Calcium imbalance in comorbid gastroduodenal ulcers

Purpose of the study. To study the level of blood calcium, reflecting the functional state of the calcium-regulating system (CRS), in the comorbid course of gastroduodenal ulcers (GDU) with chronic erosive gastritis / chronic erosive duodenitis (CEG/CED), arterial hypertension (AH), their symptomatic nature when taking non-steroidal drugs (NSAIDs) and find out its effect on the activity of the ulcerous process, the state of regional microcirculation and the secretory function of the stomach.Materials and methods. 132 patients with GDU were examined. All patients were divided into groups: the first (39 people) – patients with recurrent peptic ulcer (PU) and CEG/CED, the second – 23 people with recurrent peptic ulcer and hypertension, the third – 20 patients with symptomatic gastroduodenal ulcers (SGDU) when taking NSAIDs. The fourth (control) group included 56 patients with PU without associated pathology.Results and discussion. Recurrence of PUr, comorbid to its course with CEG/CED, AH, SGDU, when taking NSAIDs, occurs with an increase in the level of calcium in the blood, which contributes to the activation of the acid-peptic factor, impaired microcirculation and repair processes in the mucous of the gastroduodenal zone, the development and maintaining the ulcerous process.Conclusion. Gastroduodenal ulcers are accompanied by dysfunction of the calcium regulatory system, which is characterized by an increase in blood calcium, which supports the formation of the main ulcerous mechanisms. In the treatment of comorbid and symptomatic gastroduodenal ulcers, it is necessary to include drugs for correcting the calcium-regulating system, which will increase the activity of sanogenic mechanisms.

Modern Clinical and Epidemiological Features and New Technological Possibilities in the Treatment of Bleeding Gastroduodenal Ulcers

The aim of this research was to study the current clinical and epidemiological features of ulcerative gastroduodenal bleeding (GDB) and to evaluate the outcomes of using new technological approaches in patients with bleeding from acute (symptomatic) and chronic (peptic ulcer disease) gastroduodenal ulcers (GDUs). Methods and Results: The present study involved 221 patients with bleeding GDUs. Depending on the source of bleeding, all patients were divided into 2 groups. Group 1 included 143 patients with acute symptomatic GDUs; Group 2 consisted of 78 patients with peptic ulcer disease complicated by bleeding. In the complex treatment of patients of all the studied groups, an individual approach was used that included the innovative technologies of endoscopic cytoprotective treatment of GDB, based on the combined use of traditional means of EH in combination with the use of endoscopic pneumoinsufflation of biologically active drainage sorbent of a new generation Aseptisorb-D and powdered hemostatic Zhelplastan. Our analysis showed that acute symptomatic GDUs prevailed in the structure of GDB – 143(64.7%) patients; PUD complicated by bleeding was diagnosed in 78(35.3%) cases. The use of new technological approaches, including cytoprotective treatment of bleeding defects with biologically active draining sorbents of a new generation in combination with local hemostatics in the complex therapy of patients with ulcerative GDB, has significantly improved the results of treatment, which is confirmed by high rates of final hemostasis (95.0%), indicators of the effectiveness of primary EH in type FIA-IB (93.1%) and prevention of recurrence of FIIA-IIB bleeding (92.5%), with a low frequency of repeated bleeding (4.07%), emergency surgeries (2.7%), and mortality (3.2%). Conclusion: Currently, in the structure of ulcerative GDB, acute symptomatic GDUs are the most common – 64.7%, and the share of PUD complicated by bleeding accounts for 35.3% of cases only. PUD and GDUs complicated by bleeding have certain clinical and epidemiological features, which must be taken into account when treating these patients. Symptomatic GDUs are more difficult to treat, which shows the need to develop new complex technologies for their treatment.

Peptic ulcer disease: changes it has undergone over the past 50 years

This review considers the main changes in our understanding of the etiology of peptic ulcer disease (PUD), its treatment and prevention. It is emphasized that the discovery of H. pylori infection and the implementation of eradication therapy did not solve all the issues related to PUD. Further investigation is needed to study the pathogenesis of idiopathic gastroduodenal ulcers, as well as ulcerative lesions of the stomach and duodenum, caused by various medications (non-steroidal anti-inflammatory drugs in particular).

Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

Background Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU. Methods In total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis. Results Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR] 3.43; 95% confidence interval [CI] 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR 5.80; 95% CI 2.08–16.2), and heart disease (OR 3.05; 95% CI 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR 8.24; 95% CI 2.36–28.7). Conclusion In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.