Российский кардиологический журнал (Oct 2012)
GASTRO-DUODENAL ULCERS AND EROSIONS ASSOCIATED WITH UNSTABLE ANGINA: CLINICAL AND MORPHOLOGICAL FEATURES AND THE ROLE OF PATHOPHYSIOLOGICAL FACTORS IN THEIR DEVELOPMENT
Abstract
Aim. To investigate clinical and morphological features of gastro-duodenal ulcers and erosions associated with unstable angina (UA) and to study the role of the disturbances of gastric secretion, microcirculation, and haemostasis in their development Material and methods. The study included 82 UA patients with gastro-duodenal ulcers or erosions confirmed by the clinical findings and endoscopy results. Parameters of gastric secretion, gastro-duodenal tissue blood flow, systemic microcirculation, and haemostasis were assessed with the methods adapted to the pathology of interest. Results. Acute erosions were found in 73,2% of UA patients, acute ulcers in 11,0%, and recurrent ulcers in 15,8%. Clinical manifestations of acute erosions typically included various dyspeptic symptoms, or, less often, diffuse epigastric pain during the first treatment days. For acute ulcers, moderate abdominal pain syndrome was often less intense than the gradually receding and disappearing symptoms of gastric dyspepsia. Recurrent ulcers were characterised by the combination of moderate abdominal pain, often without a typical circadian rhythm, and dyspeptic symptoms, typically persisting throughout the first two weeks of treatment. The symptoms of minor gastro-duodenal haemorrhage were registered in 33,3% of UA patients with acute ulcers, 11,8% of the participants with acute erosions, and 7,7% of the individuals with recurrent ulcers. The development of gastro-duodenal erosions and ulcers in UA patients was associated with increased acidic and peptic gastric secretion, reduced production of protective mucus, and disturbed blood flow in gastro-duodenal tissues, which could be regarded as a manifestation of Stage 1–2 haemorrhagic syndrome. Conclusion. Gastro-duodenal erosions and ulcers in UA patients have some morphological, clinical, and pathogenetic features which should be taken into account in order to facilitate the early diagnostics and adequate choice of pharmacological therapy.
