroduodenoscopy, 24-h intragastric pH-metry were made in 42 DU and 20 CHG patients. RESULTS: In comparable secretion, the patients of the above groups differed by severity and frequency of duodenogastric reflux (DGR). Grave and moderate DGR was typical for CHG and DU in the absence of complications. Minimal DGR occurred in DU with complications. CONCLUSION: DGR severity may be of prognostic significance for DU course.

[Circadian monitoring of intragastric pH in evaluation of efficiency of antisecretory therapy of duodenal ulcer]. / Sutochnoe monitorirovanie vnutrizheludochnoi kislotnosti v otsenke éffektivnosti antisekretornoi terapii iazvennoi bolezni dvenadtsatiperstnoi kishki.

Inhibitors of proton pump are thought "golden standard" in the treatment of ulcer. Usage of omeprasol generics in standard doses sometimes fail to adequately reduce acid production. In pain persistence in patients with duodenal ulcer receiving standard antisecretory therapy it is effective to control it with 24-h intragastric pH-metry which either indicate the necessity of dose correction or another cause of pain (concomitant affections as a rule). As shown by 24-h pH-metry, a new generic of omeprasol, omeprus, is close by effectiveness to the known drug omeaz.

[Life quality, mental status and specific features of the course of diseases in patients with peptic ulcer]. / Kachestvo zhizni, psikhologicheskii status i osobennosti techeniia zabolevaniia u bol'nykh pri iazvennoi bolezni.

At present, medicine pays a great attention to studies into life quality (LQ) in patients. A relationship is examined between LQ and the course of a disease and the personality traits of a patient. Sixty patients with peptic ulcer (PU) were included in this study. The questionnaires filled by the patients were used to assess their LQ and the factors that modify LQ to the greatest degree, as well as personality traits and pain perception in patients. The same aspect of the patients' life was additionally evaluated by physicians. Studies indicated that LQ in patients was regularly decreased with their worse health. At the same time, there were increases in the degree of emotional stress and in the proportion of patients with depressive-hypochondriac personality traits and higher pain perception. At the same time the patients' emotional experiences and neurotization rather than the course of a disease were found to predominantly affect LQ. This is likely to be borne in mind in managing such patients.

[Somatoform disorders in ulcers]. / Somatopsikhovegetativnye narusheniia pri iazvennoi bolezni.

We studied correlations between psychoemotional and vegetative disorders in ulcer. 60 patients with ulcer varying in severity were examined. The severity was judged by the disease history, endoscopic and x-ray findings. Emotional and personality characteristics were evaluated by answers in special questionnaires, vegetative deviations were studied with special tests, scale, cardiointervalogram. It was found that more severe course of ulcer correlated with growing vegetative dysfunction. The progressive ulcer course ran with predominance of sympathetic autonomic nervous system and is accompanied with marked psychoemotional tension and development of anxiodepressive personality traits.

[Neurophysiological mechanisms of the cortical-subcortical interrelationships in the organization of behavior]. / Neirofiziologicheskie mekhanizmy korkovo-podkorkovykh vzaimootnoshenii v organizatsii povedeniia.

Specific intersystem relationships seem to exist characterising interrelationships among neurons within pools of which plasticity of a single neuron is able to maintain integration processes of the whole system. The neurons under study seem to become united into various functional blocks during different phases of conditioned behaviour which determines a formation of a dominant condition of the centres and vectors of a specific behavioural action in a given situation and at a given time.