[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 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.