DIAGNOSTIC ASPECTS OF CHANGES IN THE UPPER GASTROINTESTINAL TRACT MUCOUS IN PATIENTS WITH ATHEROSCLEROSIS OF UNPAIRED VISCERAL BRANCHES OF THE ABDOMINAL AORTA
Original research article
Published September 4, 2023
Keywords
atherosclerosis
atrophic gastritis
erosion
atrophic gastritis
erosion
How to Cite
Shuleshova A. G., Lisitsa A. A., Danilov D. V., Golikova Z. N. DIAGNOSTIC ASPECTS OF CHANGES IN THE UPPER GASTROINTESTINAL TRACT MUCOUS IN PATIENTS WITH ATHEROSCLEROSIS OF UNPAIRED VISCERAL BRANCHES OF THE ABDOMINAL AORTA // Kremlin Medicine Journal. 2023. VOL. № 3. С. 60-67.
Abstract
Purpose. To evaluate endoscopic and morphological manifestations of gastroduodenopathies, as well as Helicobacter pylori (Hp) state and secretory function in patients with atherosclerosis of unpaired visceral branches of the abdominal aorta. Materials and methods. 118 patients with atherosclerosis of unpaired visceral branches of the abdominal aorta, aged 45–89, were examined. The comparison group consisted of 120 patients without atherosclerosis of unpaired visceral branches of the abdominal aorta. Patients of both groups had atherosclerosis of coronary arteries. The mucous membrane in esophagus, stomach and duodenum was examined at endoscopy; morphological tests and Hp infection tests were made using bioptats taken from the esophagus and stomach mucous. Acidic production was measured with endoscopic pH-metry. So as to verify occlusive-stenotic lesions in the unpaired visceral branches of the abdominal aorta, the following diagnostic tools were used: ultrasound Dopplerography for screening, computed tomographic angiography, aortography of unpaired visceral branches of the abdominal aorta with multispiral computed tomography. Results. At the endoscopic examination of upper gastrointestinal tract in patients with verified diagnosis of chronic abdominal ischemia, atrophy of stomach mucous (focal or diffuse) was met in 94.2% of cases. Erosive and ulcerative lesions in the stomach mucous were combined with atrophic changes in the mucous: erosion in the stomach – in 55.1%; ulcers in the stomach – in 27.1%. The incidence of detected focal changes in the esophageal mucous was 27.9%, in the stomach mucous – 54.1%, mostly due to intestinal metaplasia. Conclusion. The results obtained in the trial helped the researchers to formulate basic diagnostic criteria specific for erosive-ulcerative lesions of ischemic etiology.References
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32. Minushkin O.N. et al. Therapy of erosive esophagitis induced by mixed refluxate in patients with CAD // Medical Council. – 2018. – № 14. – P. 73–77. In Russian.
33. Smirnova O.V. et al. Features of the course of coronary heart disease in elderly and senile patients depending on the state of blood flow in the abdominal aortic basin // Experimental and clinical gastroenterology. – 2014. – № 11 (111). – P. 25–29. In Russian.
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2. Alonso A. et al. Blood lipids and the incidence of atrial fibrillation: the multiethnic study of atherosclerosis and the Framingham heart study // J Am Heart Assoc. – 2014. – V. 3. – № 5. – P. 112–122.
3. Marston A. Vascular diseases of the intestine: pathophysiology, diagnosis and treatment. – Moscow: Medicine. – 1989.
4. Barkhatov I.V. Features of the clinical picture and burdensome problems in diagnosing the syndrome of chronic abdominal ischemia // Kazan Medical Journal. – 2013. – V. 94. – № 4. – P. 505–509. In Russian.
5. Prakash V.S. et al. Acute and chronic ischemic disorders of the small bowel // Current gastroenterology reports. – 2019. – V. 21. – P. 1–6.
6. Becquemin J.P. Management of the diseases of mesenteric arteries and veins: Clinical practice guidelines of the European Society for Vascular Surgery (ESVS) // Eur J Vasc Endovasc Surr. – 2017. – V. 53. – № 4. – P. 455–457.
7. Oinotkinova O.Sh. et al. Atherosclerosis and abdominal ischemic disease: monograph. – Moscow: Medicine. – 2001. In Russian.
8. Clair D.G. et al. Mesenteric ischemia // N Engl J Med. – 2016. – V. 374. – № 10. – P. 959–968.
9. Oynotkinova O.Sh. Diagnostic criteria for abdominal ischemic disease and methods of correction // Evidence-based gastroenterology. – 2017. – V. 6. – № 1. – P. 9–20. In Russian.
10. Ivanov Y.V. et al. Syndrome of chronic abdominal ischemia in the practice of general surgeons // J Clin Pract. – 2014. – V. 5. – № 2 (18). – P. 61–74. In Russian.
11. Smirnova O.V. et al. Features of the course of coronary heart disease in elderly and senile patients depending on the state of blood flow in the abdominal aortic basin // Experimental and clinical gastroenterology. – 2014. – № 11 (111). – P. 25–29. In Russiаn.
12. Gubergrits N.B. et al. Abdominal ischemic syndrome // News of Medicine and Pharmacy. – 2013. – № 5. – P. 7–13. In Russian.
13. Lawson R.M. Mesenteric ischemia // Crit Care Nurs Clin. – 2018. – V. 30. – № 1. – P. 29–39.
14. Miklosh B. Diagnostic and therapeutic approaches in chronic mesenteric ischemia have improved // United European Gastroenterol J. – 2020. –V. 8. – № 4. – P. 369–370.
15. Mutaev M.M. et al. Syndrome of chronic abdominal ischemia // Medicine. – 2020. – № 4. – P. 4–12. In Russian.
16. Kalinin A.V. Symptomatic gastroduodenal ulcers and peptic ulcer: what are the similarities and what are the differences? // Russian Journal of Gastroenterology, Hepatology, Coloproctology. – 2008. – V. 18. – № 1. – P. 59–68. In Russian.
17. Van Dijk L.J.D. et al. Clinical management of chronic mesenteric ischemia // United European Gastroenterol J. – 2019. – V. 7. – № 2. – P. 179–188.
18. Akasheva D.U. et al. Chronic mesenteric ischemia. Clinical case and literature review // Cardiovascular therapy and prevention. – 2020. – V. 19. – № 1. – P. 85–93. In Russian.
19. Van Petersen A.S. et al. Mesenteric stenosis. Collaterals and compensatory blood flow // J Vasc Surg. – 2014. – V. 60. – № 1. – P. 111–119.e2.
20. Lazebnik L.B. et al. Chronic ischemic disease of the digestive system. – Moscow: Anacharsis. – 2003. In Russian.
21. Barkhatov I.V. et al. Pathomorphology and endoscopic picture of chronic abdominal ischemia syndrome // Modern science: actual problems of theory and practice. Series: Natural and technical sciences. – 2019. – № 10. – P. 205–209. In Russian.
22. Burakovsky V.I. et al. Cardiovascular surgery. – Moscow: Medicine. – 1989. – 752 p. In Russian.
23. Mostyko S.V. Endoscopic diagnosis of chronic abdominal ischemia: PhD diss. – 2007. In Russian.
24. Zvenigorodskaya L.A. et al. Chronic ischemic disease of the digestive system: an algorithm for diagnosis and treatment // Russian medical journal. – 2010. – V. 18. – № 9. – P. 544–548. In Russian.
25. Shubina E.N. Changes in the gastroduodenal zone in patients with chronic abdominal ischemia: PhD diss. – 2000. In Russian.
26. Zverkov I.V. et al. Modern approaches to the diagnosis of typing and the treatment of chronic gastritis (results of our own research). – Moscow: Sam Polygraphist LLC. – 2022. In Russian.
27. Burdina E.G. et al. Approaches to the treatment of chronic gastritis depending on the morphofunctional features of the stomach. Diagnostics and treatment of diseases of the digestive system from the standpoint of evidence-based medicine. – Moscow: GNIVTS GMU UD of the President of the Russian Federation. – 2008. In Russian.
28. Oinotkinova O.Sh. Many-sided atherosclerosis: abdominal ischemic disease – symptom or syndrome? // Medical Bulletin. – 2007. – № 42. – P. 10–11. In Russian.
29. Aruin L.I. et al. Morphological diagnosis of diseases of the stomach and intestines. – Moscow: Triada-X. – 1998. In Russian.
30. Drapkina O.M. et al. Modern algorithm of diagnostics and management of patients with chronic atrophic gastritis and intestinal metaplasia of the stomach // Profilakticheskaya Meditsina. – 2023. – V. 26. – № 1. – P. 7–10. In Russian.
32. Minushkin O.N. et al. Therapy of erosive esophagitis induced by mixed refluxate in patients with CAD // Medical Council. – 2018. – № 14. – P. 73–77. In Russian.
33. Smirnova O.V. et al. Features of the course of coronary heart disease in elderly and senile patients depending on the state of blood flow in the abdominal aortic basin // Experimental and clinical gastroenterology. – 2014. – № 11 (111). – P. 25–29. In Russian.
34. Shuleshova A.G. et al. Prevention of bleeding from erosive and ulcerative lesions of the upper gastrointestinal tract in patients with pathology of the cardiovascular system // Medical Bulletin of the Ministry of Internal Affairs. – 2013. – № 6. – P. 21–25. In Russian.