The vegetative disbalance and its effect on the formation of peptic ulcer of gastroenteroanastomosis

Abstract

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.