Aim.To evaluate the sensitivity and specificity of the clinical criteria for the diagnosis of chronic mesenteric ischemia in elderly and senile patients with mesenteric atherosclerosis. Materials and methods.The study included 142 patients (82 men and 60 women). The median age of patients is 66.0 [62.0; 72.0] years. Results.According to MDCT atherosclerotic lesions of the abdominal aorta and its unpaired visceral branches were diagnosed in 105 (73.9%) patients. A combination of atherosclerosis of the celiac trunk and the superior mesenteric artery with the presence of hemodynamically insignificant stenosis was revealed. Hemodynamically significant atherosclerotic narrowing of at least one mesenteric artery was present in 15% of cases. Among them, a single vascular lesion was found in 6 patients (4.2%), a combination of hemodynamically significant lesions of two arteries in 15 (11%) patients. Depending on the clinical manifestations, all patients are divided into two groups: the first group 30 (21.1%) patients with the presence of symptoms characteristic of chronic mesenteric ischemia (CMI). The second group consisted of 112 (78.8%) patients without a characteristic triad of symptoms. The clinical symptom complex of СMI, including postprandial abdominal pain, intestinal dysfunction and progressive weight loss, as a diagnostic criterion showed low sensitivity 13.3% and specificity 77.9%. At the same time, the sensitivity of such a clinical combination as a combination of atherosclerosis of the arteries of the lower extremities, weight loss and abdominal pain syndrome with a severity of more than 5.5 points, with respect to the detection of hemodynamically significant stenoses of two or more mesenteric arteries was sensitivity 86.7%, specificity 74.0%.
Aim. To evaluate the clinical and endoscopic features of diseases of the upper gastrointestinal tract (GIT) in patients with atherosclerosis of the mesenteric arteries (MA). Materials and methods. The study included 48 patients with atherosclerosis of MA and 43 patients without atherosclerosis of MA, who were hospitalized in the department of vascular surgery of the Chelyabinsk Regional Clinical Hospital in the period from 2019 to 2021. All patients underwent multispiral computed tomoangiography of the visceral and lower limb arteries, esophagogastroduodenoscopy. Results. Assessment of lesions of the upper gastrointestinal tract revealed a higher incidence of erosive and ulcerative gastroduodenopathies among patients with atherosclerosis of MA (60.4%), compared with patients without atherosclerosis MA (39.5%); p=0.047. Signs of severe atrophy according to the data of histological examination were statistically significantly more frequent among patients with atherosclerosis of MA (29.2 and 11.6%; p=0.031). According to the results of logistic regression, the following predictors of erosions and ulcers of the upper gastrointestinal tract were revealed: the severity of stenosis of the superior mesenteric artery (SMA) is more than 35%, the body mass index (BMI) is less than 25.9 and the total score on the HADS scale is more than 6.5 points for depression (p=0.008). Conclusion. Erosive-ulcerative gastroduodenopathies and atrophy of the gastric mucosa are significantly more common in the group of patients with MA atherosclerosis. The main risk factors for erosions and ulcers of the upper gastrointestinal tract in patients with MA atherosclerosis are: the severity of SMA stenosis is more than 35%, a decrease in BMI is less than 25.9 and an increase in the HADS score is more than 6.5 points.
Introduction. The high frequency of complicated forms of the stomach and duodenum peptic ulcer (PU) in patients with atherosclerosis requires the study of additional factors of ulcerogenesis in addition to infection with Helicobacter pylori (H. pylori) and the use of non-steroidal anti-inflammatory drugs (NSAIDs). Currently, there is no clear understanding of the role of mesenteric artery (MA) atherosclerosis in the development of gastroduodenal ulcers. The purpose of the study. To evaluate the contribution of MA atherosclerosis to the development of gastric and duodenal ulcer in patients with multifocal atherosclerosis. Material and methods. The study included 91 patients with atherosclerosis of two or more vascular beds in the period from 2019 to 2021. The examination included the determination of the gastrin-17, pepsinogen I, pepsinogen II and antibodies to H. pylori IgG concentration in blood serum, as well as multispiral computed tomoangiography of the abdominal aortic branches and esophagogastroduodenoscopy with histological examination. Results. The patients were divided into two groups: group I – 36 (39.6%) patients with PU, group II – 55 (60.4%) patients without PU. A more frequent occurrence of hemodynamically significant stenosis of the MA and a higher percentage of the superior mesenteric artery (SMA) stenosis in group I were noted. A positive correlation was found between the severity of erosive and ulcerative lesions and the percentage of SMA stenosis, levels of pepsinogen I and pepsinogen II. The combination of PU and MA atherosclerosis is characterized by a lesser severity of abdominal pain syndrome (p = 0.049). Risk factors for PU were identified: MA atherosclerosis (OR 4.953; CI 1.571–15.608); more than 8 points on the HADS depression scale (OR 2.970; CI 1.062–8.320) and on the Audit questionnaire (OR 5.787; CI 1.348–24.837). Conclusions. Risk factors for PU in patients with multifocal atherosclerosis were identified: MA atherosclerosis, subclinical depression, and health-threatening alcohol consumption. PU in patients with multifocal atherosclerosis is characterized by asymptomatic course.
Aim. To assess the prevalence and structure of upper gastrointestinal (GI) lesions, as well as the factors associated with their development, in patients with lower extremity peripheral artery disease (PAD).Material and methods. This retrospective analysis of medical records with lower extremity PAD includes data from 258 patients. All patients underwent multislice computed tomography angiography of abdominal aortic visceral branches and lower limb arteries, as well as esophagogastroduodenoscopy.Results. Endoscopic evidence of upper GI lesions was detected in 164 (63,6%) patients. In particular, gastroduodenal erosions and ulcers were observed in 57,8% of patients. All patients were divided into two groups: group I — 149 (57,8%) patients with gastroduodenal erosions and ulcers, group II — 109 (42,2%) patients without it. In group I patients, a higher incidence of mesenteric artery disease was recorded — 61,7 vs 43,1% (p=0,003). An independent factor associated with the development of gastroduodenal erosions and ulcers in patients with PAD is mesenteric artery disease (relative risk: 4,43; 95% confidence interval: 1,15-17,12 (p=0,031)).Conclusion. In patients with lower extremity PAD, upper GI diseases (63,6%) occur with a high frequency, while gastroduodenal erosions and ulcers was observed in 90,9% of them. The factors associated with the development of erosions and ulcers in patients with lower extremity PAD include mesenteric artery atherosclerosis.
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