The role of vegetative portrait of patients with peptic ulcers of the stomach and duodenum complicated with bleeding
Background. The prevalence of gastroduodenal ulce-rative bleeding reaches 170 cases per 100 thousand adults, and the annual mortality rate from them is 15 %. Bleeding from peptic ulcers of the stomach and duodenum is closely associated with the disorders of the autonomic nervous system (ANS) that is more common in sympathotonics (CT) while the perforations of ulcers are recorded mainly in vagotonics (VT), but the course of such complications in patients with different vegetative portrait has not been studied. The purpose of the study: to analyze the nature of gastroduodenal bleeding in patients with peptic ulcers depending on the type of ANS, to identify the prognostic criteria. Materials and methods. Among 1261 observed patients with gastroduodenal bleeding VTs were 4 %, CT — 54.9 %, eutonic (ET) — 41.1 %, thus the ratio of VT : CT : ET was 1 : 14 : 10, whereas in the population of healthy people in this region the ratio was 1 : 2 : 8.
The vegetative index in the VT group was 11.0 ± 7.3 × 103 r.u. (or ln9.3 ± 8.9), for CT — 6.0 ± 3.2 × 103 r.u. (ln8.7 ± 8.1), for ET — 8.60 ±3.11 × 103 r.u. (ln9.1 ± 8.0). Results. According to Wilcoxon-Rao multivariate analysis, the ANS condition affects the integral endoscopic signs of peptic ulcers and as evidenced by Kendall’s univariate dispersion and non-parametric correlation analysis there is an inverse relationship with the index of the vegetative index of ulcer volume, the number of duodenal ulcerations, the severity of comorbid diabetes. The vegetative portrait of the patients and the level of the vegetative index impact the incidence of reflux esophagitis, the number of bleeding recurrences and the survival of patients, which is significantly worse for CT, and VT are characterized by a greater frequency of blood leakage through the walls of ulcers, the formation of necrosis and hemorrhages on their bottom. It is established that the index of the vegetative index is < 3.5 × 103 r.u. in ulcerative gastroduodenal bleeding, which is recommended to use for the diagnosis of background reflux esophagitis. Conclusions. The course of peptic ulcers of the stomach and gastroduodenal bleeding depends on the type of ANS while sympathotonia is a risk factor for a severe course of the pathological process.
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