Gastroenterologìa (Apr 2021)
Clinical and vegetative disorders, adaptive capacity and stress resistance in patients with precancerous conditions of the stomach in comorbidity with thyroid pathology
Abstract
Background. An important aspect of the course of precancerous conditions of the stomach is comorbidity with thyroid pathology. To date, there is no consensus among researchers regarding the involvement of the autonomic nervous system in ensuring the reactivity of the body and the formation of adaptive processes in patients with atrophic gastritis combined with thyroiditis. The purpose was to determine the features of clinical manifestations, autonomic status and heart rate variability in patients with precancerous conditions of the stomach in comorbid thyroid pathology. Materials and methods. The study included 72 patients with chronic atrophic gastritis, who were divided into 3 groups depending on the changes in the structure of the thyroid gland: group I consisted of 35 people with nodular changes, II — 22 with diffuse changes, III — 15 people without any changes. To study the clinical picture in the examined patients, a survey was conducted using the Gastrointestinal Symptom Rating Scale. To identify signs of autonomic disorders, we used the questionnaire of O.M. Vein. Adaptive capacity was assessed using Precise system on a CONTEC 8000GW cardiograph with software that analyzes heart rate variability. Results. In patients with comorbid pathology, symptoms of abdominal pain syndrome and dyspeptic syndrome were often revealed regardless of structural changes in the thyroid gland; the frequency of diarrheal syndrome in group I was 1.9 times lower than in group II (p = 0.02) and 1.8 times compared with group III (p > 0.05). A high frequency of autonomic dysfunction (83.3 %) was detected in patients with precancerous conditions of the stomach. At the same time, individuals with nodular changes in the thyroid gland quite often complained of decreased performance, rapid fatigue (68.6 %) and sleep disturbances (65.7 %). Patients with diffuse changes in the thyroid gland had numbness of the fingers and toes (68.2 %), a tendency to facial redness and increased sweating (63.6 %). Correlations were determined between the score on Vein's questionnaire and the severity of syndromes such as abdominal pain (r = 0.53; p = 0.030), diarrheal syndrome (r = 0.58; p = 0.012), dyspeptic syndrome (r = 0.44, p = 0.029). Analysis of stress resistance showed that 33.3 % of patients with nodular changes in the thyroid gland and 28.6 % of those with diffuse changes had anxiety syndrome, while people without thyroid pathology had no anxiety. Conclusions. According to Precise system data, half of patients with precancerous conditions of the stomach in thyroid comorbidity have an increased cardiovascular risk against the background of an increase in parasympathetic regulation of the autonomic nervous system, and one-third of patients have a breakdown/disorder of adaptation, anxiety syndrome and depletion of the sympathetic and parasympathetic components of the autonomic nervous system. The revealed correlations indicate a significant contribution of autonomic disorders to the formation of clinical symptoms in patients with comorbid pathology of the stomach and thyroid gland.
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