Research objective. To study the effect of vegetative nervous system dysfunction on mechanisms of peptic ulcer of gastroenteroanastomosis formation and to improve the results of treatment of patients after gastric resection for peptic ulcer disease.Material and methods. The study included 30 patients with peptic ulcers of gastroenteroanastomosis being operated on for gastric ulcer and duodenal ulcer. Instrumental research included: cardiorhythmography, esophagogastroduodenoscopy, intragastric pH-metry, electrogastrography, laser Doppler fl owmetry.Results. In patients with peptic ulcers of gastroenteroanastomosis, according cardiorhythmography, parasympathicotonia prevailed in 20 (66,7%) patients, sympathicotonia was observed in 8 (26,7%) patients, eutonia — in 2 (6,6%) patients. Microcirculation data against the background of sympathicotonia were signifi cantly lower than in the control group (p<0,05) and lower than those in parasympathicotonia and eutonia. With the hyperkinetic type of motility, the predominance of parasympathicotonia(87,5% patients), while the acid-producing function of the stomach was increased in 70% patients (рН 0,9±0,3). Autonomic dysfunction and helicobacteriosis were observed in 26 patients (86,6%). Correlation analysis between cardiorhythmography data and gastric acidity established positive correlation of average strength (r=0,726), which determined the important role of acid-peptic exposure against the background of an increase in the tone of the parasympatic part of the vegetative nervous system. With the predominance of parasympathicotonia, M-anticholinergic Нyoscine butylbromide was included in the complex therapy. After the treatment, the results of cardiorhythmography showed the normotensive nature of the cardiorhythmograms, motor data improved in 60% patients, the acidity data corresponded to the normality (рН 1,2–2,0).Conclusions. The results of the study showed the predominance of parasympathicotonia in patients with peptic ulcers of gastroenteroanastomosis, which contributes to impaired microcirculation, motor- evacuation and secretory functions of the gastric stump and creates conditions for persistence. The сardiorhythmography made it possible to objective assess of the state of the vegetative nervous system. The inclusion of hyoscinebutylbromide in complex treatment with the predominance of parasympathicotonia has a modulating effect on the vegetative nervous system.
Abstract. The main goal of the study was to prevent the development of gastric and duodenal ulcers in patients with colorectal cancer receiving adjuvant therapy with 5-fluorouracil. Materials and methods. The study included 60 patients with a verified diagnosis of localized or locally advanced colon and rectosigmoid cancer after radical surgical treatment. The patients are divided into two groups. The first group included 28 people who were found to have Helicobacter pylori during fibro-gastroduodenoscopy and 13C-respiratory urease test. Patients underwent anti-Helicobacter and gastro-protective therapy before adjuvant chemotherapy with 5-fluorouracil according to the developed scheme. The second group included 32 people. Tests for infection with Helicobacter pylori in these patients were negative, they did not receive gastroprotective therapy. Research results. The study showed the effectiveness of prophylactic therapy administered to patients from the first group before the start of the adjuvant chemotherapy program, since ulcerative lesions of the mucous membranes of the stomach and duodenum in patients were detected less frequently, responded better to conservative therapy, and also did not cause a delay in the next course of drug treatment. including 5-fluorouracil. When preventive antiulcer treatment was administered, the chance of developing ulcer complications in patients decreased by 5.08 times. The most vulnerable in terms of mucosal damage were female pa-tients of elderly and senile age, complications developed even against the background of antiulcer treatment.
Introduction. Adjuvant therapy with the inclusion of 5-fluorouracil is used in patients with neoplasms of the colon and rectosigmoid in the postoperative period. However, along with a positive antitumor effect, 5-fluorouracilcontaining regimens have a negative effect on the mucosa of the gastrointestinal tract, which often leads to the need to replace or cancel drugs, thereby reducing the effectiveness of treatment.Aim of the study was to improve the idea of the possibility of erosive and ulcerative lesions of the stomach and duodenum during treatment with 5-fluorouracil in patients with malignant tumors of the colon and rectosigmoid and the factors that aggravate their course, as well as to highlight the problem of prevention and treatment of gastrointestinal complications.Materials and methods The search for publications by keywords was carried out in the databases of PubMed, Google Scholar, elibrary.ru and Russian specialized journals related to therapy, surgery, gastroenterology, oncology for the period from 2010 to 2022.Results and Discussion An analysis of the literature allows us to conclude that the risk of damage to the mucous membrane of the stomach and duodenum during the use of chemotherapy with the inclusion of 5-fluorouracil is very high and amounts to 30–40 %. In addition, there are many factors that can complicate the course of this undesirable phenomenon. These include the advanced age of patients, the presence of serious comorbidity and postoperative complications in patients, as well as infection with Helicobacter pylori. The lack of generally accepted recommendations for the prevention and treatment of damage to the lining of the stomach and duodenum during the use of chemotherapy is a serious problem in modern medical practice.Conclusion Gastrointestinal toxicity associated with the use of 5-fluorouracil in the form of mucositis in patients with malignant neoplasms of the colon and rectosigmoid deserves close attention. The presence of damage to the mucous membrane of the stomach and duodenum in a patient requires immediate therapy, as this will improve the long-term results of the treatment of the underlying disease and ensure a high quality of life for the patient.
Астраханский государственный медицинский университет, Россия risK facTors anD prognosis preVenTion refluX gasTriTis folloWing gasTric resecTion antonyan s. V., antonyan V. V., Kulkov V. n. astrakhan state medical university, russiaИзучены возможные причины развития рефлюкс-гастрита после резекции желудка по поводу язвенной болезни. Рассматривались различные модификации резекции желудка, а также факторы риска возникнове-ния рефлюкс-гастрита в дооперационном периоде у 32 пациентов. Оценивалась предрасположенность к раз-витию рефлюкс-гастрита с учётом критериев, влияющих на развитие данной патологии: данные эзофагога-стродуоденоскопии, кардиоритмографии, электрогастрографии, рентгенографии желудка, титра суммарных антител к Helicobacter pylori, уровня С-реактивного белка. Установлено, что после резекции желудка возни-кает ряд факторов, влияющих на развитие послеоперационного рефлюкс-гастрита: состояние анастомоза, вегетативный дисбаланс и связанная с ним моторно-эвакуаторная дисфункция оперированного желудка. На основе изученных факторов возможно прогнозирование в дооперационном периоде данного осложнения с рекомендацией при высокой вероятности развития рефлюкс-гастрита выполнения резекций желудка с ареф-люксными анастомозами.Ключевые слова : рефлюкс-гастрит, резекция желудка, язвенная болезнь, прогнозирование
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