[Duodenal motility in norm and in some diseases. Hypothesis]

Characteristic of disorders of motor-evacuator activities of the stomach and intestinal in chronic duodenal insufficiency

Aim. To assess the psychoemotional status and the state of the autonomic nervous system and their importance in the violation of the motor-evacuation function of the gastrointestinal tract in chronic duodenal insufficiency (CDI). Materials and methods. A prospective study of 40 patients with CDI was carried out. The control group consisted of 30 healthy individuals. Anamnestic and physical data, results of X-ray and endoscopic studies, and intracavitary manometry were used to verify CDI. The study of the gastrointestinal tract was carried out using the "Gastroscan-GEM". Assessment of autonomic homeostasis was carried out using cardiac rhythmographic research and analysis of heart rate variability using the "Varicard 2.51" complex. To assess personal and situational anxiety test questionnaire SpielbergerKhanin. Eysenck's test questionnaire was used to determine the type of temperament. Results and discussion. We revealed a postprandial decrease in the contribution of the frequency spectrum of the duodenum (Pi/Ps 1.70.07; p=0.000) and the colon (Pi/Ps 39.622.45; p=0.000) in the total spectrum in comparison with the starving study, at the same time there is an aberrant significant increase in the contribution of the stomach to the total spectrum (46.55.8%; p=0.00). In patients with CDI, the prevalence of the sympathetic division of the autonomic nervous system AMo was noted 94.0 [92.5; 97.5]% with an asymptotic type of autonomic reactivity (IN2/IN1=1.1 [1.05; 1.17]) and insufficient adaptation reserve coefficients (0.32 [0.2; 0.4]) in relation to the control group. The psychoemotional state in patients with chronic duodenal stasis is in direct correlation with changes in the postprandial ratio of the electrical activity of the stomach and duodenum (r=0.7, p=0.021), and in reverse with the coefficient of the ratio of intraduodenal pressure to intragastric pressure (r=-0,8, p=0.000). Conclusion. In patients with CDI, changes in the functional state of the stomach and duodenum are of a systemic nature, which is due to stimulating (parasympathetic) and inhibitory (sympathetic) effects. The relationship between the motor-evacuation activity of the stomach and duodenum and the psychoemotional state in patients with CDI was revealed.

[Characteristics of the course of gastric and duodenal ulcer disease concurrent with duodenal insufficiency]

AIM

To comprehensively study the course of gastric ulcer disease (GUD) and duodenal ulcer disease (DUD) concurrent with chronic duodenal insufficiency (CDI).

MATERIAL AND METHODS

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.

RESULTS

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.

CONCLUSION

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.