SOME PROPERTIES OF THE CLINICAL COURSE AND TREATMENT OF GASTROESOPHAGEAL REFLUX DURING GASTRIC AND DUODENAL ULCER

A.N.YUSIFOVA

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

According to the latest data of the World Health Organization, the increase of gastroesophageal reflux is observed on the background of reduction of duodenal ulcer. Moreover, there is a growth tendency in the joint occurrence of duodenal ulcers and reflux esophagitis. According to different authors, joint appearance of the diseases occur in 50% of cases. Formation of reflux-esophagitis during duodenal ulcer changes clinical symptoms pf the ucer disease, that significantly complicates timely detection of the main disease. Therefore, the purpose of the works is to study some properties of the clinical course of gastroesophageal reflux in addition to the gastric and duodenal ulcer.

To achieve the set purpose clinical, endoscopic and morphologic properties of the mucous tunic of esophagus in 70 patients were studied. Moreover, there was carried out dynamic assessment of clinical-endoscopic properties and morphologic changes of the esophagus of patients in which joint reflux-esophagitis and gastroesophageal reflux occurs after long-term treatment with antihelicobacterial and antisecretory drugs. As a result of conducted examinations, there was worked out a scientifically grounded approach to the treatment tactics of patients with gastroesophageal reflux. In addition, clinical and morphologic criteria of esophagitis of prognostic significance in the course of reflux-esophagitis. It was determined, that formation and course of gastroesophageal reflux is closely connected with gastritis associated with Helicobacter pylori that makes it possible to consider Helicobacter pylori infection as a background factor of formation of gastroesophageal reflux disease.

As a result of conducted examinations, there were worked out adequate approaches to diagnostics and treatment of reflux-esophagitis in patients with gastroesophageal reflux associated with Helicobacter pylori. The necessity of long-term antisecretory treatment was grounded by consideration of dynamics of the results of morphologic investigations. All the abovementioned obviously proves advantages of offered pathogenetic treatment of gastroesophageal reflux during the gastric and duodenal ulcer.

OCCURENCE RATE OF ESOPHAGITISES

A.N.YUSIFOVA

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

Despite the recent significant achievements in the diagnostics and treatment of esophagitis, there are a number of problems in the pathology. If to consider that gastroesophageal reflux is one of the mostly occurred disease, then the urgency of the problem becomes clear. The main purpose of the work was to determine occurrence rate of esophagitis disease based on archive materials.

Results of 63584 patients examined in 1990 – 2008 in Ibn Sina Hospital of Ankara University and Endoscopic Center of Jebeji Clinics were retrospectively assessed in the result of the endoscopy of upper-gastrointestinal system. All the patients were exposed to esophagogastroduodenoscopic examination by means of Fujinon (Japan) videoendoscopic system representing a combination of Processor EPX – 201H and EG 201FP endoscope. Division of the esophagitis into stages was carried out based on the Savary – Miller and since 1999 on Los Angeles classification. The age, sex and endoscopic results of patients associated with esophagitis (diaphragmatic hernia, duodenal ulcer, bulbus deformation, gastric ulcer, pyloric stenosis, gastric surgery, gastritis, bile gastritis) were noted.

52,9% of 63854 patients exposed to endoscopy were women. Average age limit was 46,75 (15 – 98). In 10275 patients there was observed esophagitis. In 61,9% of them 1^st degree, in 26,5% - 2^nd degree, in 8,1% - 3^rd degree and in 3,4% 4^th degree esophagitis was determined. The more the age of patients, the more was occurrence rate and severity of esophagitis (<20 years: 14,6%, 21 – 30 years: 17,5%, 31 – 40 years: 19,7%, 51 – 60 years: 19%, 61 – 70 years: 18,6%, 71 – 80 years: 21,4%) (p = 0,0001). Esophagitis mainly occurred in men and was at higher degree. In every five-year assessments from 1990 up to date there was noted linear growth in the occurrence rate of esophagitis (1990 – 1994: 11,2%, 1995 – 1999: 12,7%, 2000- 2004: 19,9%, 2005 – 2008: 20,9%) (p =0,0001). In multivariate analysis variation of esophagitis in connection with male sex, duodenal ulcer, pyloric narrowness, diaphragmatic hernia, lower esophageal cardio-insufficiency, antral gastritis, pangastritis was determined.

During endoscopic analyses in about twenty-year assessment the detection rate was 16,1%. Growth in the occurrence rate of esophagitis in 2000s as compared to 1990’s was observed. In 88,4% of the investigated cases mild degree (I + II degree) esophagitis was encountered. In such cases of diaphragmatic narrowness, lower esophageal cardio-insufficiency, pyloric stenosis and peptic ulcer the occurrence rate of esophagitis was higher.

CHARACTERISTIC FEATURES OF MICROCIRCULATORY BED AND STATE OF IMMUNE STATUS IN GASTRODUODENAL ULCER DISEASE

Sh.Y. ZAKIRKHODJAEV, D.A. PARPIBAEVA, N.M. NARZIEV, B.N. NURIDDINOV

Tashkent Medical Academy, Ibn Sino International Foundation, Tashkent, UZBEKISTAN

The gastrointestinal tract is one of the main routs of pesticide administration into body then it is naturally reflected on the morphological and hemocirculatory bed that results in effect on the character of morphofunctional changes of this organ.

Purpose: To study characteristics microcirculatory bed and gastroduodenal tissue structures in the patients with gastroduodenal ulcer during the period of rehabilitation and correction of traditional antiulcerous therapy with drug Vazonit retard 600 mg.

Clinical investigations: The study was performed on 38 patients with main diagnosis of gastroduodenal ulcer disease. The patients were divided into 2 groups, group 1 received traditional antiulcerous therapy ranitidine daily dose 300 mg, amoxicilline daily dose 1000 mg, metronidasole daily dose 500 mg, group received additionally to the traditional therapy Vazonit, daily dose 600 mg, beginning from the 15^th day after onset of the traditional antiulcerous therapy during 30 days.

Results: In patients from group 1 there was noted stopping of the pain and dyspeptic syndromes on the 8-10 day of therapy, however microcirculatory disturbances preserved. The content of absolute and relative (percentage) content of T-lymphocytes was reduced 40-53%. Group 2- the pain syndrome disappeared on the 6-7 days after therapy, arteriole spastic state was liquidated, the number of functioning capillaries increased, and morphologic changes reduced. Inclusion of Vazonit into the treatment resulted in increase of he CD3+, CD8+ contents in the peripheral blood, normalized the Ig A content, provided elimination of cerebral circulation disorders.

MORPHOLOGICAL CHARACTERISTICS AND HEMOC1RCULATION

OF THE ULCER IN PATIENTS WITH DUODENAL ULCER DISEASE

Sh.Y. ZAKIRKHOJAEV, D.A. KARIMOVA, G.B. SADRIDDINOVA,

N.M. NARZIEV

Tashkent Medical Academy, Tashkent, UZBEKISTAN

Possible mechanisms of ulcer genesis in patients for a long time are discussed. However, now the problem remains unresolved.

The purpose of the present research was to analyze morphological and hemo-circulation pictures of duodenal ulcer in patients with duodenal ulcer disease.

Materials of research were 27 patients with duodenal ulcer. Endoscopy has found the phenomena of the moderate hypostasis and hyperemia of the mucous membrane in stomach and duodenum. Erosive-inflammatory defects of mucosa were mainly established in proximal portion of the duodenum, and also a syndrome of duodenal regurgitation. Expressed inflammatory changes of mucous membrane of the duodenum were revealed in 24% examinees.

Result of studying of the biopsies is established; that among surveyed it is most widespread sharply expressed duodenitis without an atrophy of a mucous membrane. The quantity bokal cells are sharply increased. In own plate mucosa environments cellular infiltration it has been strengthened basically due to lymphocytes and plasmatic cells. In patients the mucous membrane of duodenum with the phenomena moderately expressed duodenitis without atrophy

has not been changed. Quantity bokal cells moderately increased both in fuzz, and in crypts. At duodenitis with an atrophy of the mucous membrane last was sharply thinned, and fuzzes are truncated and enlarged. The quantity bokal cells have been reduced in crypts.

Date: 2014-12-28; view: 985