Gastroenterologìa (Nov 2019)
Aggressive and protective factors of gastric juice in patients with pyloroduodenal stenosis of the ulcerative origin
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).
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