DOI: https://doi.org/10.22141/2308-2097.53.4.2019.182400

Aggressive and protective factors of gastric juice in patients with pyloroduodenal stenosis of the ulcerative origin

V.M. Ratchik, S.O. Tarabarov, A.I. Rudenko, N.V. Prolom

Abstract


Background. The purpose was to evaluate the aggressive and protective properties of gastric juice depending on the severity of pyloroduodenal stenosis in patients with severe peptic ulcer disease. Materials and methods. In 2014–2019, 157 patients with different degrees of pyloroduodenal stenosis of ulcerative origin were examined at the Department of Surgery of the Digestive Organs of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”. Of these, 92 patients with compensated and subcompensated degree of stenosis were selected for the study of gastric acid and mucus production, among which there were 71 men and 21 women aged 38–56 years, mean age (45.3 ± 5.2) years. Patients were divided into 2 groups depending on the degree of stenosis: group 1 — 57 persons with compensated stenosis, group 2 — 35 patients with subcompensated stenosis. The control group consisted of 20 apparently healthy individuals. In gastric contents, we determined: pH level, concentration of pepsin, glycoproteins, hexosamines, fucose, sialic acids. Results. Analysis of the levels of acid and mucus production in piloroduodenal stenosis of varying severity showed that in patients with subcompensated stenosis, there was an increase in the frequency of hyperacid secretion by 21.1 % (p < 0.05), a significant increase in pepsin level (p < 0.05), a reduced concentration of total glycoproteins (p < 0.05) (due to a significant decrease in fucose and hexosamine levels), compared to patients with compensated stenosis for whom normacid secretion was more characteristic. The data we received regarding the imbalance of factors of aggression and protection of gastric contents allowed us to form various adaptation-compensatory variants of their ratios: 1 (hyperreactive) — simultaneous increase in the factors of aggression and protection; 2 (compensatory) — increased level of aggressive factors, normal concentration of protective factors; 3 (decompensatory) — increased level of aggressive factors, decreased content of protection factors. Conclusions. It is revealed that the progression of pyloroduodenal stenosis of ulcerative origin from compensated to subcompensated is accompanied by a reliable prevalence of aggression factors over the factors of protection of gastric juice and the depletion of the functional capabilities of the mucus-producing apparatus of the stomach. As a result of isolation of three variants of the ratio of the factors of aggression and protection of gastric juice (hyperreactive, compensatory, decompensatory), it is found that decompensatory type is more often found in patients with subcompensated pyloroduodenal stenosis, and thus the risk of stenosis progression in such patients is significantly higher than with other variants. The identified ratios of aggression and protection factors in patients with stenosis allow for a differentiated approach to the choice of treatment (minimally invasive endoscopic or combined endolaparoscopic method).


Keywords


ulcerative stenosis of the pyloroduodenal zone; aggressive and protective factors of gastric juice

References


Durleshter VM, Didigov MT, Karipidi GK. Tactics of treatment decompensated scar-ulcerative stenosis of the duodenum. Kubanskii nauchnyi meditsinskii vestnik. 2013;(142):81-86. (in Russian).

Didigov MT, Klyuchnykov OYu. Surgical treatment of decompensated cicatrical-ulcerative duodenal stenosis: resection of the stomach or diametrical duodenoplasty. In the world of scientific discoveries. 2013;(47):175-196. (in Russian).

Mittal RK. Pathophysiolоgy of gastroesophageal reflux: motility factors. J Gastroenterol. 2003 Mar;38 Suppl 15:7-12.

Ramkumar D, Schulze KS. Gastroduodenal motility. Curr Opin Gastroenterol. 2003 Nov;19(6):540-5.

Yandrapu H, Sarosiek J. Protective Factors of the Gastric and Duodenal Mucosa: An Overview. Curr Gastroenterol Rep. 2015 Jun;17(6):24. doi: 10.1007/s11894-015-0452-2.

Lazebnik LB, Lychkova AE. Gastroesophageal Reflux Disease Pathogenesis. Uspehi fiziologičeskih nauk. 2006;37(4):57-81. (in Russian).

Kononov AV. Cytoprotection of the stomach mucosa: molecular and cellular mechanisms. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2006;16(3):12-17. (in Russian).

Yusuf S, Nok AJ, Ameh DA, Adelaiye AB, Balogun EO. Correlation of gasric mucosal damage with sialic acid profile in rats: effect of hydrochloric acid, pepsin and hypertonic saline. Cell Biochem Funct. 2005 Sep-Oct;23(5):339-45. doi: 10.1002/cbf.1156.

Aase S. Disturbances in the balance between aggressive and protective factors in the gastric and duodenal mucosa. Scand J Gastroenterol Suppl. 1989;163:17-23. doi: 10.3109/00365528909091170.

Allen A, Flemstrom G. Gastroduodenal mucus bicarbonate barrier: protection against acid and pepsin. Am J Physiol Cell Physiol. 2005 Jan;288(1):C1-19. doi: 10.1152/ajpcell.00102.2004.

Milyukov VE, Dolgov EN, Nguen KK, Polunin SV. Factors of aggression and protection of the gastric mucosa in case of acute intestinal obstruction. Journal of Experimental and Clinical Surgery. 2012;5(3):596-600. (in Russian).

Sheleketina II, Kozhukhar' NP, Min'ko AF, Rudenko AI. Kolichestvennyi metod opredeleniia gastromukoproteidov: informatsionnoe pis'mo [Quantitative method for the determination of gastromucoproteins: information letter]. Kyiv; 1983. 3 p. (in Russian).

Rudenko AI, Maykova TV, Mosijchuk LM, et al. Kliniko-laboratorna ocinka funkcional'nogo stanu sekretornyh zaloz shlunka: metodychni rekomendacii' [Clinical and laboratory assessment of the functional state of the secretory glands of the stomach: guidelines]. Kyiv; 2004. 23 p. (in Ukrainian).

Pokrovskaia MI, editor. Metody biokhimicheskikh issledovanii [Biochemical research methods]. St Petersburg: St Petersburg University; 1982. 272 p. (in Russian).

Lang TA, Secik M. How to Report Statistics in Medicine: Annotated Guidelines for Authors, Editors, and Reviewers. 2nd ed. Philadelfia, USA: ACP Press; 2006. 490 p.

Mamaev AN. Osnovy meditsinskoi statistiki [Fundamentals of Medical Statistics]. Moscow: Prakticheskaia Meditsina; 2011. 128 p. (in Russian).




Copyright (c) 2019 GASTROENTEROLOGY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2020

 

   Seo анализ сайта