[Role of stress in the etiopathogenesis of duodenal ulcer in young patients]. / Rol' stressa v étiopatogeneze iazvennoi bolezni dvenadtsatiperstnoi kishki u bol'nykh molodogo vozrasta.

The analysis of the acid-forming function of the stomach, both basal and stimulated with insulin, atropine test, tests for the content of the adrenocorticotropic hormone, somatotropic hormone, thyrotropic hormone, triiodothyronine, thyroxin, cortisol in the blood and the content of gastrin in the blood and gastric juice, activity of the processes of lipid peroxidation, content of ceruloplasmin in the blood, content of Helicobacter pylori (Hp) in the gastric mucosa were conducted in 68 men and 64 women at the age from 18 to 40 years suffering from gastroduodenal ulcer in order to examine the role of stress in ulcer formation. 38 patients with duodenal ulcer took proton pump blockers and antioxidants for 3 years whenever they were in a stress situation. The research revealed that young patients with duodenal ulcer show enhanced sensitivity of parietal cells and sympathoadrenal system to stressful situations, and stimulation of the acid-forming stomach function takes place under the effect of both catecholamines and gastrin. Men can have both Hp-dependent and Hp-independent duodenal ulcers, while women have mostly Hp-dependent duodenal ulcers. Prescription of proton pump blockers of and antioxidants for patients with duodenal ulcer, who are in a stressful situation, reduces the frequency of duodenal ulcer recurrences.

[The characteristics of peptic ulcer in subjects with concomitant ischemic heart disease]. / Osobennosti iazvennoi bolezni u lits s soputstvuiushchei ishemicheskoi bolezn'iu serdtsa.

AIM: The study of clinical running of gastric or duodenal ulcer in associated coronary heart disease (CHD). MATERIALS AND METHODS: 209 CHD patients with gastric ulcer (GU) or duodenal ulcer (DU) were examined clinically plus histological examination of gastric or duodenal mucosa biopsies was made. RESULTS: In CHD patients GU occurred more frequently (56%) than DU. The lesions involved more frequently lesser curvature of the stomach and pyloric part of the stomach. Males developed ulcers 3.5 times more frequently than females. Ulcers tended to a painless course without season exacerbations. The disease manifested first with gastric bleeding in 52% of the patients. GU and DU ran with frequent recurrences and long-term exacerbations (76% of patients) which coincided in time with CHD exacerbations. 68% of patients developed exacerbations within 10 days after myocardial infarction or aortocoronary bypass operation. Helicobacter pylori was present as a resolving factor in arising ulcer in 26% of patients. Microcirculatory disorders, reduced blood flow speed in gastric or duodenal mucosa, hypocoagulation syndrome, dyslipidemia provoked exacerbations in 62% of patients. Examinations of biopsies from gastric and duodenal mucosa showed marked dystrophic changes in the mucosa, its connective tissue basis in the vessels in the presence of mild inflammation at ulcer site. CONCLUSION: The onset of ulcers and erosions in the mucosa of the gastrointestinal tract in CHD may be due to circulatory disorders in gastric mucosa. The main factors of aggression are hypoxia, hypoxia-induced trophic defects in gastric and duodenal mucosa, circulatory disorders.

[The hormonal characteristics of the pathogenesis of gastric peptic ulcer and duodenal peptic ulcer]. / Gormonal'nye osobennosti patogeneza iazvennoi bolezni zheludka i iazvennoi bolezni dvenadtsatiperstnoi kishki.

Blood levels of STH, ACTH, somatostatin, bombesin, gastrin, hydrocortisone, aldosterone, testosterone, estradiol, progesterone and gastric juice levels of gastrin and somatostatin were measured in remission and exacerbation of gastric and duodenal ulcer (GU), (DU) using radioimmunoassay. The study included 250 DU, 200 GU and 5O control subjects. As a result, two forms of DU were identified. DU type 1 is characterized by basal and stimulated hypergastrinemia, paradoxical D-cell response to stimulation, high blood concentrations of STH, ACTH, testosterone. Type 2 DU exhibits basal hypogastrinemia, elevated gastrin concentration in response to stimulation, adequate reaction of D-cells, low levels of estradiol and progesterone. In GU there were low concentrations of STH, bombesin, hydrocortisone, estradiol, testosterone, progesterone, somatostatin. D-cell response to loading was adequate. It is concluded that DU and GU pathogeneses are different, that DU is a heterogeneous disease.

[The content of gastrin, bombesin and somatostatin in the blood and gastric juice of patients with duodenal and gastric peptic ulcer]. / Soderzhanie gastrina, bombezina i somatostatina v krovi i zheludochnom soke bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki i zheludka.

Ninety patients suffering from peptic ulcer and 25 healthy subjects were examined for the content of gastrin, bombesin and somatostatin in blood and gastric juice. Among patients with duodenal ulcer, 2 groups were distinguished: group I included patients in whom peptic ulcer occurred before 30 years; the majority of the patients manifested blood hypergastrinemia, a decrease of bombesin concentration and normal somatostatin concentration; gastric juice was characterized by a lowering of somatostatin concentration and unchanged gastrin concentration; group II was made up of patients who developed peptic ulcer after 30: in the majority of the patients, gastrin concentration was reduced under basal conditions, after loading it was unchanged; in part of the patients, blood somatostatin concentration was elevated, in 16 in exacerbation and in 19 in remission; in the remainder, it was unchanged. The concentration of bombesin in blood remained unchanged. In gastric juice, gastrin concentration was increased only after histamine administration, somatostatin concentration was unchanged whatever the disease stage. In patients with gastric ulcer, gastrin concentration in blood was elevated only under basal conditions, being unchanged in gastric juice irrespective of the disease stage. Meanwhile, the concentration of bombesin was lowered both under basal conditions and after insulin administration, the concentration of somatostatin was decreased both in blood and gastric juice whatever the disease stage.

[The characteristics of the clinical picture and course of gastric and duodenal peptic ulcer in patients with ischemic heart disease]. / Osobennosti klinicheskoi kartiny i techeniia iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Altogether 117 case reports were analyzed and 32 patients with associated gastric or duodenal ulcer and coronary heart disease (CHD) as well as 48 controls suffering from gastric or duodenal ulcer were examined. A relationship was established between the clinical picture and the course of associated ulcer disease and CHD and the time of ulcer disease onset. Patients suffering from ulcer disease that occurred at a young age manifested the typical clinical picture, seasonal exacerbations while ulcer exacerbations were often accompanied by CHD exacerbations. Ulcer disease that developed in CHD patients often runs an atypical or asymptomatic and a longer course marked by more frequently occurring ulcer complications. Ulcer occurs in the stomach more frequently, with gastric secretion being considerably lowered. Analysis of the above-enumerated characteristic features makes it possible to individualize the treatment of patients with combined ulcer disease and CHD.

[Secretion of cortisol and growth hormone in patients with peptic ulcers of the stomach and the duodenal bulb]. / Sekretsiia kortizola i gormona rosta u bol'nykh iazvennoi bolzen'iu zheludka i lukovitsy dvenadtsatiperstnoi kishki.

A total of 42 patients with gastric ulcer and ulcer of the duodenal bulb were investigated. A decrease in the blood concentration of STH and cortisol, high indices of gastric acidifying function in the 2nd hour after insulin administration were noted in the patients with gastric ulcer indicating a decrease in the trophic influence of the hormones of the hypophysis-adrenal system on the GI tract, on the one hand, and raised sensitivity of parietal cells to the effects of this system, on the other hand. In the patients with duodenal ulcer the blood levels of STH and cortisol did not change, indices of gastric acidifying function within the 1st hour after insulin administration were higher than during the 2nd hour indicating an important role of the vagus nerve hypertonicity in the pathogenesis of this disease.