[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.

[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.

[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.

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.

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 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.

[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.

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.

[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.

[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.

Personality profiles of patients with duodenal ulcer.

Cluster analysis of personality profiles determined by the Sixteen Personality Factor Questionnaire separated 79 patients with duodenal ulcer into three homogeneous subgroups: 32 dependent and anxious patients, 31 neurotic and anxious patients, and 16 patients with a balanced personality. No significant differences among these three groups emerged for the variables of age, sex, duration of illness, fasting total serum pepsinogen, fasting serum pepsinogen group I, and number of cigarettes smoked per day, although there was a nonsignificant trend for both pepsinogen values to be higher in the patients with a balanced personality than in the other two groups. These results support the concept of heterogeneity of peptic ulcer disease.

Abdominal pain and the emotions.

Sites in the gut that are related to pain are reviewed with respect to the special psychophysiological factors that operate locally. Topics considered are the irritable bowel, appendicitis and appendicectomy, duodenal ulceration and biliary disorders. Psychological states that promote the complaint or experience of abdominal pain are discussed. Possible psychological mechanisms are considered for abdominal pain with the reservation that we still do not know even the main physical mechanisms of pain related to gut disturbance.

Acute gastro-intestinal bleeding in the critically ill patient.

Endoscopic studies have shown that all critically ill patients are liable to a degree of stress ulceration. Diffuse erosions appear first in the fundus and then spread to the corpus and antrum within 48 h. Duodenal disease is particularly common in burns patients. Discrete ulceration occurs in most severely injured patients. Mucosal damage is probably initiated by ischaemia but only develops in the presence of acid. Although related to the severity of underlying illness, haemorrhage is unpredictable. Mortality is high and largely unaffected by treatment. Emphasis should therefore be made on prophylaxis. Improved intensive reducing intra-luminal acid by antacid or H2 receptor antagonists appears to be the most effective measure, but controlled studies are required.

Prevalence of Helicobacter pylori infection in stress-induced gastric mucosal injury.

OBJECTIVE: To determine the role of Helicobacter pylori infection in critically ill patients admitted to the intensive care unit in the formation of gastric and duodenal mucosal injury in these patients. DESIGN AND SETTING: Prospective cohort analysis in an 18-bed mixed medical and surgical closed format ICU in a teaching hospital. PATIENTS: Fifty consecutive patients admitted to the intensive care unit for emergency reasons and requiring mechanical ventilation were included. INTERVENTIONS: H. pylori infection was detected by the laser-assisted ratio analyzer [13C]urea breath test (UBT). Gastric and duodenal mucosal lesions were assessed by upper gastrointestinal endoscopy and classified as minor (up to five erosions or submucosal hemorrhages) or major (more than five erosions or submucosal hemorrhages) mucosal injury. MEASUREMENTS AND MAIN RESULTS: Six patients were not eligible because the UBT could not be processed. Of the 44 eligible patients 22 were H. pylori positive by UBT and 22 H. pylori negative. Either minor or major gastric mucosal injury was found on endoscopy in 66 %. Of the 29 patients with minor mucosal injury 10 (34.5 %) were infected with H. pylori as indicated by positive LARA 13C-UBT. In contrast, of the 15 patients with major mucosal injury 12 (80%) were infected with H. pylori (p = 0.004). H. pylori was the only risk factor significantly associated with major mucosal injury in a multiple regression analysis (p = 0.019). CONCLUSION: The severity of gastric and duodenal mucosal injury in critically ill patients during mechanical ventilation is significantly correlated with the presence of H. pylori infection.

Cimetidine affords protection equal to antacids in prevention of stress ulceration following thermal injury.

A prospective, randomized, double-blind, endoscopic study is described in which the efficacy of cimetidine (13 patients) is compared to that of antacids (14 patients) in the prevention of stress ulceration following severe thermal injury. Each treatment modality was equally effective in the prevention of acute gastroduodenal disease and its associated complications. Both cimetidine and antacids produced a near elimination of duodenal disease and markedly reduced the severity of gastric disease when compared to that of untreated historical controls. Lack of major side effects and ease of administration make cimetidine an attractive alternative to antacid therapy in the prophylaxis of stress-induced gastroduodenal disease in the thermally injured patient.

Doxepin and cimetidine in the treatment of duodenal ulcer: a double-blind comparative study.

Twenty-one patients with endoscopically proven active duodenal ulcers were studied in a double-blind randomized trial comparing doxepin hydrochloride (50 mg during the first week, and 100 mg thereafter, at bedtime) and cimetidine (1,200 mg/day in four divided doses). After two weeks, the average size of the ulcers had decreased 94% in the doxepin group (n = 8) versus 66% in the cimetidine group (n = 13) (P less than 0.01). After six weeks, the average size of the ulcers had decreased 97% in both the doxepin group (n = 5) and the cimetidine group (n = 10). Doxepin was significantly (P less than 0.01) more effective than cimetidine in women. Although cimetidine was less effective than doxepin, it was more effective in men than in women. Neither drug significantly altered ratings of the patients' anxiety or depression, most of which were within the normal range before and throughout treatment. Possible mechanisms of action of this tricyclic antidepressant and suggestions for its use in ulcer therapy are discussed.

Psychologic factors associated with peptic ulcer disease.

Peptic ulcer disease provides an excellent model for the study of mind-body interactions in the pathogenesis and course of an illness. Early psychodynamic explanations of the role of personality factors in the evolution of peptic ulcer disease have been supplemented in recent years by more scientifically based studies on the role of stress and coping ability. Multiple psychosocial variables have confounded the outcome of many of these studies. Yet, a clear need and guidelines exist for the comprehensive medical and psychosocial evaluation and treatment of patients with peptic ulcer disease. Concomitant psychiatric assessment and management, including psychotherapeutic and psychopharmacologic approaches, for those patients with refractory symptoms or ongoing psychiatric symptoms carried out in close collaboration with primary caregivers will significantly decrease overall morbidity and mortality.