Features of stomach and duodenum peptic ulcer in patients with mesenteric atherosclerosis

Abstract

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.