MODULATION OF MELOXICAM-INDUCED CHANGES IN GASTROINTESTINAL AND MOTOR ACTIVITY OF THE STOMACH BY APPLYING PLACENTA CRYOEXTRACT

Introduction. Current approaches to reducing the ulcerogenicity of nonsteroidal anti-inflammatory drugs are aimed primarily at eliminating the damaging effect on the gastric mucosa, and according to the literature, the use of proton pump inhibitors can even worsen the course of enteropathy. Objectives. To characterize the influence of cryopreserved placenta extract on the state of secretory and motor-evacuation activity of the stomach under the conditions of experimental meloxicam-induced gastropathy and enteropathy. Methods. Serial randomized placebo-controlled studies were performed on nonlinear rats and mice using a model of small intestine-induced gastrointestinal lesions. Gastric secretion in rats, gastric evacuation function and intestinal motor function in mice were studied with the help of standard methods. Results. The administration of meloxicam leads to a statistically significant increase (p <0.05) in the volume of gastric secretion by 31.6±7.3%, an increase in total acidity (p=0.002) by 7.7 [7.7; 16.6]% and a statistically significant increase (p<0.05) in peristaltic activity by 18.9% relative to intact animals. The administration of cryopreserved placenta extract led to a statistically significant (p=0.002) decrease in the ratio of free and total acidity by 2.3 times, with a statistically significant decrease (p<0.05) by 14.5% in peristaltic activity relative to intact animals. The combined threaded administration of meloxicam and cryopreserved placenta extract was accompanied by a decrease in the ratio of free and total acidity by 43.0±3.0%. Conclusion. The combined application of placental cryoextract and meloxicam eliminates meloxicam-induced hypersecretion of gastric juice and gastric hypermobility. The cryoextract has also proved to reduce the aggressiveness of gastric juice by reducing its free and increasing combined acidity.

The Role of Prehabilitation in Patients Undergoing Pancreatoduodenal Resection

Background. Currently, the introduction of pre-rehabilitation programs has shown its effectiveness in various sections of abdominal surgery, however, its role in surgical pancreatology is still not entirely clear Aim. To study the effectiveness of the implementation of pre-rehabilitation programs (preoperative exercises and diet therapy) during the waiting period for surgery and their effect on the physical and nutritional status, as well as postoperative complications and the duration of hospital stay in patients who underwent pancreatoduodenal resection. Material and methods. A prospective study was carried out including 44 patients who underwent pancreatoduodenal resection. The patients included in the study were divided into two groups. The control group (23 patients) preoperative preparation, which was carried out according to the standard method. The main group consisted of 21 patients who underwent pre-rehabilitation. Results. Among the patients in the compared groups, there were no statistically significant differences in age, gender, ASA and body mass index, concomitant diseases, and basic laboratory parameters. In the group of patients who underwent pre-rehabilitation, there was a statistically significant increase in the 6-minute walk test (p = 0.02), as well as the prognostic nutritional index (p = 0.01). There was no statistically significant difference between the compared groups in the incidence of major postoperative complications (Clavien - Dindo III / IV) (p = 0.8), clinically significant pancreatic fistulas (p = 0.5), and mortality (p = 0, 6), however, in the pre-rehabilitation group there was a significant decrease in the incidence of gastric evacuation disorders in comparison with the control group (9.5% versus 34.8%, p = 0.04). The average postoperative bed-day was 16.1 5.6 days in the pre-rehabilitation group and 19.8 6.2 days in the control group (p = 0.04). Conclusion. The introduction of pre-rehabilitation in patients undergoing pancreatoduodenal resection is effective and allows improving the physical and nutritional status of the patient, reducing the postoperative bed day and reducing the frequency of delayed gastric evacuation.

Peculiarities of the Pathology of Gastrointestinal Tract in Patients with Gastroesophageal Reflux Disease on the Background of Hypothyroidism

The article identifies the features of the pathology of the gastrointestinal tract in patients with gastroesophageal reflux disease on the background of hypothyroidism. The frequency of gastroesophageal reflux disease and the severity of this disease increase with age and the presence of comorbid pathology. In the elderly, the frequency of the typical esophageal manifestations decreases, and the erosive esophagitis with atypical symptoms is more common. The growing number of cases of combined thyroid dysfunction with gastropathology requires in-depth study of the reasons for the relationship between these processes. Pathological changes in the gastrointestinal tract in these patients make their condition severer, contributing to the development and progression of metabolic disorders. An important aggravating effect on the regulatory mechanisms of esophageal kinetics has a pathological functioning of the thyroid gland on the background of iodine deficiency. Results and discussion. In patients with gastroesophageal reflux disease with hypothyroidism, all changes in gastric and duodenal function are associated with a decrease in the acid-forming function of the gastric mucosa, due to its atrophy, decreased tone and contractility of the stomach. This in turn leads to a slowing of gastric and duodenal evacuation, dysfunction of the closing capacity of the cardia and, as a consequence, the development of duodenogastroesophageal reflux. The esophageal contents are not so pronounced, so patients with non-erosive forms of esophagitis predominate (46.2%) against 16% of patients in the second group (patients with gastroesophageal reflux disease). At the same time, erosive forms predominate among patients in the control group with predominant acid reflux. It should be noted that there is a clear relationship between the frequency of erosive changes in the esophageal mucosa and the duration of the disease. Thus, among patients of the main group with a 5-year history of the disease, the number of erosive forms of gastroesophageal reflux disease was minimal. The number of erosive changes in the esophageal mucosa increased sharply in patients with a 10-year history and reached its maximum after 15 years from the onset of the disease. Conclusion. The delay in gastric evacuation is more pronounced in patients with gastroesophageal reflux disease on the background of hypothyroidism. It can be explained by a decrease in gastric motility and the presence of duodenostasis. The slowing of gastric evacuation was more pronounced in patients with gastroesophageal reflux disease on the background of reduced thyroid function. In patients with gastroesophageal reflux disease on the background of hypothyroidism there is an alkaline duodenogastroesophageal reflux as a consequence of reduced acid-forming function of the gastric mucosa and reduced contractility of the stomach and duodenum

The fast-track surgery program application after pancreaticoduodenectomy, using interintestinal anastomosis in accordance to Brown procedure

Objective. To estimate the impact of formation of gastroenteroanastomosis with Brown’s anastomosis, while performing of pancreatico-duodenectomy, on the gastric evacuation arrest rate in a frame of the fast-track surgery program implementation. Materials and methods. To the investigation 92 patients, ageing 28 -75 yrs old, were included, to whom pancreaticoduodenectomy for benign and malignant pancreatic and peripancreatic zone pathology was performed in Jan. 2015 - Aug. 2020 yrs. Perioperative treatment was conducted in accordance to the fast-track surgery program. The first Group consisted of 60 patients, in whom reconstruction in accordance to Child was done, and the second Group - of 32 patients, in whom gastroenterostomy with anastomosis in accordance to Brown procedure was performed. Results. In the Group I complications have had occurred in 16 (26.7%) patients, in the Group II - in 7 (21.9%), in Group I there were 22 complications, in the Group II - 10, but trustworthy difference between the Groups in accordance to these indices was absent (p > 0.05). Analysis of parameters for restoration of peroral feeding have shown enhanced susceptibility of the program in patients of Group II. The rate of the gastric evacuation arrest in first Group of patients have exceeded the analogous index in patients of Group II in 2 times - 13.3 and 6.3%, accordingly, but statistically significant difference between the Groups in accordance to this index was absent (p = 0.299). Conclusion. While formation of gastroenteroanastomosis with anastomosis in accordance to Brown procedure in pancreatico-duodenectomy the implementation level for the fast-track surgery program raises and the rate of gastric evacuation arrest diminishes.

Modeling the Effects of Water Temperature on Growth Rates, Gastric Evacuation and the Return of Appetite in Juvenile Nile Tilapia, Oreochromis niloticus L.

Optimized aquafeeds have long been a major concern of the sustainable aquaculture development. Not only should the feed composition meet the nutritional requirements of the fish, it should also be reasonably managed (feed ration and feeding frequency) to enhance the feed utilisation efficiency, growth performance and decrease the amount of wastes. At present there is no detailed information on how rearing temperature impacts gastric evacuation rate, return of appetite (RA) and daily feed ration among tilapias, considered as one of the leading fish species for worldwide aquaculture production. The objective of this study was to develope mathematical models to estimate maximum daily feed intake for Nile tilapia in relation to feeding frequency and water temperature. Growth was measured in 480 fish (initial body mass 4.30&plusmn;0.02 g) fed in slight excess, following their exposure to four thermal treatment (22, 26, 30 and 34 &deg;C) (four replications per treatment, 21-days rearing period, growth monitoring at 5-days intervals). Gastric evacuation and return of appetite measurement were made by radiographic technique. A growth model was developed using a stepwise multiple-regression analysis against fish body mass and water temperature (r2 = 0.939, df = 15) as follow: SGR (%M/day) = -70.606 + 98.433 Log T&deg; &ndash; 33.762 (Log T&deg;)2 - 0.153 Log M (Log T&deg;)2. The gastric emptying was described by an exponential function, which was found to be inversely related to the RA. The instantaneous evacuation rates (Re) determined by linearizing the data were strongly affected by rearing temperature (Q10 = 0.047) in Nile tilapia. The RA following a satiation meal was also significantly dependent on rearing temperature. Based on these data, the maximum daily feed consumption was estimated in relation to feeding schedule for juvenile tilapia reared at different temperatures. Considering that unsuitable use of feed adversely impacts on the farm revenue and profit, these results contribute to improve feed management strategies.