Busygina M S, Vakhrushev Ya M
Izhevsk State Medical Academy, Ministry of Health of Russia, Izhevsk, Russia.
Ter Arkh. 2017;89(12):76-80. doi: 10.17116/terarkh2017891276-80.
To comprehensively study the course of gastric ulcer disease (GUD) and duodenal ulcer disease (DUD) concurrent with chronic duodenal insufficiency (CDI).
Ulcer disease (UD) was verified on the basis of the results of clinical and fibrogastroduodenoscopic examinations. The data of contrast duodenography and cavitary manometry were used to identify CDI. Gastroduodenal motor activity was investigated using the peripheral electrogastrograph EGG-4M. The results of pH measurements were employed to assess the state of gastric acid secretion and duodenal pH values.
A comprehensive examination was made in 106 patients with UD concurrent with CDI (a study group) and 30 UD patients without CDI (a comparison group). Epigastric pain was noted in the patients with GUD in the study and comparison groups (91.5 and 84.6%, respectively), but the pain was mainly aching in the patients with concomitant CDI and more intense (77.8%) in those without this condition. In the study group, heartburn was more common in patients with GUD and DUD (75.3 and 71.4%, respectively) than in those with UD in the comparison group (28.5 and 37.5%, respectively). Helicobacter pylori tests were positive in 23.8% of the patients in the study group and in 57.2% in the comparison group. Electrogastrography indicated that the patients with GUD and CDI had bradygastria and hypokinesis on an empty stomach; the electrical activity was reduced after eating. In the comparison group, tachygastria and hyperkinesis were detected on an empty stomach; these postprandial indicators were elevated. H. pylori tests were positive in 34.7% of the patients with DUD and CDI and in 63.6% of those with DUD without CDI. The postprandial electrical activity increased in patients with DUD and decreased in the comparison group. The specific features of changes in gastric and duodenal pH values in GUD and DUD concurrent with CDI in comparison with the isolated course of UD.
The immediate and long-term follow-ups show that GUD and DUD concurrent with CDI run a more persistent course; the time of ulcer healing increases and the periods of remission decrease.
全面研究并发慢性十二指肠功能不全（CDI）的胃溃疡疾病（GUD）和十二指肠溃疡疾病（DUD）的病程。
根据临床和纤维胃十二指肠镜检查结果确诊溃疡病（UD）。利用十二指肠造影和腔内测压数据来识别CDI。使用外周胃电图仪EGG - 4M研究胃十二指肠运动活性。采用pH测量结果评估胃酸分泌状态和十二指肠pH值。
对106例并发CDI的UD患者（研究组）和30例无CDI的UD患者（对照组）进行了全面检查。研究组和对照组中GUD患者均有上腹部疼痛（分别为91.5%和84.6%），但伴有CDI的患者疼痛主要为隐痛，而无此情况的患者疼痛更剧烈（77.8%）。在研究组中，GUD和DUD患者的烧心症状比对照组中的UD患者更常见（分别为75.3%和71.4%，对照组分别为28.5%和37.5%）。研究组23.8%的患者幽门螺杆菌检测呈阳性，对照组为57.2%。胃电图显示，GUD和CDI患者空腹时胃蠕动缓慢、运动功能减退；进食后电活动降低。在对照组中，空腹时检测到胃蠕动过速和运动功能亢进；这些餐后指标升高。34.7%的DUD和CDI患者幽门螺杆菌检测呈阳性，无CDI的DUD患者中这一比例为63.6%。DUD患者餐后电活动增加，而对照组则降低。与孤立的UD病程相比，并发CDI的GUD和DUD患者胃和十二指肠pH值变化的具体特征。
近期和长期随访表明，并发CDI的GUD和DUD病程更持久；溃疡愈合时间延长，缓解期缩短。
