THE INFLUENCE OF ANTI HELICOBACTER THERAPY ON THE MUCOUS COAT OF ESOPHAGUS

Z.M. SHAMKHALOV, R. T. SALIMOVA, H.G. HUSEYNOV, N.S. MAGALOVA

Scientific Center of Surgery named after acad. M.A. Topchubashov, Baku,AZERBAIJAN

Numerous observations show that anti-helicobacter therapy (AHT) in the course of treatment often causes changes in the mucous coat (MC) of the stomach (S) and esophagus (E). Purpose of investigation: to assess the general status and condition of the MC of S of patients with different pathologies of E and D before and after the AHT.

In 2009-2011, at the Department of Therapeutic Gastroenterology of the Center there were treated 173 patients (98 men and 75 women) at the age of 17-55 years, average age 36 ± 4,6 years. DU was diagnosed in 87, GU - in 21, H.p.-associated gastritis CSG-in 65 patients. Patients were underwent to all standard studies before and after the course AHT: proton pump inhibitors (PPI) 1^st week - 2 doses/day, 2 - 4th week - 1 dose/s + clarithromycin 500mg 2t/d with 1000 mg of amoxicillin 2t /d within 1 week. The SOP state was estimated according to Savary-Miller classification. Before the treatment patients were divided into 3 groups: 1^st - normal SOP - 32 patients, II - esophagitis (E) of the 1^st degree- 129 patients, III- E of the 2^nd stage - 12 patients. Control EGDS was carried out by the end of the 4th week.

In patients of the 1^st group indistinct symptoms of reflux esophagitis (RE) were observed only in 7 patients, and in the 2^nd and 3^rd groups such complaints were of different degrees of intensity and did not have concurrency endoscopic picture of E. 4 patients dropped out survey for various reasons.

By the end of AHT, in patients of the 1^st group 1 (p = 32) the normal SOP was preserved in 22 patients, with the absence of complaints specific of RE. Of the remaining 10 patients these complaints were insignificant in 6 patients on the background hyperaemia / plaque at the lower / 3 SOP in 4 and addition to this pattern of surface erosions in 2 patients. Patients of the 2^nd group (p = 126) complaint characteristic for RE were absent by end of treatment in 85 (67.4%), remained in 37 (29.4%), increased in 4 patients (3.2%). SOP state improved in 10 (7.9%), remained at 1^st stage of RE in 113 patients(89.7%), and passed to the 2^nd stage in 3 patients (2.4%). In the 3^rd group (p = 11), these complaints disappeared in 5 (45.5%), remained unchanged in 4 (36.4%), increased in 2 (18.2%) patients. SOP state of all patients in this group remained main unchanged.

Thus, we may come to a conclusion that AHT conducted within the specified times and doses reduces symptoms of the RE, while endoscopic picture of MC of E does not change significantly, and even worsens in a number of cases. To our mind, it is advisable to extend the term of assignment of both maximum and supporting doses of PPI after 4 weeks of AHT and add, if necessary, such drugs such as prokinetics, cytoprotectors, and reparants.

GASTRİC TUBERCULOSİS SIMULATED GASTROİNTESTİNAL PYLORİC OBSTRUCTİON

İ. SHEN, O. DORUKOZ, O. GUL UTKU, H. ERDAL, E. KARATAY, M. ARHAN, M. İBİŞ, Ş. DUMLU, S. ÜNAL

Gazi University Faculty of Medicine, Ankara, TURKEY

Most common site for gastrointestinal tuberculosis is the ileocecal region. Gastric tuberculosis without pulmonary involvement is rare and reported as case reports. Mostly reported in male patients. Gastric tuberculosis usually presents as an nonhealing ulcer or gastric outlet obstruction. Ulcers range from a few milimetres to 20cm. The hypertrophic infiltrating type presenting as pyloric obstruction is the second most common type. So far, only one case reported representing as linitis plastica. Here we report a case of gastric tuberculosis presenting as linitis plastica.

Case: A 22 year ols female, 8 months before she was consulted at another clinic for abdominal pain and dyspepsia recieved PPI for 3 months with diagnosis of gastritis. Patient admitted to our clinic with 5 kgs weight loss in one month and abdominal pain dorsal radiation, with occasional vomiting after meals. Her past medical history was unremarkable. Physical examination was normal. Chest X-ray was also normal. Laboratory test revealed only elevated erythrocyte sedimentation rate of 49mm per hour. The tuberculin test showed 18mm induration at the end of 72 hours. Upper gastrointestinal endoskopi demonstrated diffuse marked hyperaemia,thickining of whole gastric folds except prepyloric region, mucosal oedema and there was patchy spontaneous oozing of blood on touch from the gastric mucosa and gastric expansion was extremly limited. Histopathological examination of the endoscopic biopsy showed granulomatous inflammation. Ziehl–Neelsen and kinyoun staining revealed acid-fast bacilli. Quadruple anti-tuberculous treatment was initiated. 8 weeks after on control we observed improvement on appetite and general well-being status, also control endoscopy showed mucosal healing.

Date: 2014-12-28; view: 895